血浆PAI-1和TAFI的变化对STEMI患者静脉溶栓治疗后血管再通的预测价值

The tendency of PAI-1 and TAFI levels in STEMI patients after thrombolytic treatment and its predictive value to restoration of coronary perfusion

目的通过检测急性心肌梗死（AMI）患者静脉溶栓前、后2小时内血浆凝血酶激活的纤溶抑制物（TAFI）和纤溶酶原激活物抑制剂-1（PAI—1）的含量，探讨两者的变化是否对溶栓后血管再通具有预测价值。方法2007年1月至2009年3月期间收集广州医学院第二附属医院急诊科16例急性ST段抬高心肌梗死（STEMI）患者溶栓前、后0．5，1，1．5，2h的血浆标本，并以16名健康人作为健康对照组，用ELISA法测定血浆中TAFI和PAI-1的含量。结果（1）与健康对照组相比，STEMI患者溶栓前的血浆PAI-1水平显著升高（P〈0．01）；而TAFI活性与对照组相比差异无统计学意义。（2）与溶栓前相比，溶栓后0．5，1，1．5，2h的血浆TAFI活性较溶栓前比较，差异无统计学意义（P〉0．05）；溶栓后1．5，2h的血浆PAI-1显著升高（P〈0．01）。（3）溶栓后2h冠脉未通组PAI-1水平显著高于再通组（P〈0．05）；而冠脉未通组和再通组TAFI活性差异无统计学意义（P〉0．05）。结论升高的血浆PAI-1在溶栓后2h下降可能对溶栓后血管再通具预测价值，TAFI对血管再通不具预测价值。

Objective To observe the tendency of the plasma concentration of plasminogen activator inhibitor type-1 （PAI-1） and thrombin activatable fibrinolysis inhibitor （TAFI） before and after thrombolytic treatment of acute ST elevation myocardial infarction （STEMI） and to explore their recanalization predictive value of PAI-1 and TAFI for acute myocardial infarction patients with thrombolytic treatment. Methods Sixty patients, who received thromobolytie treatment from January 2007 to March 2009, were prospectively recruited. The blood sample were collected within 2 hours of thromobolytic treatment （ 0, 0. 5 h, 1 h, 1.5 h and 2 h）. The plasma concentration of TAFI and PAI-1 were test by ELISA. 16 healthy people were recruited as control group. Results The plasma levels of PAI-1 in STEMI patients before thrombolytie treatment were higher than those of Control group （ P 〈 0. 01 ） , however the same significant change of TAFI level was not seen. The levels of TAFI were no significant difference before and after thrombolytic therapy during whole observation periods. However, the level of PAI-1 increased at 1.5 h and 2 h after thrombolytic therapy （P 〈 0. 01 ）. The plasma PAI-1 levels of no - revascularigation group at 2 h after thrombolytie therapy were significant higher than that in revascularization group （ P 〈 0.05 ）. The levels of TAFI were not significantly different between two groups （ P 〉 0. 05 ）. Conclusions The decrease of plasma PAI-1 from high level within 2 hours after thrombolysis treament may be exploring the predictive value for revaseularization. The tendency of TAFI can＇ t forecast the result of revascularization.