凝血功能及血尿酸与急性冠脉综合征临床类型及心功能的关系  

Relationship between blood coagulation, serum uric acid and clinical classification, heart function of acute coronary syndrome

作　　者：王昭军[1] 侯建民[1] 任国庆[1] 吴骏[1] 梁仪[1] 

机构地区：[1]江苏大学附属医院心内科,江苏镇江212001

出　　处：《临床荟萃》2005年第15期853-855,共3页Clinical Focus

摘　　要：目的探讨内、外源性凝血功能和血尿酸与急性冠状动脉综合征(ACS)临床类型及心功能之间的关系。方法选择发病24小时内的ACS患者144例,依其临床类型分为两组,ST段抬高的急性心肌梗死(STEMI)患者99例,不稳定型心绞痛(UAP)患者45例,测定其凝血酶原时间(PT)及国际标准化比率(INR)、活化部分凝血活酶时间(APTT)、血浆纤维蛋白原(Fbg)和血清尿酸(SUA),比较两组之间的差异,并分析Fbg及SUA与心功能的相关性。结果STEMI组患者PT及INR和APTT均长于UAP组,其差异有统计学意义,分别为PT(13.44±2.68)svs(12.11±0.78)s,INR(1.15±0.27)vs(1.02±0.09),APTT(30.93±5.98)svs(26.75±3.12)s,均P<0.001。STEMI组Fbg、SUA均高于UAP组,但两组差异无统计学意义;在UAP组,血尿酸水平与心功能无相关性;而在STEMI组,血尿酸水平与心功能密切相关(rs=0.375,P=0.0001),血尿酸水平越高其心功能越低下。结论内、外源性凝血功能在ACS不同的临床类型存在差异,但STEMI患者全身凝血功能并不强于UAP患者。血清尿酸水平与心肌梗死患者的心功能等级呈正相关。血尿酸水平可能对心肌梗死患者的心功能预后有一定预测价值。Objective To investigate the relationship between blood coagulation, serum uric acid and clinical classification, heart function with acute coronary syndrome(ACS). Methods One hundred and forty-four patients suffering from ACS were divided into two groups: 99 patients with ST-segment elevation myocardial infarction(STEMI) and 45 patients with unstable angina pectoris(UAP). Prothrombin time(PT), international normalized ratio(INR), activated partial thromboplastin time(APTT),plasma fibrinogen(Fbg) and serum uric acid(SUA) were measured in all patients. The differences of above measurements in two groups of ACS were analysed. The relationships between the level of Fbg, SUA and the degree of heart failure were explored. Results PT,INR and APTT were longer in STEMI patients than those in UAP patients( 13.44 ± 2.68 ) s vs ( 12.11 ± 0.78 ) s, 1.15 ± 0.27 vs 1.02 ± 0.09 , ( 30.93 ± 5.98 ) s vs ( 26.75 ± 3.12 ) s, respectively, P < 0.001 ). The levels of Fbg and SUA in STEMI group were higher than those of UAP patients ( 4.50 ± 2.56 ) g/L vs ( 3.94 ± 1.94 )g/L,( 376.42 ± 154.32 ) μmol/L vs ( 343.31 ± 108.66 )μmol/L, respectively, P = 0.150 ). In STEMI group, there is a relationship between the level of SUA and the grade of heart failure ( r_s = 0.375 , P = 0.0001 ). The higher the level of SUA is, the worse the heart failure is. Conclusion The function of blood coagulation differs from each other in different subgroups of ACS. The function of blood coagulation in STEMI may not be stronger than that of UAP patients. There is a positive relationship between serum uric acid and the grade of heart failure in patient with STEMI. The level of serum uric acid may be a predictor for patients' heart function suffering from STEMI.

关 键 词：凝血酶原时间 凝血酶原 尿酸 冠状动脉疾病 心室功能 

分 类 号：R542.22[医药卫生—心血管疾病]