急性心肌梗死患者内皮纤溶储备功能的研究

The study on endothelial fibrinolytic reserve capacity in patients with acute myocardial infarction

目的 :探讨急性心肌梗死 (AMI)患者全身纤溶状态及内皮纤溶储备功能的变化规律。方法 :2 1例 AMI患者于入院第 1天和入院后第 10天采集静脉血测定纤溶指标 ,并与 15例正常人作对比 ,同时做静脉闭塞试验以确定最大内皮组织纤溶酶原激活剂 (t PA)释放。结果 :AMI患者 t PA含量、纤溶酶原激活剂抑制物 - 1(PAI- 1)活性均较正常人明显为高。最大内皮 t PA释放于入院第 1天降低为 (2 .3± 0 .9) μg/ L(P<0 .0 1) ,第 10天恢复至(4.5± 1.2 ) μg/ L(P >0 .0 5 )。结论 :内皮纤溶功能紊乱与血管内血栓形成的联系要比全身纤溶指标的变化更为密切 ,在

Objective:To explore the altered regularity of the fibrinolytic system and the endocthelial fibrinolytic reserve capacity in patients with acute myocardial infarction (AMI).Method:Venous blood was sampled for determination of fibrinolytic system at admission and on day 10 after admission in 21 patients with AMI and compared with 15 normal subjects.An occlusion test to determine the maximal endothelial tissue plasminogen (tPA) release was performed.Result:Patients with AMI had a marked elevation of tPA mass concentration,PAI-1 activity on admission and day 10 compared with normal subjects.Maximal endothelial tPA release was initially reduced to ( 2.3 ± 0.9 ) μg/L(P< 0.01 ,vs normal subjects),but the levels recovered on follow up 10 d to ( 4.5 ± 1.2 )μg/L 〔P> 0.05 ,vs ( 4.1 ± 1.1 )μg/L in normal subjects〕.Conclusion:Endothelial fibrinolytic reserve capacity is reduced only during the acute phase and becomes normalized during followup,alterations of plasma makers of systemic fibrinolysis persist longer in patients with AMI.The results demonstrate that the disturbances of endothelial fibrinolysis may link more to intravascular thrombus formation than to steady state levels of makers of systemic fibrinolytic system,it is very important to correct the disturbances of endothelial fibrinolysis during the acute phase in patients with AMI.