活化蛋白-C抵抗在心肌梗塞患者中的阳性率及与动脉血栓发生的关系

The positive rate of activated protein C resistance in Chinese healthy adults and in the patients with myocardial infarction

目的 活化蛋白C抵抗 (activatedproteinCresistance,APCR)是已知发生率最高的静脉血栓危险因子 ,但与动脉血栓形成的关系尚无定论。了解正常成年人和心肌梗塞患者APCR的阳性率。方法 采用Dahlback法对 2 0～ 80岁 10 0例健康成年人 (对照组 )及 10 0例心肌梗塞患者 (MI组 )进行APCR阳性 ( <2 0为阳性 )率测定 ,同时测定受检者蛋白C(PC ,正常值 70 %～ 14 0 % )和蛋白S(PS ,正常值 60 %～ 14 0 % )。结果 对照组APCR阳性率为 4 0 % ,性别亚组间阳性率相同。MI组APCR阳性率为 2 0 0 % ,为对照组 5倍 (P <0 0 1) ,男女各亚组的阳性率差异无显著性。两组被检者的PC、PS均无异常。MI合并糖尿病者 ( 2 0 8% )或合并高血压者 ( 18 8% )的APCR阳性率均与无合并症MI患者差异无显著性。MI组APCR阳性者合并脑梗塞的发生率 ( 4 0 0 % )显著高于APCR阴性者 ( 8 8% ,P <0 0 0 1)。结论 在MI组中APCR阳性者有动脉血栓发生的倾向。

Objective Activated protein C resistance (APCR) is the most common risk factor for venous thrombosis, but the relation between arterial thrombotic events and APCR is still unclear This study was aimed to know the positive rate of APCR in healthy Chinese adults and in patients with myocardial infarction (MI) Methods APCR (by Dahlback′s method), protein C (PC) and protein S (PS) were estimated in 100 healthy adults (controls) and 100 patients with MI aged 20 80 years old The value of APCR less than 2 0 was defined as positive, the normal limits of PC and PS were 70% 140% and 60% 140% respectively Results All the values of PC and PS in both control and MI groups were in normal limits The positive rate of APCR in controls was 4 0% with the same rate in either male or female subgroup The positive rate of APCR in MI was 20 0%, which was five times higher than that in controls ( P <0 001) The positive rates between MI with (20 8%) and without diabetes (19 7%) or between MI with (18 8%) and without hypertension (20 6%) were similar (both P >0 05) The incidence of cerebral infarction was much higher in the cases with positive APCR than that in the cases with negative APCR (40 0%, 8 8%, P <0 001) Conclusion Arterial thrombosis occurred more likely in MI patients with positive APCR