心房颤动患者血栓前状态研究

Study of Prothrombotic State in Patients With Atrial Fibrillation

目的 :研究心房颤动 (房颤 )患者血栓前状态相关指标 ,探讨其临床意义。方法 :在慢性房颤患者、具器质性心脏病无房颤患者和健康正常人中 ,测定血浆D 二聚体、血管性血友病因子(vWF)、纤维蛋白原 (Fg)、平均血小板体积 (MPV ) ,以及二磷酸腺苷、肾上腺素、胶原、花生四烯酸诱导的血小板最大聚集率。房颤患者根据是否服阿司匹林分为 2组 :房颤 1组为未服阿司匹林者 (17例 ) ,房颤 2组为服阿司匹林者 (18例 )。具器质性心脏病无房颤且未服用阿司匹林患者 (19例 )为窦性心律组 ,另选 17例正常健康者为对照组。结果 :房颤 1、2组血浆D 二聚体、vWF以及MPV明显高于窦性心律组和对照组 (P <0 0 5～ 0 0 1)。房颤 1、2组血浆Fg明显高于对照组 (P <0 0 5 )。以上指标在房颤 1组和房颤 2组之间的差异无显著性。与房颤 1组比 ,房颤 2组四种诱导剂的血小板最大聚集率均显著降低 ,有极显著性差异 (P <0 0 0 1)。vWF >15 0 %房颤患者Fg更高、左心房内径更大 ,与vWF≤ 15 0 %房颤患者比有显著性差异 (P <0 0 5 )。结论 :房颤患者存在着血栓前状态 ,且不受小剂量阿司匹林的影响 ,这些异常可能与房颤患者心房内血栓形成相关。

Objective: To investigate the prothrombotic state markers in patients with atrial fibrillation and their clinical significance. Methods: Thirty five patients with chronic atrial fibrillation were divided into 2 groups, one group being not on aspirin (group 1, n =17) and the other being on(group 2, n =18). There were two age matched and sex matched control groups,the normal sinus rhythm group including 19 patients with cardiovascular disease but in sinus rhythm, the health control group including 17 healthy subjects. The plasma fibrin D dimer and vWF were assayed using enzyme linked immunoassay. Fibrinogen (Fg) and mean platelet volume (MPV)were measured. The maximal platelet aggregation rates by four different agonists (ADP 45.0 μmol/l, EPI 5.0 μmol/l,COL 2.0 μg/ml, AA 500.0 μg/ml) were assayed using comparative turbidity method. Results: Compared with the healthy control group and the normal sinus rhythm group, patients with atrial fibrillation had significant increase of fibrin D dimer, vWF and MPV( p <0.05). Plasma Fg level was higher in group 1 and group 2 than that in the health control group ( p <0 05). The maximum platelet aggregation rates of the four agonists were significantly lower in group 2 than those in group 1 ( p <0 001). There were no significant differences in the levels of D dimer, vWF, Fg and MPV between group 1 and group 2 ( p >0 05). In atrial fibrillation patients with vWF>150%, Plasma Fg level was higher and left atrial size was larger than in those with vWF≤150% ( p <0.05). Conclusion: Patients with atrial fibrillation show evidence of prothrombotic state of coagulation system activation, endothelial cell disturbance and platelet activation, which may be correlated with the atrial thrombogenesis. In patients with atrial fibrillation, low dose aspirin inhibits platelet aggregation dramatically, but does not effect the levels of plasma D dimer, vWF, Fg and MPV.