中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2012年
4期
225-228
,共4页
贾雪芹%董晨明%秦静%张凌
賈雪芹%董晨明%秦靜%張凌
가설근%동신명%진정%장릉
凝血%纤溶%冠心病
凝血%纖溶%冠心病
응혈%섬용%관심병
Coagulation%Fibrinolysis%Coronary heart disease
目的 观察冠心病患者急性期凝血与纤溶指标变化规律及药物的干预作用.方法 采用前瞻性研究方法,检测110例冠心病患者[其中急性心肌梗死(AMl)50例,不稳定型心绞痛(UAP)35例,缺血性心肌病(ICM)25例]入院即刻及治疗14d后的血浆血管性血友病因子(vWF)、血小板活化因子(PAF)、组织型纤溶酶原激活剂(t-PA)等凝血、纤溶指标变化,以19例健康体检者的检测指标作为对照.同时采用随机、双盲方法,观察给予常规治疗(阿司匹林+低分子肝素)或联用氯吡格雷治疗14d后AMI及UAP患者血浆中vWF、PAF、t-PA等凝血、纤溶指标变化.结果 AMI及UAP患者入院时血浆vWF、PAF(nmol/L)水平均明显高于健康对照组[ vWF:(202.31±27.38)％、( 188.65±31.08)％比(120.37±18.79)％;PAF:50.64±13.25、48.87±13.24比15.43±9.27,均P＜0.05],t-PA(μg/L)均较健康对照组明显降低(3.52±1.57、4.03±2.04比9.54±1.32,均P＜0.01);治疗14d后AMI及UAP患者血浆vWF、PAF、t-PA、纤维蛋白原(Fib,g/L)、D二聚体(mg/L)水平接近健康对照组[vWF:( 116.56±26.10)％、( 111.28±22.31)％比(120.37±18.79)％;PAF:17.48±9.16、16.23±9.17比15.43±9.27;t-PA:7.91±2.42、9.01±2.01比9.54±1.32;Fib:3.64±0.53、2.74±0.72比2.92±0.91;D-二聚体:0.370±0.150、0.288±0.169比0.255±0.109,均P＞0.05];ICM组患者治疗前后血浆vWF、PAF、t-PA、Fib、D-二聚体水平与健康对照组比较差异均无统计学意义[vWF:( 124.14±21.17)％、( 119.44±26.28)％比(120.37±18.79)％;PAF:15.69±7.14、14.84±9.16比15.43±9.27;t-PA:8.62±2.24、8.07±2.51比9.54±1.32;Fib:3.24±0.74、3.04±0.77比2.92±0.91;D-二聚体:0.257±0.132、0.268±0.117比0.255±0.109,均P＞0.05].多元线性回归分析显示,冠心病患者PAF与vWF呈正相关(r=0.42,P＜0.01),与t-PA呈负相关(r=-0.31,P＜0.01).AMI及UAP患者中,氯吡格雷治疗14 d后血浆vWF、PAF、t-PA、Fib、D-二聚体水平与常规治疗组比较无明显差异[vWF:( 120.16±16.57)％比(118.12±14.32)％;PAF:12.01±3.70比13.33±1.10;t-PA:9.75±1.60比7.59±2.46;Fib:2.73±0.49比3.09±0.50;D-二聚体:0.233±0.101比0.252±0.088,均P＞0.05].结论 AMI及UAP患者急性期有明显凝血、纤溶功能异常,其中t-PA水平降低最显著.对AMI及UAP患者,氯吡格雷联用阿司匹林与单用阿司匹林在改善凝血、纤溶功能指标方面无明显差别.
目的 觀察冠心病患者急性期凝血與纖溶指標變化規律及藥物的榦預作用.方法 採用前瞻性研究方法,檢測110例冠心病患者[其中急性心肌梗死(AMl)50例,不穩定型心絞痛(UAP)35例,缺血性心肌病(ICM)25例]入院即刻及治療14d後的血漿血管性血友病因子(vWF)、血小闆活化因子(PAF)、組織型纖溶酶原激活劑(t-PA)等凝血、纖溶指標變化,以19例健康體檢者的檢測指標作為對照.同時採用隨機、雙盲方法,觀察給予常規治療(阿司匹林+低分子肝素)或聯用氯吡格雷治療14d後AMI及UAP患者血漿中vWF、PAF、t-PA等凝血、纖溶指標變化.結果 AMI及UAP患者入院時血漿vWF、PAF(nmol/L)水平均明顯高于健康對照組[ vWF:(202.31±27.38)％、( 188.65±31.08)％比(120.37±18.79)％;PAF:50.64±13.25、48.87±13.24比15.43±9.27,均P＜0.05],t-PA(μg/L)均較健康對照組明顯降低(3.52±1.57、4.03±2.04比9.54±1.32,均P＜0.01);治療14d後AMI及UAP患者血漿vWF、PAF、t-PA、纖維蛋白原(Fib,g/L)、D二聚體(mg/L)水平接近健康對照組[vWF:( 116.56±26.10)％、( 111.28±22.31)％比(120.37±18.79)％;PAF:17.48±9.16、16.23±9.17比15.43±9.27;t-PA:7.91±2.42、9.01±2.01比9.54±1.32;Fib:3.64±0.53、2.74±0.72比2.92±0.91;D-二聚體:0.370±0.150、0.288±0.169比0.255±0.109,均P＞0.05];ICM組患者治療前後血漿vWF、PAF、t-PA、Fib、D-二聚體水平與健康對照組比較差異均無統計學意義[vWF:( 124.14±21.17)％、( 119.44±26.28)％比(120.37±18.79)％;PAF:15.69±7.14、14.84±9.16比15.43±9.27;t-PA:8.62±2.24、8.07±2.51比9.54±1.32;Fib:3.24±0.74、3.04±0.77比2.92±0.91;D-二聚體:0.257±0.132、0.268±0.117比0.255±0.109,均P＞0.05].多元線性迴歸分析顯示,冠心病患者PAF與vWF呈正相關(r=0.42,P＜0.01),與t-PA呈負相關(r=-0.31,P＜0.01).AMI及UAP患者中,氯吡格雷治療14 d後血漿vWF、PAF、t-PA、Fib、D-二聚體水平與常規治療組比較無明顯差異[vWF:( 120.16±16.57)％比(118.12±14.32)％;PAF:12.01±3.70比13.33±1.10;t-PA:9.75±1.60比7.59±2.46;Fib:2.73±0.49比3.09±0.50;D-二聚體:0.233±0.101比0.252±0.088,均P＞0.05].結論 AMI及UAP患者急性期有明顯凝血、纖溶功能異常,其中t-PA水平降低最顯著.對AMI及UAP患者,氯吡格雷聯用阿司匹林與單用阿司匹林在改善凝血、纖溶功能指標方麵無明顯差彆.
목적 관찰관심병환자급성기응혈여섬용지표변화규률급약물적간예작용.방법 채용전첨성연구방법,검측110례관심병환자[기중급성심기경사(AMl)50례,불은정형심교통(UAP)35례,결혈성심기병(ICM)25례]입원즉각급치료14d후적혈장혈관성혈우병인자(vWF)、혈소판활화인자(PAF)、조직형섬용매원격활제(t-PA)등응혈、섬용지표변화,이19례건강체검자적검측지표작위대조.동시채용수궤、쌍맹방법,관찰급여상규치료(아사필림+저분자간소)혹련용록필격뢰치료14d후AMI급UAP환자혈장중vWF、PAF、t-PA등응혈、섬용지표변화.결과 AMI급UAP환자입원시혈장vWF、PAF(nmol/L)수평균명현고우건강대조조[ vWF:(202.31±27.38)％、( 188.65±31.08)％비(120.37±18.79)％;PAF:50.64±13.25、48.87±13.24비15.43±9.27,균P＜0.05],t-PA(μg/L)균교건강대조조명현강저(3.52±1.57、4.03±2.04비9.54±1.32,균P＜0.01);치료14d후AMI급UAP환자혈장vWF、PAF、t-PA、섬유단백원(Fib,g/L)、D이취체(mg/L)수평접근건강대조조[vWF:( 116.56±26.10)％、( 111.28±22.31)％비(120.37±18.79)％;PAF:17.48±9.16、16.23±9.17비15.43±9.27;t-PA:7.91±2.42、9.01±2.01비9.54±1.32;Fib:3.64±0.53、2.74±0.72비2.92±0.91;D-이취체:0.370±0.150、0.288±0.169비0.255±0.109,균P＞0.05];ICM조환자치료전후혈장vWF、PAF、t-PA、Fib、D-이취체수평여건강대조조비교차이균무통계학의의[vWF:( 124.14±21.17)％、( 119.44±26.28)％비(120.37±18.79)％;PAF:15.69±7.14、14.84±9.16비15.43±9.27;t-PA:8.62±2.24、8.07±2.51비9.54±1.32;Fib:3.24±0.74、3.04±0.77비2.92±0.91;D-이취체:0.257±0.132、0.268±0.117비0.255±0.109,균P＞0.05].다원선성회귀분석현시,관심병환자PAF여vWF정정상관(r=0.42,P＜0.01),여t-PA정부상관(r=-0.31,P＜0.01).AMI급UAP환자중,록필격뢰치료14 d후혈장vWF、PAF、t-PA、Fib、D-이취체수평여상규치료조비교무명현차이[vWF:( 120.16±16.57)％비(118.12±14.32)％;PAF:12.01±3.70비13.33±1.10;t-PA:9.75±1.60비7.59±2.46;Fib:2.73±0.49비3.09±0.50;D-이취체:0.233±0.101비0.252±0.088,균P＞0.05].결론 AMI급UAP환자급성기유명현응혈、섬용공능이상,기중t-PA수평강저최현저.대AMI급UAP환자,록필격뢰련용아사필림여단용아사필림재개선응혈、섬용공능지표방면무명현차별.
Objective To investigate the changes in coagulation and fibrinolysis parameters during acute phase of coronary heart disease,and to explore the effects of drug intervention in same period.Methods A prospective study was conducted.The changes in plasma yon Willebrand factor (vWF),platelet activating factor (PAF),tissue type plasminogen activator (t-PA) of 110 patients with coronary heart disease [50 patients with acute myocardial infarction (AMI),35 patients with unstable angina pectoris (UAP),25 patients with ischemic cardiomyopathy (ICM)] were determined immediately at admission and 14 days after treatment.The indexes of 19 healthy individuals were collected as control.At the same time,randomized and double-blind observation of the changes in plasma coagulation and fibrinolysis system indexes including vWF,PAF and t-PA was made in AMI and UAP patients who received conventional treatment (aspirin + low molecular weight heparin) or combination of conventional treatment and clopidogrel for 14 days.Results The vWF and PAF levels (nmol/L) of AMI and UAP patients at admission were significantly higher than those in healthy control group [ vWF:(202.31 ± 27.38 )％,(188.65 ± 31.08 )％ vs.(120.37 ± 18.79)％; PAF:50.64 ±13.25,48.87 ±13.24 vs.15.43 ±9.27,all P＜0.05],however,t-PA (μg/L) was remarkably lower than that in healthy control group (3.52 ± 1.57,4.03 ± 2.04 vs.9.54 ± 1.32,both P＜0.01 ).After 14 days of treatment,the levels of vWF,PAF,t-PA,fibrinogen (Fib,g/L),D-dimer (mg/L) in plasma of AMI and UAP patients were close to those of healthy control group [vWF:( 116.56 ± 26.10 )％,( 111.28 ± 22.31 )％ vs.( 120.37 ±18.79)％; PAF:17.48 ± 9.16,16.23 ± 9.17 vs.15.43 ± 9.27; t-PA:7.91 ± 2.42,9.01 ± 2.01 vs.9.54 ± 1.32; Fib:3.64 ±0.53,2.74 ±0.72 vs.2.92 ±0.91; D-dimer:0.370 ±0.150,0.288 ± 0.169 vs.0.255 ± 0.109,all P＞0.05].However,there was no statistical difference in vWF,PAF,t-PA,Fib and D-dimer levels before and after treatment in ICM group compared with healthy control group [vWF: (124.14 ± 21.17)％, (119.44 ± 26.28)％ vs. (120.37 ±18.79)％; PAF:15.69 ±7.14,14.84 ±9.16 vs.15.43 ±9.27; 1-PA:8.62 ±2.24,8.07 ±2.51 vs.9.54 ± 1.32; Fib:3.24 ±0.74,3.04 ±0.77 vs.2.92 ±0.91; D-dimer:0.257 ±0.132,0.268 ±0.117 vs.0.255 ±0.109,all P＞0.05].Multiple linear regression analysis showed that,in patients with coronary heart disease,PAF be positively correlated with vWF (r=0.42,P＜0.01 ),but negatively correlated with t-PA (r=-0.31,P＜0.01 ).In patients with AMI and UAP,using the treatment of clopidogrel for 14 days,the levels of vWF,PAF,t-PA,Fib and D-dimer in plasma showed no significant differences compared with those of conventional treatment group [vWF: ( 120.16 ± 16.57 )％ vs.(118.12 ± 14.32)％; PAF:12.01 ± 3.70 vs.13.33 ± 1.10; t-PA:9.75 ± 1.60 vs.7.59 ± 2.46; Fib:2.73 ± 0.49 vs.3.09 ±0.50; D-dimer:0.233 ±0.101 vs.0.252 ±0.088,all P＞0.05].Conclusions There were changes in coagulation and fibrinolysis status in patients with AMI and UAP at the initial stage,the level of t-PA was decreased significantly.For patients with AMI and UAP,there were no obvious differences in coagulation and fibrinolysis parameters between combination therapy of clopidogrel and aspirin and aspirin alone.
