溶栓治疗对急性心肌梗死者纤维蛋白溶解指标的影响  

Influence of Thrombolysis on Fibrinolytic System in Acute Myocardial Infarction

作　　者：齐新[1] 刘克强[1] 刘丽[1] 黄繁嫱[1] 刘丽芸[1] 李家增[1] 

机构地区：[1]天津市第一中心医院心内科,天津300192

出　　处：《中国心血管杂志》1999年第2期67-68,102,共3页Chinese Journal of Cardiovascular Medicine

摘　　要：目的 研究急性心肌梗死(AMI)患者溶栓治疗过程中,血浆纤维蛋白溶解系统各指标的变化.方法 首次AMI者26例,男性17例、女性9例,给予尿激酶150万单位(U)溶栓治疗,测定溶栓前、及溶栓后0.5、6、12、24、72小时的血浆总体纤维蛋白溶解活力(GFC)、纤维蛋白原(Fg)、纤维蛋白溶解酶原(PLG)、组织型纤维蛋白溶解酶原激活因子(t-PA)及其抑制因子(PAI)水平.结果(1)血浆Fg、PLG浓度在尿激酶静脉注射后6小时显著降低至治疗前的50%,在24～72小时又逐渐回升至治疗前水平,72小时Fg浓度超过治疗前(P<0.05);血浆GFC、PAI则在治疗后0.5小时立即升高至峰值水平,在6～72小时迅速下降甚至低于治疗前水平(P<0.05);而t-PA水平在治疗后有所升高但变化无显著差异(P>0.05).(2)溶栓治疗后临床再灌注与无再灌注组血浆GFC的峰值水平及时间存在显著差异(P<0.05).结论 血浆GFC水平比其他指标更能揭示纤维蛋白溶解药物对体内纤维蛋白溶解系统的作用机制,溶栓治疗后血浆总体纤维蛋白溶解活力被激活的程度及时间是决定临床再灌注的重要因素.Objective To investigate the changes of global fibrinolytic capacity (GFC), fibrinogen(Fg), plasminogen (PLG), tissue-plasminogen activator (t-PA) and its inhibitor (PAD in the patients with acute myocardial infarction (AMI) before and after thrombolytic therapy. Methods 26 patients were treated with 1,500,000U urokinase (UK). The fibrinolytic parameters were measured before and 0. 5. 6. 12, 24, 72 hours after thrombolytic therapy. Results (1) After thrombolytic therapy, the concentration of Fg and PLG declined to 50% at 6h,and then recovered to the level of before treatment at 24-72h (P<0. 05), the GFC level and PAI activity increased immedi-ately to the highest at 0. 5h and then decreased significantly during 6 - 72h (P<0. 05), but t-PA antigen did not increased significantly (P>0. 05). (2)There were significantly difference in GFC peak and it's reaching time between the clinical reperfusion and without reperfusion group (P<0. 05). Conclusion GFC level can evaluate the body's fibrinolytic potential more exactly than other fibrinolytic parameters and it plays an importent role in predicting the clinical outcomes such as reperfusion after thrombolytic therapy.

关 键 词：血浆 溶栓治疗 纤维蛋白溶解系统 治疗后 t—PA 再灌注 急性心肌梗死 激酶 水平 纤维蛋白溶解酶 

分 类 号：R542.22[医药卫生—心血管疾病] R743[医药卫生—内科学]