急性心肌梗死患者尿激酶型纤溶酶原激活物系统在静脉溶栓治疗前后的变化及意义  

The Change and Significance of Urokinase-type Plasminogen Activator System in Patients with Acute Myocardial Infarction Treated with Thrombolysis

作　　者：陈洁茹[1] 林仪[1] 陈晓辉[1] 冯莹[1] 江慧琳[1] 张弋[1] 

机构地区：[1]广州医学院附属二院,广州510260

出　　处：《血栓与止血学》2011年第2期57-60,共4页Chinese Journal of Thrombosis and Hemostasis

基　　金：广东省社会发展领域科技计划项目(73056);广州市卫生局科研基金资助课题(2008-YB-175);广州医学院科研基金资助课题(02-K-32)

摘　　要：目的检测急性心肌梗死(AMI)患者溶栓治疗前后血浆尿激酶型纤溶酶原激活物(uPA)及其受体(uPAR)和纤溶酶原激活物抑制剂-1(PAI-1)的含量,探讨三者在溶栓治疗前后的变化及对溶栓后血管再通及出血的预测价值。方法应用ELISA双抗体夹心法分别测定16例AMI患者溶栓前后血浆uPA、uPAR和PAI-1含量并与对照组(16例)进行比较。根据溶栓后血管是否再通及出血将16例患者分为冠脉再通组与未通组、出血组及无出血组,比较组间的血浆uPA、uPAR和PAI-1含量。结果与对照组相比,溶栓前的uPAR和PAI-1水平明显升高。与溶栓前相比,溶栓后0.5 h、1 h、1.5 h、2 h的uPA水平明显下降(P<0.01);溶栓后1.5 h、2 h的PAI-1水平则明显高于溶栓前(P<0.01);溶栓后uPAR与溶栓前比较无明显变化。溶栓后2 h冠脉再通组PAI-1水平显著低于未通组(P<0.05);而冠脉再通组和未通组uPA、uPAR水平差异无统计学意义(P>0.05)。溶栓后2 h出血组PAI-1水平显著高于无出血组(P<0.05);无出血组和出血组血浆uPA、uPAR水平差异无统计学意义(P>0.05)。结论血浆uPAR、PAI-1水平升高提示AMI发生的可能性增大,临床医生应及早干预,如尽早行PCI治疗等。血浆PAI-1水平降低,对AMI患者溶栓后血管再通及出血提供了一定临床预测价值。Objective To analyze the plasma concentration of uPA,uPAR and PAI-1 and monitor the dynamic variation of these three markers before and after thrombolytic therapy and explore the predictive value for revascularization after thrombolysis and hemorrhage occurrence in patients with acute myocardial infarction（AMI）.Methods To analyze the plasma concentration of uPA,uPAR and PAI-1 by ELISA and compared to the control group.16 AMI cases are divided to different groups according to the result such as recanalization and hemorrhage,the plasma concentration of uPA,uPAR and PAI-1 are compared.Results The plasma uPAR and PAI-1 levels of acute myocardial infarction group was much higher than those of the control group（P0.01）.The plasma uPA was not significantly different between two groups（P0.05）.Patients with acute myocardial infarction after thrombolysic therapy 0.5 h,1 h,1.5 h,2 h,uPA levels significantly decreased（P0.01）.uPAR levels decreased,but there is no significant difference（P0.05）.PAI-1 level significantly increased after thrombolystic therapy 1.5 h,2 h（P0.01）.The plasma PAI-1 levels 2 h after thrombolysic therapy in no revascularization group is significant higher than that in revascularization group（P0.05）.However,the plasma uPA,uPAR were not significantly different between two groups（P0.05）.2 h after thrombolystic therapy,the plasma PAI-1 level in non-bleeding group is significantly higher than that in bleeding group（P0.05）.However,the plasma uPA,uPAR level were not significantly different between two groups（P0.05）.Conclusion The plasma uPAR and PAI-1 levels can suggest the likelihood of AMI.Clinicians should make early intervention and present the reperfusion therapy as soon as possible.The plasma PAI-1 level after thrombolytic therapy in patients with AMI can provide somewhat prediction to revascularization and hemorrhage occurrence.

关 键 词：急性心肌梗死 溶栓治疗 尿激酶型纤溶酶原激活物 

分 类 号：R542.22[医药卫生—心血管疾病]