急性心肌梗塞行直接介入治疗患者早期血浆纤溶活性的动态变化

Serial Changes of the Systemic Fibrinolysis in Patients with Acute Myocardial Infarction Undergoing Primary Interventional Treatment

目的：研究急性心肌梗塞行直接介入治疗患者在治疗前及治疗后早期血浆纤溶活性的动态变化规律，为临床抗凝治疗提供参考。方法：以急性心肌梗塞发病６ 小时之内成功地进行直接冠状动脉成形术的患者为研究对象，按不同时间点采集周围静脉血，采用发色底物法分别测定血浆中组织型纤溶酶原激活剂（ｔＰＡ） 、纤溶酶原激活物抑制剂（ＰＡＩ１） 的活性，并计算ＰＡＩ１／ｔＰＡ 活性比值。结果：３６ 例急性心肌梗塞患者，在介入治疗前，血浆ＰＡＩ１ 活性、ＰＡＩ１／ｔＰＡ 显著高于正常，ｔＰＡ 活性明显低于正常；介入治疗后，ＰＡＩ１ 活性进一步上升，２４ 小时达到峰值；ｔＰＡ 活性逐渐下降，２４ 小时达到最低值，与心肌梗塞自然病程相比峰值提前，二者活性的比值也在术后２４ 小时达到高峰。结论：急性心肌梗塞行直接介入治疗患者早期存在纤溶活性受损，这一改变在血管开通后２４

Objective: To study the serial changes of the systemic fibrinolysis before and early after primary interventional treatment in patients with acute myocardial infarction (AMI), thus to provide a reference to anticoagulant therapy Methods: Patients with AMI undergoing primary coronary angioplasty within 6 hours after the onset of symptom were included Venous blood samples were obtained according to the schedule The fibrinolytic activity was examined by measuring activities of plasma plasminogen activator inhibitor 1 (PAI 1) and tissue type plasminogen activator (t PA) The ratio of the above two indexes was calculated Results: In the thirty six patients with AMI, before interventional treatment, the activity of plasma PAI 1 and the ratio of PAI 1 and t PA were significantly higher than normal, while the activity of plasma t PA was significantly lower After treatment, plasma PAI 1 activity increased further and plasma t PA activity decreased gradually Both reached peak at 24 hours after recanalization, earlier than those in patients with AMI without any treatment Conclusion: The fibrinolytic activity is impaired in patients with AMI undergoing primary coronary angioplasty The changes are strongest at 24 hours after reperfusion