急性心肌梗塞溶栓疗法对血浆凝血活性影响的研究  

Studies related to coagulation activation after thrombolytic therapy in acute myocardial infarction

作　　者：许俊堂[1] 胡大一[1] 翁心植[1] 李俊华[1] 肖洁[1] 郑虹伟 朱佐民[1] 崔亮[1] 顼志敏[1] 

机构地区：[1]首都医科大学附属北京红十字朝阳医院心脏中心

出　　处：《中华医学检验杂志》1999年第2期112-114,共3页

基　　金：北京市科委科技新星计划资助

摘　　要：目的探讨溶栓疗法对血浆凝血活性的影响。方法连续监测３７例急性心肌梗塞病人，不管是否接受溶栓治疗，于确定诊断后定期从外周静脉采血，酶联免疫双抗体夹心法测定血浆凝血酶修饰抗凝血酶Ⅲ（ａｎｔｉｔｈｒｏｍｂｉｎⅢｍｏｄｉｆｉｅｄ，ＡＴＭ）和Ｄ二聚体（ＤＤ）的动态变化。结果溶栓开始２小时后，血浆ＡＴＭ显著性增加（８５８０±２４５９μｇ／Ｌ比２３２２±１０５９μｇ／Ｌ，Ｐ＜００５），４小时达峰植（１１６９８±３３６５μｇ／Ｌ），持续３日以上；血浆ＤＤ于２小时即达到峰值（６７５±２４１ｍｇ／Ｌ比２５９±１２７ｍｇ／Ｌ，Ｐ＜００５），维持８小时以上，２４小时以后恢复正常。在溶栓组病人，不同采血时刻血浆ＡＴＭ和ＤＤ的平均值呈明显正相关。未溶栓组病人血浆ＡＴＭ和ＤＤ浓度未见显著性变化。结论溶栓疗法激活凝血系统，与血栓溶解的标志物（ＤＤ）呈明显正相关。本研究应用的抗栓措施和抗栓剂不足以抑制凝血系统的激活，早期应用有效抗血栓药物可能抑制凝血系统的激活，减少血栓再闭塞的发生。Objective This study was designed to dynamically observe the changes of haemostasis before and after thrombolytic therapy. Methods Consecutive 37 patients presenting with acute myocardial infarction were included, 28 of which matched with the inclusion criteria for thrombolysis. Upon the diagnosis of acute myocardial infarction established, blood sampling was performed periodically, and plasma ATM (antithrombin Ⅲ modified) and D D (D Dimer) determined by ELISA. Results Plasma ATM levels increased significantly (85.80±24.59 μg/L vs 23.22±10.59 μg/L, P <0.05) 2 hours after thrombolytics administration, peaked 4 hours later at 116.98± 33.65 μg/L, sustained for at least 3 days. Plasma D D peaked in 2 hours (6.75±2.41 mg/L vs 2.59± 1.27 mg/L, P <0.05) and returned progressively to normal 12 hours after thrombolysis. A positive correlation was present between plasma ATM and D D levels in thrombolytic patients. In patients without thrombolysis, no significant changes were found in plasma ATM and D D levels during the whole monitoring period. Conclusion Thrombolytic therapy activates coagulation system, which is positively related to clot lysis (elevated plasma D D). The anticoagulant regimen we used could not sufficiently suppress the activation of coagulation. Earlier administration of intensive anticoagulation may benefit more from thrombolytic therapy for patients with acute myocardial infarction.

关 键 词：心肌梗塞 恶性 凝血酶 溶栓疗法 

分 类 号：R542.22[医药卫生—心血管疾病]