脑血栓形成患者血浆组织型纤溶酶原激活物及其快速抑制物的变化及临床意义

The fluctuation of t PA and PAI 1 activity in patients with cerebral thrombosis, and their clinical significance

目的观察急性动脉硬化性脑血栓形成患者血浆组织型纤溶酶原激活物（ｔＰＡ）及其快速抑制物（ＰＡＩ１）的变化规律，探讨血浆纤溶活性在脑血栓发生、发展及转归中的作用；同时测查恢复期或后遗期脑血栓形成患者血浆ｔＰＡ及ＰＡＩ１的变化规律，了解此类患者再次发生血栓的危险性。方法采用美国∑９６０酶标读数仪，用发色底物法对２５例急性脑血栓形成患者血浆ｔＰＡ及ＰＡＩ１活性进行动态测查（发病后１、３、７、１４及２１天），并与３８名健康对照组进行比较。同时对３３例恢复期或后遗期脑血栓形成患者血浆ｔＰＡ及ＰＡＩ１进行测查。结果急性脑血栓形成发病后２４小时内，血浆ｔＰＡ活性明显降低，随时间延长逐渐增高，第７天达最高水平，以后又呈逐渐降低趋势。ＰＡＩ１发病后２４小时内明显增高，第２天起随时间进展逐渐降低，第７天达最低水平，以后又呈逐渐增高趋势。除第７天、１４天外，各观测点血浆ｔＰＡ与ＰＡＩ１之比均明显低于正常对照组。恢复期或后遗期脑血栓形成患者血浆ｔＰＡ明显低于正常对照组，而ＰＡＩ１明显高于正常对照组。结论急性脑血栓形成患者血浆纤溶活性明显下降，说明血浆ｔＰＡ及ＰＡＩ１参与了血栓形成的病理过程；而恢复期或?

Objective To observe the regularity of fluctuation of tissue type plasminogen activator (t PA) and plasminogen activator inhibitor 1 (PAI 1) in patients with acute, convalescent and chronic stages of atherosclerotic cerebral thrombosis respectively, to probe into their role in the development and prognosis of cerebral thrombosis, and into the danger of recurrence of cerebral thrombosis. Methods T PA and PAI 1 activities were dynamically (day 1, 3, 7, 14 and 21 after onset) determined by ELISA using Σ960 chromgenic substrate reader made in USA and corresponding development substrate in 25 patients with acute cerebral thrombosis, and 33 patients with cerebral thrombosis during convalescent and chronic stages (>1 month), and 38 normal controls. Results In acute thrombotic group, the level of t PA was the lowest on day 1, gradually increased and reached the top on day 7, then tended to decrease gradually to day 21; the PAI 1 level increased sharply and reached the top within the first 24 hrs after onset of cerebral thrombosis, decreased gradually and reached the valley on day 7, then tended to rise again. The plasma levels of t PA and PAI 1 in patients with cerebral thrombosis were significantly lower than those of normal controls except on day 7 and 14. In patients with convalescent and sequel stages, the level of t PA was significantly lower and that of PAI 1 was significantly higher than those of normal controls. Conclusion The plasma fibrinolytic activity was significantly lower than normal. It suggested that the plasma t PA and PAI 1 might play a role in the pathogenetic process of cerebral thrombosis. The thrombolytic activity in patients with cerebral thrombosis within 1 month was lower than that of normal controls. The patients with thrombosis history longer than 1 month were in precoagulation state, they had the danger of recurrence of cerebral thrombosis.