抗凝治疗对非瓣膜性心房颤动患者纤溶指标的动态影响

Effects of anticoagulant therapy on alteration of fibrinolysis parameters in patients with nonvalvular atrial fibrillation

目的:探讨纤溶因素在非瓣膜性心房颤动(房颤)患者高凝状态形成中的作用及抗凝治疗早期纤溶指标浓度的变化趋势。方法:应用酶联免疫吸附(ELISA)法分别测定窦性心律组(窦律组,27例)及房颤组(25例)患者抗凝治疗各时间点(1d、7d、1个月、2个月)组织型纤溶酶原激活物抑制剂-1(PAI-1)、D-二聚体(D-dimer)浓度和INR值。分析两组患者PAI-1和D-dimer浓度的差异、该指标随抗凝治疗时间的变化趋势及PAI-1、D-dimer和INR三者之间的相关性。结果:①房颤组PAI-1和D-dimer水平均明显高于窦律组;②PAI-1和D-dimer浓度在抗凝治疗各时间点均差异有统计学意义(均P<0.05),PAI-1浓度随抗凝治疗各时间点下降百分比分别为7%、18%及31%,D-dimer浓度分别下降19%、34%及43%;③房颤组PAI-1浓度在抗凝治疗1个月、2个月时与窦律组比较均差异有统计学意义(均P<0.05),D-dimer浓度治疗7d、1个月时均差异有统计学意义(均P<0.05);④INR≤2.0较INR>2.0组PAI-1和D-dimer均值较高(均P<0.05)。相关分析发现PAI-1、D-dimer和INR之间均呈显著负相关(r值分别为-0.263、-0.443,P值分别为0.010、0.000),PAI-1和D-dimer之间呈显著正相关(r=0.468,P=0.000)。结论:低纤溶状态可能是非瓣膜性房颤患者高凝状态形成的重要原因;抗凝治疗可有效快速改善房颤患者的低纤溶状态。

Objective：To explore the role of fibrinolysis system in the formation of hypercoagulable state with nonvalvular atrial fibrillation （NVAF） patients and investigate the variation tendency of PAI-1 and D-dimer levels along with the anticoagulant therapy. Method： Patients were divided into NVAF group （n=25） and control group （sinus rhythm with age matched hypertensive patients, n= 27）. ELISA method was used to detect the plasma lev els of PAI-I and Ddimer. The difference of PAI 1 , D-dimer levels in two groups, the variation tendency of the two indexes along with anticoagulant therapy, and the correlation among PAI 1, D-dimcr and INR were analyzed. Result：（1）The levels of PA1-1 and Ddimer in NVAF group were higher than those in control group （both P〈 0.05）. （2）The plasma levels of PAI-1 and D-dimer significant changed at each time points （the 1st day, 7th day, 1st month, 2nd month） （all P〈0.05）. The decreased percentage of PAI-1 concentration were 7%, 18% and 31%, respectively; while D-dimer were 19%, 34% and 43%. （3）The variations of PAI-1 level at 1st month and 2nd month were different between control group and NVAF group （both P〈0.05）, the variations of D dimer lev el at 7thdayand 1st month were different between control group and NVAFgroup （both P〈0. 05）. （4）PAI 1 and D-dimer levels were higher in INR≤2.0 group than those in INR〉2.0 group. PAI-1, D dimer and INR levels were negatively correlated （r were =0. 263, 0.,143; P were 0.010, 0.000, respectively）, while PAI-1 and Ddimer were positively correlated （r= 0. 468, P= 0. 000）. Conclusion： Low fibrinolysis state is an important factor in the formation of hypercoagulable state in NVAF. Anticoagulant therapy can improve the fibrinolysis state in NVAF patients quickly and effectively.