急性冠状动脉综合征患者血浆F1+2和SFMC测定及肝素治疗的临床研究

Clinical study of prothrombotic state in patients with acute coronary syndrome

目的:测定急性冠状动脉综合征(acutecoronarysyndrome,ACS)患者的血浆血栓前片段1+2(prothrombinfragment1+2,F1+2)和可溶性纤维蛋白单体复合物(solublefibrinmonomercomplex,SFMC)水平,观测肝素抗凝治疗对ACS患者血浆F1+2和SFMC水平的影响,为早期诊断和防治ACS患者的血栓前状态提供参考。方法:将86例ACS患者分为急性心肌梗死(acutemyocardialinfarction,AMI)组和不稳定心绞痛(unstableangina,UA)组,分别以酶联免疫法测定血浆F1+2和SFMC含量,并与75例稳定性心绞痛(stableangina,SA)患者进行对照分析。同时用肝素抗凝治疗ACS患者,观察治疗前后血浆F1+2和SFMC含量的变化。结果:ACS组及其分组的血浆F1+2和SFMC水平均明显高于SA组,差异有统计学意义(P均<0.01),AMI组的血浆F1+2和SFMC水平亦明显高于UA组,差异有统计学意义(P均<0.05)。肝素抗凝治疗后血浆F1+2和SFMC水平明显下降,与治疗前比较有统计学意义(P均<0.05)。结论:ACS患者存在明显的血栓前状态,肝素抗凝治疗后症状得到改善,血浆F1+2和SFMC是早期诊断ACS和指导抗凝治疗的敏感指标。

Objective:To observe levels of plasma prothrombin fragment 1+2(F1+2)and solu-ble fibrin monomer complex (SFMC)in patients with acute coronary syndrome (ACS)and their changes after anticoagulation with heparin,and provide a new laboratory method of early diagnosis and treatment of prothrombotic state.Meth ods:Eighty-six patients with ACS were randomly divided into2groups:acute myocardial infarction(AMI )group and unstable angina(UA)group,and75pa-tients with stable angina(SA)were selected as control group.Plasma F1+2and SFMC were measured by enzyme-linked immunosorbent assay(ELISA)in all these three groups.While in group AMI and UA they were measured again after anticoagulation with heparin.Re sults:The plasma concentration s of F1+2and SFMC in patients with ACS were significantly higher than those of patients with SA(P<0.01).And the plasma concentrations of F1+2and SFMC in group AMI were higher than those of group UA(P<0.05).After anticoagulation with heparin there were significant decreases in theplasma concentration s of F1+2and SFMC(P<0.05).Con clu sion:The ACS patients have an obvious prothrombotic state which can be decreased by anticoagulation with heparin.The plasma F1+2and SFMC are sensitive indexes of early diagnosis and anticoagulation.