冠心病患者血浆TF、TFPI水平的变化及其临床意义

Changes of plasma tissue factor and pathway inhibitor in patients with coronary heart disease

目的 观察冠心病患者血浆组织因子 (TF)、组织因子途径抑制物 (TFPI)水平的变化及其临床意义。方法 79例临床确诊的冠心病患者 ,其中急性心肌梗死 (AMI组 ) 32例、不稳定型心绞痛 (UAP组 ) 2 7例、稳定型心绞痛 (SAP组 ) 2 0例 ,15例健康对照组作为对照组。采用发色底物法测定血浆TF、TFPI活性。结果 与对照组、SAP组比较 ,AMI组血浆TF、TFPI显著增高 ,三组差异具有显著性意义 (P<0 0 5 ) ;AMI组血浆TF活性与UAP组比较差异无统计学意义 (P >0 0 5 ) ,但TFPI活性较UAP组明显升高 ,两者差异具有显著性意义 (P <0 0 5 )。UAP组血浆TF活性较健康对照组及SAP组明显升高 ,三组间差异具有显著性意义 (P <0 0 5 ) ,UAP组血浆TFPI活性较健康对照组及SAP组差异无统计学意义 (P >0 0 5 ) ;SAP组血浆TF、TFPI活性较健康对照组差异无统计学意义 (P >0 0 5 )。结论 (1)AMI、UAP患者存在异常激活的高凝状态 ,TF触发的外源性凝血途径在冠脉内血栓形成上发挥重要作用。 (2 )AMI、UAP患者体内TF。

Objective To observe the changes of tissue factor (TF) and tissue factor pathway inhibitor(TFPI) in patients with coronary heart disease. Methods 32 patients with acute myocardial infarction(AMI),27 patients with unstable angina pectoris(UAP),and 20 patients with stable angina pectoris(SAP) were studied.15 healthy volunteers served as control.Plasma TF and TFPI activities were measured with chromogenic assay. Results Plasma TF and TFPI activities were significantly higher in patients with AMI than those in control group and patients with SAP( P <0.05); there were no significant changes of plasma TF,compared with those of patients with UAP(P >0.05 ). Plasma TFPI activity was significantly higher in patients with AMI than those of patients with UAP (P <0.05). Plasma TF activity was significantly higher in patients with UAP than those in control group and patients with SAP (P <0.05), but there were no significant changes of plasma TFPI compared with those of controls and patients with SAP (P >0.05 ) .There were no statistical differences of TF and TFPI in patients with SAP compared with those of controls (P >0.05 ).Conclusion (1) There exists an abnormally activated hyper-coagulation state in patients with AMI and patients with UAP. TF is recognized as the initial trigger of the extrinsic coagulation pathway which play a critical role in the pathogenesis of coronary thrombosis.(2)The balance between TF and TFPI is deranged in patients with AMI or with UAP.