慢性肺心病急性加重期纤溶状态的研究

Clinical study of fibrinolysis indicators in patients with chronic pulmonary heart disease

目的 探讨慢性肺心病患者血浆Ｄ二聚体等纤溶指标变化。方法 对４２ 例肺心病患者治疗前后及２０ 例对照组的血浆纤溶活性分别进行测定。结果 血浆Ｄ二聚体水平在肺心病加重期患者明显升高（与对照组和缓解期比较Ｐ＜ ０－００１）；血浆纤溶酶活性在肺心病加重期明显下降；血浆纤溶酶活性与二氧化碳分压（ＰａＣＯ２） 呈负相关（ｒ＝ －０－４３，Ｐ＜０－０１），与氧分压（ＰａＯ２）呈正相关（ｒ＝０－３９ ，Ｐ＜０－０１） 。结论 血浆纤溶活性降低与肺心病高凝状态有关，并容易导致肺小动脉血栓形成，Ｄ二聚体可作为慢性肺心病肺小动脉血栓形成的实验室指标。慢性肺心病患者临床上可应用溶栓药物。

Objective To investigate the change of D dimer and other fibrinolysis indicators in patients with chronic pulmonary heart disease Methods The fibrinolytic activity of plasma was measured in 42 patients with chronic pulmonary heart disease and in 20 controls (matched with sex and age ) Results The D dimer level was significantly higher in exacerbated patients than in controls ( P <0 001); The fibrinolytic activity in patients was lower than in controls The plasma fibrinolytic activity was positively correlated with PaO 2 and negativly correlated with PaCO 2 Conclusions The depressed fibrinolysis may be associated with hypercoagulability state of chronic pulmonary heart disease and contributes to thrombi in small pulmonary arteries and arterioles D dimer can be used in diagnosis of thrombi formation in small pulmonary arteries and arterioles Patients with chronic pulmonary heart disease can be treated with fibrinolysis drugs