缺血性心力衰竭患者血栓前状态标志物与左心室功能的关系

The relationship between the markers of prethrombotic state and the left ventricular function in ischemic heart failure

目的 探讨缺血性心力衰竭时血栓前状态标志物与心功能的关系。方法 测定 118例缺血性心力衰竭患者(心功能 ～ 级 )的血浆纤维蛋白原 (Fg) ,血管性血友病因子 (v WF) ,P-选择素 (P- selectin) ,组织型纤溶酶原激活剂 (t- PA)及其抑制物 (PAI- 1) ,D-二聚体 (D- dim er)水平。彩色多普勒超声心动图测定左心室射血分数 (L VEF)。 4 5例心功能 级患者随机分成 3组 ,福辛普利组 15例 ,缬沙坦组 15例 ,比索洛尔组 15例 ,治疗 3个月后重复测定血浆标志物。结果 不同程度心力衰竭患者的血栓前状态标志物存在明显差异 (P<0 .0 1)。福辛普利组 ,缬沙坦组治疗后较用药前血浆 Fg,v WF,P- selectin(P均 <0 .0 5 ) ,D- dimer,PAI- 1(P<0 .0 1)水平均显著降低 ,t- PA水平显著升高 (P<0 .0 1) ,但两组间治疗前后变化值相比无显著性差异 (P>0 .0 5 )。比索洛尔对血浆血栓前状态标志物水平无影响 (P>0 .0 5 )。结论 缺血性心力衰竭存在血栓前状态 ,并与心力衰竭的严重程度密切相关。血管紧张素转换酶抑制剂 (ACEI)或血管紧张素 (Ang )受体阻滞剂 (ARB)可改善血栓前状态 ,但 β受体阻滞剂未见此作用。

Objective To explore the relationship between the markers of prethrombotic state(PTS) and left ventri- cular function in ischemic heart failure. Methods The levels of fibrinogen(Fg),P-selectin,tissue plasminogen activator(t-PA),plasminogen activator inhibitor-1 (PAI-1),D-dimer were observed in 118 patients(New York Heart Association class Ⅱ-Ⅳ) with ischemic heart failure. Echocardiography was applied to measure left ventricular ejection fraction(LVEF). 45 patients of NYHA class Ⅱ were randomly divided into three groups: fosinopril group, valsartan group and bisoprolol group. 3 months after drugs administration, the markers of PTS were examined again. Results There were significant difference in the levels of the markers of PTS with more severe sympotoms(NYHA class Ⅱ-Ⅳ),and the significant changes has close relationship with LVEF. After fosinopril or valsartan was introduced, the levels of Fg,vwF, P-selectin(P<0.05,respectively), D-dimer,PAI-1(P<0.01,respectively) were significantly decreased and the level of t-PA significantly increased(P<0.01),but there was no significant difference between the two groups. There were no significant changes in the markers after the introduction of bisoprolol(P>0.05). Conclusion PTS is present in ischemic heart failure, especially in those with more severe NYHA class. Treatment with ACEI or ARB can improve PTS with CHF, whereas the addition of β-blockers is not effective.