食道超声心动图及血浆纤溶活性检测探讨风湿性心脏病栓塞危险性  

Exploring Thromboembolic Risk in Patients with Rheumatic Heart Disease by Transesophangeal Echocardiography and Detection of Fibriflolytic Activity in Blood .Plasm

作　　者：李琴 张端伟[2] 

机构地区：[1]广东省军区专科医院,广州510500 [2]广东省人民医院心血管病研究所

出　　处：《华南国防医学杂志》2001年第2期12-14,共3页Military Medical Journal of South China

摘　　要：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。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 echocardio-graphy (TEE). The von Willebrand factor antigen (vWF:Ag) , activated platelet marker a granule membrane protein - 140 ( GMP -140) ,fibrinous peptide A (FPA) and fibrinous D- Dimer (D- D) in the plasm were determined by EIJSA 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.

关 键 词：食道超声心动图 血浆纤溶活性 风湿性心脏病 栓塞 

分 类 号：R[医药卫生] 514.2