急性心肌梗死溶栓疗法对血浆凝血活性影响

Influence of Thrombolytic Therapy on Plasma Coagulation Activation in Acute Myocardil Infarction

目的探讨溶栓疗法对血浆凝血活性的影响。方法连续监测35例急性心肌梗死患者,于确诊后定期从外周静脉采血,酶联免疫双抗体夹心法测定血浆凝血酶修饰抗凝血酶Ⅲ(antithrombinⅢmodified,ATM)和D-二聚体(D-D)的动态变化。结果溶栓开始2h后,血浆ATM显著内性增加(87.80μg/L±25.19μg/L,比24.48μg/L±11.62μg/L,P<0.05),4h达峰值(120.87μg/L±31.54μg/L),持续3d以上;血浆D-D于2h即达到峰值(7.76mg/L±2.58mg/L,比2.7mg/L±1.36mg/L,P<0.05),维护8h以上,24h以后恢复正常。在溶栓组患者,不同采血时刻血浆ATM和D-D的平均值呈明显正相关。未溶栓组患者血浆ATM和D-D浓度未见显著性变。结论溶栓疗法激活凝血系统,与血栓溶解的标志物(D-D)呈明显正相关。早期应用有效抗血栓药物可能抑制凝血系统的激活,减少血栓再闭塞的发生。

Objective To probe into the influence of thrombolytic therapy on plasma coagulation activation. Methods Totally 35 patients with acute myocardial infarction were tested when the diagnosis of acute myocardial infarction was established, blood sampling was performed periodically, and plasma ATM （ antithrombin Ⅲ modified） and D - D were determined by ELISA. Results Plasma ATM levels increased significantly （87.80±25.19） μg/L vs （24. 28 ± 11.62）μg/L, P 〈 0. 05,2 hours after thrombolytics administration, peaked 4 hours later at （ 120. 87 ± 31.54 ） μg/L, sustained for at least 3 days;Plasme D -D peaked in 2 hours（7.76 ±2.58）mg/L,vs （2. 74 ± 1.36） μg/L, P 〈 0. 05） and returned progressively to normal 24 hours after thrombolysis. A positive correlateion was present between plasma ATM and D - D levels in thrombolytic patients without - thrombolysis, no significant changes were found in plasma ATM and D - D levels during the whole monitoring period. Conclusion Thrombolytic therapy activates coagulation system which is positively related to clotlysis（ elevated plasma D - D）. Earlier administration of intensive anticoagulant may benefit from thrombolytie therapy for patients with acute myocardial infarction.