急性冠脉综合征并糖尿病患者凝血-纤溶功能的研究

Plasma FⅦ, PAI-1, and vWF increased in patients with acute coronary syndrome and with non insulin-dependent diabetes mellitus

目的 研究冠心病、糖尿病患者的血栓形成异常状态 ,探讨凝血、纤溶机能及血管内皮功能变化在冠心病、糖尿病的发生发展中的作用。方法 检测 2 5例急性冠脉综合征患者 (A组 )、15例Ⅱ型糖尿病患者 (B组 )和 15例急性冠脉综合征合并Ⅱ型糖尿病患者 (C组 )的血浆凝血因子Ⅶ(CoagulationfactorⅦ ,FⅦ )、vonWillebrand因子 (vWF)水平及纤溶酶原激活物抑制因子 1(PlasminogenActivatorInhibitor 1,PAI 1) ,与对照组 2 0例健康人比较 ,A、C组中 15例还检测了常规治疗 10～ 14d后的各指标水平。结果 A组的三项指标皆较对照组明显升高 ;C组FⅦ水平高于B、D组 ,PAI 1水平与B组相似 ,明显高于对照组 ,vWF水平低于A、B组 ,差别无显著性 ;B组FⅦ水平近似于对照组 ,PAI 1和vWF水平升高。在B、C组中 ,FⅦ与血清总胆固醇水平呈正相关 (r =0 6 3 ,P <0 0 0 1) ,与高密度脂蛋白水平呈负相关 (r=- 0 5 2 ,P <0 0 0 1)。在正常对照组中 ,vWF与FⅦ水平呈负相关 (r =- 0 5 6 ,P <0 0 5 )。A、C两组中 15例患者在经治疗后vWF水平显著降低而FⅦ水平略升高 (P <0 0 5 ) ,PAI 1活性无变化。结论 急性冠脉综合征及糖尿病患者具有血栓前状态的特征性改变 ,血浆FⅦ、PAI 1及vWF水平可能是急性冠脉综合征的预测因子 。

Objective To investigate the abnormal state of thrombosis in patients with coronary artery diseases(CAD) and non-insulin-dependent diabetes mellitus(NIDDM)and to study the effects of hemostatic factors on the relation of CAD and NIDDM.Methods The plasma coagulation factor Ⅶ (FⅦ), Plasminogen Activator Inhibitor-1(PAI-1), and von Willebrand factor (vWF) levels were assessed in 25 male patients with acute coronary syndrome(Group A), 15 with NIDDM (Group B), 15 with acute coronary syndrome and NIDDM (Group C) and 20 normal control persons.Results The FⅦ, PAI-1, and vWF levels in group A were markedly higher than in control group. The FⅦ and PAI-1levels were higher in group C than in control. PAI-1 and vWF levels in group B significantly increased. The FⅦ was positively correlated with total cholesterol( r=0 63,P<0 001 ), and negatively with HDL cholesterol ( r= -0 52 ,P<0 001 ) in group B and C. The vWF level was negatively correlated with FⅦ in control group( r=-0 56,P<0 05 ). The vWF levels of 15 cases in group A and C were measured 10～14 days after the routine therapy, and were significantly decreased 10～14 days after the routine therapy, and were significantly decreased (148.25%±19.45% vs . 163.05%±19.22%), while FⅦ level in the same cases slightly increased ( P>0 05 ).Conclusions The results indicate that there are characteristic prothrombosis changes in patients with acute coronary syndrome and NIDDM. The levels of FⅦ, PAI-1, and vWF may be predictive factors of acute cornary syndrome.