冠状动脉痉挛或血栓形成导致急性心肌梗死的D-二聚体水平  

D-dimer level of acute myocardial infarction in coronary artery spasm or thrombosis

作　　者：和渝斌[1] 郭晓东[2] 王长华[3] 曾晓林[4] 林月[1] 

机构地区：[1]北京军区总医院心内科,北京100700 [2]北京武警总医院急诊科,北京100039 [3]北京安贞医院心内科,北京100029 [4]湖南湘雅医院心内科,湖南长沙410001

出　　处：《临床药物治疗杂志》2013年第5期22-25,共4页Clinical Medication Journal

摘　　要：目的 ：分析D-二聚体（D-dimer）水平在溶栓治疗急性心肌梗死时的水平,探讨其在治疗过程中演变的意义。方法：连续随机选择急性心肌梗死患者90例,根据是否进行溶栓治疗及溶栓后冠状动脉造影结果,将入选患者分为冠状动脉狭窄溶栓再通组（A,n=23）、无冠状动脉明显狭窄再通组（B,n=25）、非再通组（C,n=24）及非溶栓组（D,n=18）。各组患者在治疗前后测定血清D-dimer水平。治疗前测定磷酸肌酸激酶同工酶、肌钙蛋白I、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、血糖、凝血酶原时间及活化部分凝血活酶时间。溶栓组用rt-PA进行静脉溶栓,非溶栓组静脉滴注等量生理盐水。经冠状动造影对溶栓效果进行评价。结果 ：各组患者磷酸肌酸激酶同工酶及肌钙蛋白I水平均明显增高,各再通组患者磷酸肌酸激酶同工酶峰值小于13h,A组及B组D-dimer水平在溶栓后1.0h快速升高,但A组血中D-dimer水平明显高于B组（溶栓后1~8h,P〈0.05~0.001）,A组D-dimer水平峰值出现在溶栓后4h,而B组D-dimer峰值出现在溶栓后2h,明显早于前者。但非溶栓组在相同时间内无上述变化。结论 ：D-dimer水平变化在冠状动脉痉挛及或血栓形成引起急性心肌梗死时显著不同,通过分析D-dimer水平变化有助于判断急性心肌梗死的形成原因,利于指导临床治疗。Objective： To assess the level of D-dimer during thrombolytic therapy in patients with acute myocardial infarction（AMI） and to understand its significance.Method： A total of 90 patients with AMI were randomly assigned to coronary artery stenosis reperfusion（group A,n=23）,or no obvious stenosis in coronary artery reperfusion（group B,n=25）,or no reperfusion（group C,n=24）,or nothrombolytic（group D,n=18） according to the evaluation of coronary angiography before or after thrombolytic therapy during 2001 to 2010.D-dimer was tested at 1,2,4,8,24,48 hours after treatment,as did myocardial enzyme,Troponin I,PT,APTT,TC,TG,LDL-C and glucose before treatment.All of patients did coronary angiography to assess the treatment effect.The thrombolytic patients treated with thrombolytic rt-PA and the no-thrombolytic patients treated with same volume 0.9% NaCl as control at same time.Result： The level of CK-MB and Troponin I was significantly higher than normal in all patients.The CK-MB peak was less than 13 hours after AMI in all reperfusion patients.And the serum D-dimer went up at 1.0 hour after thrombolytic treatment in group A and group B.But the D-dimer was significantly higher in group A than in group B（from 1 to 8 hours when thrombolytic treatment begin,p0.05~0.001）.However the peak of D-dimer occurred earlier in group B（at 2 hours） than in group A（at 4 hours）.Meanwhile the D-dimer level did not change obviously in no-thrombolytic treatment group（p0.05）.Conclusion： The D-dimer is really different in patients with AMI due to coronary artery spasm and / or thrombosis.This difference could help us to analyze the causes of AMI and to guide the clinical treatment.

关 键 词：急性心肌梗死 冠状动脉痉挛 血栓 D-二聚体 

分 类 号：R541.4[医药卫生—心血管疾病] R972[医药卫生—内科学]