氯沙坦和依那普利对心肌梗死后纤溶-凝血功能的影响

The effect of losartan and enalapril on haemostatic function in patients with acute myocardial infarction

目的 探讨氯沙坦和依那普利对急性心肌梗死 (AMI)患者纤溶 凝血功能的影响。方法 将 41例AMI患者随机分为氯沙坦组、依那普利组和对照组 ,以发色底物法和ELISA法测定三组患者入院即刻、发病 2周、2个月的血浆PAI 1活性、纤溶酶原激活物 (tPA)抗原水平和血管血友病病因子(vWF)含量。结果 与对照组相比 ,氯沙坦组 2周和 2个月时的PAI 1活性分别减低 2 2 % (P <0 0 1)和 18% (P <0 0 5 ) ,tPA抗原水平分别减低 32 % (P <0 0 1)和 2 5 % (P <0 0 5 ) ;依那普利组相应分别减低 2 8% (P <0 0 1)和 2 1% (P <0 0 5 ) ,tPA抗原水平分别减低 38% (P <0 0 1)和 2 9% (P <0 0 5 ) ;两个治疗组之间差异无显著性。两种药物对vWF含量均无影响。结论 氯沙坦和依那普利可改善心肌梗死后的纤溶功能 ,长期应用这两种药物可能会降低心肌梗死后发生急性心脏事件的危险。

To investigate the effect of losartan and enalapril on haemostatic function in patient with AMI Methods 41 patients with AMI were divided into losartan group, enalapril group and control group randomly The plasma activity of plasminogen activator inhibitor-1 (PAI-1), antigen level of tissue plasminogen activator (tPA) and concentration of von Willebrand factor (vWF) are measured by spectrophotometric assay or ELISA at admission, 2 weeks and 2 months after AMI Results Compared with control group 2 weeks and 2 months later, the PAI-1 activty in patients treated with losartan was markedly reduced by 22% ( P <0 01) and 18% ( P <0 05) respectively, and the antigen level of tPA was decreased by 32% ( P <0 01) and 25% ( P <0 05) significantly After 2 weeks and 2 months treatment, the PAI-1 activity of enalapril group were respectively 28% ( P <0 01) and 21% ( P <0 05) lower than that of controls, and the antigen level of tPA was reduced by 38% ( P <0 01) and 29% ( P <0 05%) respectively The two drugs have no significant influence on concentration of vWF Conclusion Losartan and enalapril can improve fibrinolytic function in patients with AMI These results suggest that losartan and enalapril would reduce the risk of acute cardiovascular events after acute myocardial infarction