急性脑梗死患者凝血、抗凝和纤溶状态的临床研究

The Clinical Study of Coagulant, Anticoagulant and Fibrinolytic Function in Patients of Acute Cerebral Infarction.

目的 :探讨急性脑梗死患者的凝血、抗凝和纤溶状态 ,为早期诊断和溶栓治疗急性脑梗死提供依据。方法 :将 13 96例急性脑梗死患者分为完全脑梗死组和进展性脑梗死组 ,均进行前瞻性研究 ,检测其血浆凝血酶原时间(PT)、部分凝血活酶时间 (APTT)、凝血酶时间 (TT)、纤维蛋白原 (Fbg)、血管性血友病因子 (vWF)、血小板聚集试验(PAgT)、抗凝血酶活性 (AT∶A)、抗凝血酶抗原 (AT∶Ag)和组织型纤溶酶原激活物活性 (t PA∶A)。结果 :完全脑梗死患者PT、TT、APTT显著低于进展性脑梗死患者 (P <0 .0 0 1) ,而Fbg和vWF显著低于进展性脑梗死患者 ,P分别 <0 .0 5和0 .0 0 1) ,PAgT显著低于进展性脑梗死患者 (P <0 .0 0 1)。而完全脑梗死患者的AT∶A、AT∶Ag和t PA∶A水平显著高于进展性脑梗死患者 (P <0 .0 0 1)。结论 :以上结果提示进展型脑梗死患者存在较高的凝血活性和较低的纤溶活性。建议临床上采用APTT、PT、vWF、AT∶A和t PA∶A水平联合指导急性脑梗死的抗凝溶栓治疗和判断患者的预后。

Objective: We assayed coagulant, anticoagulant and f ibrinolytic function of patients with acute cerebral infarcion to provide scie ntific basis for early diagnosis and therapy of this disease. Methods:1 396 pati ents with acute cerebral infarction were divided into two groups:completed cereb ral infarction group and advanced cerebral infarction group. All patients were p rospectively reviewed by examining the level of their blood prothrombin time(PT) ,actived partial thromboplastin time(APTT),thrombin time(TT),Fbg,vWF and the act ivity of antitrombin (AT),AT antigen and tissue type plasminosen activator(t-PA ).Results:The level of PT, TT, APTT and vWF in completed cerebral infarction gro upare significantly lower than advanced cerebral infarction group(P <0.001).The level of Fbg in completed cerebral infarction group are lower th an advanced cerebral infarction group (P<0.05).PAgT in complete d cerebral infarction group is also lower. However, the activity of AT,AT antige n and t PA in completed cerebral infarction group are significantly higher than advanced cerebral infarction group (P<0.001). Conclusion: The level of PT, TT, APTT, vWF, AT ,AT antigen and t-PA∶A can be adopted to as say the clinical therapy effect and prognosis of acute cerebral infarction.