组织因子途径在急性心肌梗死患者发作期间的比值变化及其意义

Change of Tissue Factor Pathway Ratio during Attack in Patients with Acute Myocardial Infarction and Its Clinical Significance

本研究旨在观察急性心肌梗死(AMI)患者发作期间组织因子途径(TFP)的变化及其意义。采用手工法检测血浆复钙时间,酶联免疫吸附法(ELISA)检测血浆中的组织因子(TF)、组织因子途径抑制物(TFPI)、凝血因子Ⅶ抗原(FⅦ:Ag)、激活的FⅦ(FⅦa)及D-二聚体(D-dimer),采用发色底物法检测TF活性(TFact);采用一期凝固法测定凝血因子Ⅶ促凝活性(FⅦ:C)。观察对象包括59名AMI患者和84名健康中老年人。结果表明,①AMI患者血浆复钙时间比正常对照者明显缩短(p<0.01);②与对照组相比,AMI患者血浆中TF活性无显著增高(p>0.05);TF与TFPI的抗原均显著增加(p<0.01),但TF增高程度较TFPI更为显著,故TF/TFPI比值升高;总TFPI(t-TFPI)和全长TFPI(fl-TFPI)含量明显增加(p<0.01),截短TFPI(tr-TFPI)含量明显降低(p<0.01),TF/t-TFPI比值高于正常组,TF/fl-TFPI比值低于正常组(p<0.05),但在AMI组TF/tr-TFPI与fl-TFPI/t-TFPI比值明显高于对照组(p<0.01),而tr-TFPI/t-TFPI与tr-TFPI/fl-TFPI比值降低(p<0.01);③与对照组比较,血浆FⅦ∶C、FⅦa在AMI组是增高的(p<0.05),FⅦ∶Ag无显著性变化,FⅦa/FⅦ∶Ag比值明显升高(p<0.01),但FⅦa/FⅦ∶C及FⅦ∶C/FⅦ∶Ag比值并无显著性差异(p>0.05);④与正常对照组相比,AMI组D-dimer明显增高(p<0.01)。结论:AMI发作期间体内TFP被启动,提示AMI患者血液呈现高凝状态,为评估AMI及其危险事件的发生,以多因子同时测定为好,而且用相对比值表示高凝状态与危险因子比单测更为可靠。

This study was aimed to investigate the change of tissue factor pathway （TFP） ratio during the attack of acute myocardial infarction （AMI） and its clinical significance. Plasma recalcification time was assayed by manual operation. Plasma tissue factor （ TF）, TF pathway inhibitor （TFPI） antigen, FⅦ： Ag, activated F Ⅶ （ FⅦa） and D- Dimer were measured by enzyme linked immunoabsorbent assay （ELISA）. TF activity was determined by chromogenic assay, plasma FⅦ coagulation activity （FⅦ：C） was detected by one-stage system. Blood samples were taken from 59 patients with AMI and 84 healthy volunteers. The results indicated that （ 1 ） plasma recalcification time was significantly shorter in the AMI group than that in the control; （2）compared with the control, TF activity in AMI patients showed no significant change （p 〉 0.05 ） ; the antigen levels of TF and TFPI in patients with AMI were remarkably increased （p 〈 0.05）, and the increment degree of TF was remarkably higher than that of TFPI, therefore the TF/TFP1 ratio was enlarged; total TFPI （t-TFPI） and full-length TFPI （fl-TFPI） were significantly higher （p 〈 0.01 ）, truncated TFPI （tr-TFPI） was significantly lower （p 〈0.01 ）; the TF/t-TFPI ratio was higher than that in normal group, the TF/t-TFPI ratio was lower than that in normal group （p 〈 0.01 ）, but the TF/tr-TFPI and fl-TFPI/t-TFPI ratios in AMI group were more remarkably higher than that in control group （p 〈 0.01 ）, the tr-TFPI/t-TFPI and tr-TFPI/fl-TFPI ratios were significantly lower （p 〈0.01 ） ; （3） compared with the control, the levels of plasma FⅦa and FⅦ： C in AMI group were higher （p 〈 0.05 ）, F Ⅶ： Ag did not significatly change; FⅦa/FⅦ： Ag ratio was more remarkably higher （p 〈 0.01 ）, but the elevation of F Ⅶa/FⅦ： C and F Ⅶ： C/FⅦ： Ag ratios showed no significant change （p 〉 0.05） ; （4） plasma D-dimer was significantly higher, compared with the normal control （p 〈 0.01 ）. It is concluded that TFP is initiated during the attack of AMI, suggesting the circulating blood in AMI patients is in hypercoagulable status, therefore the simultaneous detection of multiple coagulation factors is necessary for evaluating risk factors in AMI patients, and the use of ratio for reflecting hypercoagulable status and risk factors is more reliable to detect each of them separately.