急性心肌梗死患者直接介入治疗后无再流与血浆组织因子及其途径抑制物的关系

Plasma tissue factor and tissue factor pathway inhibitor levels in acute myocardial infarction patients with no-reflow during percutaneous coronary intervention

目的通过测定急性心肌梗死（AMI）患者直接经皮冠状动脉介入治疗（PCI）前后血浆组织因子（TF）、组织因子途径抑制物（TFPI）水平的变化，探讨TF、TFPI与无再流的关系。方法选择2006年5月至2007年5月于我院急诊行PCI的AMI患者53例，用ELISA法检测患者PCI术前、术后即刻、术后24h外周静脉血TF、TFPI水平。比较其中无再流者与再灌流者不同时点TF、TFPI水平的变化。结果PCI术前、术后即刻、术后24h无再流组血浆TF、TFPI水平均明显高于再灌流组[TF（275．3±46．2）ng／L比（236．8±44．3）ng／L、（332．7±41．3）ng／L比（282．3±38．7）ng／L、（315．5±47．8）ng／L比（248．1±46．9）ng／L；TFPI（165．2±38．4）μg／L比（128．5±18．7）μg／L、（176．3±36．8）μg/L比（135．6±20．3）μg／L、（149．8±31．7）μg／L比（118．7±19．2）μg/L；均P〈0．01]；PCI术后即刻，两组TF水平均较术前明显升高（P〈0．01）；PCI术后24h，无再流组TF水平仍高于术前水平（P〈0．05），再灌流组与术前比较无差异（P〉0．05）；PCI前后两组TFPI水平均无明显变化（P〉0．05）。结论AMI患者直接PCI后无再流的发生与血浆TF水平呈正相关，TF可激活外源性凝血途径，形成微血栓而导致无再流，而TFPI可阻止血栓形成而防治无再流的发生。

Objective To compare plasma tissue factor （TF） and tissue factor pathway inhibitor （TFPI） levels before, immediately and 24 hours after percutaneous coronary intervention （PCI） in acute myocardial infarction （ AMI ） patients with or without no-reflow. Methods Plasma TF and TFPI in AMI patients underwent PCI were measured by enzyme linked immunoadsorbent （ ELISA ） before, immediately and 24 hours after PCI. Results The levels of TF and TFPI of no-reflow patients （a = 17） were significantly higher than those of reflow patients （n =36） at baseline, immediately and 24 hours after PCIITF： （275.3±46. 2） ng/L vs. （236. 8± 44. 3） ng/L, （ 332. 7 ±41.3 ） ng/L vs. （282. 3 ± 38.7 ） ng/L, （315.5 ±47. 8 ） ng/Lvs. （248.1±46.9） ng/L;TFPI：（165.2±38.4 ）μg/Lvs. （128.5±18.7） μg/L,（176.3±36.8） μg/L vs. （ 135.6 ±20. 3 ）μg/L, （ 149. 8 ± 31.7 ）μg/L vs. （ 118.7 ± 19. 2 ） μg/L ; all P 〈 0. 01 ]. Plasma TF was significantly increased in both groups （ all P 〈 0. 01 ） immediately post PCI and the TF was still higher than that before PCI in no-reflow patients （ P 〈 0. 05 ） and returned to baseline level in fellow patients at 24 hours after PCI （ P 〉 0. 05 ） , TFPI levels were similar before and after PCI in both groups （ all P 〉 0. 05 ）. Conclusion Plasma tissue factor and tissue factor pathway inhibitor might play important roles in the development of no-reflow during PCI in AMI patients.