急性心肌梗死溶栓治疗血浆GMP-140的动态变化及临床意义

Dynamic observation and clinical significance of plasma alpha-granule membrane protein 140 during thrombolytic therapy in patients with acute myocardial infarction

目的：探讨急性心肌梗死（AMI）患者尿激酶溶栓治疗前后血小板活性的动态变化及其与血管早期再通的关系。方法：接受尿激酶静脉溶栓治疗的38例AMI患者在溶栓前及溶栓后2h、6h、12h、24h分别取血测定血浆中α-颗粒膜蛋白（GMP-140），依溶栓前临床间接指标及溶栓后90min冠状动脉造影结果，将患者分为再通组（27例）和未通组（11例），比较两组患者血中GMP-140的动态变化，并设正常对照组。结果：AMI患者溶栓前血浆GMP-140浓度明显高于正常对照组。溶栓后再通组与未通纷呈不同浓度的动态变化，溶栓未通组，GMP-140升高；溶栓再通组，则GMP-140降低，两组溶栓后6h、12h、24h血浆GMP－140浓度差异显著（P＜0．001）。结论：AMI后血小板高度活化，血浆GMP-140与AMI的血栓形成、溶解及再通密切相关，其在溶栓后的迅速下降可望作为临床判断血管再通的新指标。

Aim: To evaluate the platelet function and its reaction to early reperfusion before and after in travenous thrombolytic therapy of urokinase in patients with acute myocardial infarction (AMI). Methods:The plasma concentrations of alpha-granule membrane protein (GMP-140) were determined in 38 cases with AMI before thrombolytic therapy and 2, 6, 12, 24 hours after the completion of urokinase infusion. 38 patients were divided into 2 groups according to coronary arteriography, 27 with reperfusion group and 11 with non-reperfusion. Concentrations of GMP-140 were determined in each group respectively and 35 healthy individuals were served as controls. Results: The concentrations of GMP-140 in AMI patients before thrombolytic therapy were significantly higher than that in the controls. With the patency of infart related erteries in reperfusion goup, CMP-140 dropped quickly after thrombolytic therapy (P < 0.001), if the infarct related arteries were not patent, GMP-140 incresed rapidly (P < 0.05). The difference between the two groups was significant. Conclusion: Platelets were activated after AMI. Plasma GMP-140 was closely related to thrombosis and recanalation of AMI. It provides a new supplementary index for distinguishing early reperfusion.