急性心肌梗死患者直接介入后无复流与血浆组织因子及组织因子途径抑制物的关系

Relationship of no-reflow with plasma tissue factor and tissue factor pathway inhibitor after directly intervention in patients with acute myocardial infarction

目的通过测定急性心肌梗死(AMI)患者的血浆组织因子(TF)、组织因子途径抑制物(TFPI)水平在直接经皮冠状动脉成形术(PCI)前后的变化,研究两者与直接介入后无复流的关系。方法选择急诊行PCI的AMI患者53例,用ELISA法检测患者PCI术前、术后即刻、术后24 h外周静脉血TF、TFPI水平。根据有无复流分为无复流组与再灌流组,比较2组不同时点TF、TFPI水平的变化。结果 PCI前、PCI后即刻、PCI后24 h无复流组血浆TF、TFPI水平均明显高于再灌流组(P均<0.01);PCI后即刻,2组TF水平均较术前明显升高(P均<0.01);PCI后24 h,TF水平无复流组比术前高(P<0.05),再灌流组与术前比较差异无统计学意义(P>0.05);PCI前后2组TFPI水平比较差异均无统计学意义(P均>0.05)。结论 AMI患者直接进行PCI手术,发生无复流现象与血浆TF水平呈正相关,TFPI具有阻止血栓形成的作用,也可防治无复流现象。

Objective It is explore the relationship of no-reflow with plasma tissue factor （ TF） and tissue factor pathway inhibitor （ TFPI） by determining their changes before and after direct percutaneous coronary angioplasty （ PCI） in patients with acute myocardial infarction （ AMI） .Methods 53 patients with AMI undergoing emergency PCI were selected and the levels of plasma TF and TFPI peripheral venous blood in these patients were determined by ELISA at preoperative, postoperative time points and 24 h after PCI.The patients were divided into no-reflow group and reperfusion group according with or without re-flow, and the changes of TF and TFPI at different time point were compared between the two groups.Results The levels of plasma TF,TFPI at every time point were obviously higher in no-reflow group than that in reperfusion group （P〈0.01）.The level of TF in both groups were significantly higher after PCI instantly than that before operation （P〈0.01）, and the level at 24 h after operation in no-reflow group was higher than that before operation （P〈0.05）, but no significant difference was found in reperfusion group （P〉0.05）.There was no significant difference in TFPI level between the two groups before and after operation.Conclusion Occurrence of no-reflow is positively correlated with plasma TF level in the patients with AMI un-dergoing emergency PCI, TFPI can prevent and control the occurrence of no reflow because of its inhibiting effect of thrombo-sis.