CAJ | 학술논문

目的：探讨风湿性心脏病(风心病)血栓前状态(PTS)及血栓形成机制。方法：经食管超声心动描记术(TEE)检查风心病患者203例，确定心腔内云雾状回声、血栓形成、左心房增大情况，同时检测15例风心病房颤患者和15例正常人的血液血浆假血友病因子抗原(vWF：Ag)、血小板激活标记物一血小板α颗粒膜蛋白(GMP-140)、血浆纤维蛋白肽A(FPA)、血浆纤维蛋白D-二聚体(D-D)水平。评实PTS的存在并探讨其在血栓栓塞过程中的作用。结果：风心病患者90.1%发现云雾状回声、血栓形成30.5%，其中心房纤颤者与窦性心律者比较血栓形成差异有显著性(P<0.001)。血液学指标：VWF：AG、GMP-140、FPA和D-D血浆浓度均明显高于正常对照组(P<0.01)。结论：风心病房颤患者存在血栓栓塞的基础-PTS，凝血系统异常尤为显著，且TEE检测左房自发性超声对比现象(LASEC)是存在血栓栓塞危险性的有力预测因子，有较高的临床应用价值。
목적：탐토풍습성심장병(풍심병)혈전전상태(PTS)급혈전형성궤제。방법：경식관초성심동묘기술(TEE)검사풍심병환자203례，학정심강내운무상회성、혈전형성、좌심방증대정황，동시검측15례풍심병방전환자화15례정상인적혈액혈장가혈우병인자항원(vWF：Ag)、혈소판격활표기물일혈소판α과립막단백(GMP-140)、혈장섬유단백태A(FPA)、혈장섬유단백D-이취체(D-D)수평。평실PTS적존재병탐토기재혈전전새과정중적작용。결과：풍심병환자90.1%발현운무상회성、혈전형성30.5%，기중심방섬전자여두성심률자비교혈전형성차이유현저성(P<0.001)。혈액학지표：VWF：AG、GMP-140、FPA화D-D혈장농도균명현고우정상대조조(P<0.01)。결론：풍심병방전환자존재혈전전새적기출-PTS，응혈계통이상우위현저，차TEE검측좌방자발성초성대비현상(LASEC)시존재혈전전새위험성적유력예측인자，유교고적림상응용개치。
Objectives　To explore the prethrombotic state (PTS) and mechanism of thrombosis in the patients with rheumatic heart disease. Methods　Two hundred and three patients with rheumatic heart disease were examined by transesophageal echocardiography (TEE). The von Willebrand factor antigen (vWF:Ag)、 activated platelet marker α granule membrane protein-140 (GMP-140)、fibrinous peptide A (FPA) and fibrinous D-Dimer (D-D) in the plasm were determined by ELISA method in the 15 patients with rheumatic heart disease and atrial fibrillation and in the 15 health adults who served as control. Results　The smoke-like echo was found in 90.1% of the patients with rheumatic heart disease and thrombosis in 30.5% of them. The thrombosis in the patients with atrial fibrillation was significantly different from that in the adults with sinus rhythm (P<0.001). The plasm levels of vWF:Ag,GMP-140,FPA and D-D in the patients with rheumatic heart disease were significantly higher than those in the control group (P<0.01). Conclusion　There are the PTS, which is the base of thrombosis, the specially abnormal blood coagulation system in the patients with rheumatic heart disease and atrial fibrillation. The left atrial spontaneous echo contrast is a good factor which can predict thromboembolic risk and of a great value clinically.