老年原发性微血管心绞痛患者凝血活性的改变及其临床意义  

Changes in coagulation activity and its clinical significance in elderly patients with primary microvascular angina pectoris

作　　者：黄琪[1] 隋向前[1] 骆荣华[1] 王士生[1] 姚强[1] 吴源鸿 谢明斌[1] Huang Qi;Sui Xiangqian;Luo Ronghua;Wang Shisheng;Yao Qiang;Wu Yuanhong;Xie Mingbin(Department of Cardiology,Hangzhou Red Cross Hospital,Hangzhou 310003,China)

机构地区：[1]杭州市红十字会医院心血管内科,310003

出　　处：《中华老年医学杂志》2021年第5期566-569,共4页Chinese Journal of Geriatrics

基　　金：浙江省医药卫生科技计划项目(2019312009,2020366772);浙江省中医药科技计划项目(2020ZA083)。

摘　　要：目的测定老年原发性微血管心绞痛患者血浆纤维蛋白肽A(FPA)和血浆血小板膜糖蛋白140(GMP-140)水平,分析微血管心绞痛患者凝血活性的改变。方法前瞻性观察性病例对照研究,选择2019年1月至2020年12月杭州市红十字会医院心血管内科住院患者,经临床症状、心电图、动态心电图、冠状动脉造影检查明确诊断为微血管心绞痛的老年患者45例(微血管心绞痛组),年龄60~80岁,男性27例,女性18例;选择年龄、性别匹配的体检老年人43例为对照组。测定其血浆FPA和GMP-140及超敏C反应蛋白水平;同时测定其收缩压和舒张压,检测血小板、空腹血糖、三酰甘油、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、肾功能、尿酸、肝功能及超敏C反应蛋白等指标。结果微血管心绞痛组患者与对照组FPA(430.32±364.05)μg/L比(263.73±118.29)μg/L,较对照组升高(t=2.913,P<0.01);GMP-140(5.78±3.92)μg/L比(6.95±1.91)μg/L,两组比较差异无统计学意义(t=-1.790,P>0.05);超敏C反应蛋白水平(3.33±5.70)mg/L比(0.81±0.86)mg/L,较对照组升高(t=2.927,P<0.01)。结论微血管心绞痛患者较对照人群FPA水平升高,微血管心绞痛患者体内凝血活性增强。炎症状态可能促进微血管心绞痛发生、发展,但是否与炎症状态促进凝血活性增强有关还需进一步的研究证实。Objective To investigate plasma levels of fibrinopeptide A(FPA)and platelet alpha-granule membrane glycoprotein 140(GMP-140),and to analyze the changes of coagulation activity in elderly patients with primary microvascular angina(PMVA).Methods In this prospective case-control study,a total of 45 elderly patients(aged 60-80 years,27 males and 18 females)admitted to our hospital from Jan.2019 to Dec.2020 were diagnosed as PMVA(as microvascular angina group)by clinical symptoms,electrocardiogram,dynamic electrocardiogram and coronary angiography.Forty-three age-and sex-matched elderly subjects who took a medical check-up and had no primary microvascular angina were included as the control group.Plasma levels of FPA,GMP-140 and high-sensitivity C-reactive protein were determined.The levels of systolic blood pressure,diastolic blood pressure,platelet,fasting blood glucose,triglyceride,total cholesterol,high-density lipoprotein and low-density lipoprotein,uric acid,renal function and liver function were detected.Results The FPA level was higher in the PMVA group than in the control group[(430.32±364.05)μg/L vs.(263.73±118.29)μg/L,t=2.913,P<0.01].There was no difference in GMP-140 level between the PMVA group and the control group[(5.78±3.92)μg/L vs.(6.95±1.91)μg/L,t=-1.790,P>0.05].The high-sensitivity C-reactive protein level was higher in the PMVA group than in the control group[(3.33±5.70)mg/L vs.(0.81±0.86)mg/L,t=2.927,P<0.01].Conclusions Compared with the control group,the FPA level is significantly increased with elevated coagulation activity in patients with primary microvascular angina.The increased inflammatory state in the PMVA group might promote the occurrence and development of microvascular angina,but whether the inflammatory state promotes the enhancement of coagulation activity needs further study to confirm.

关 键 词：微血管 心绞痛 纤维蛋白肽A 血小板膜糖蛋白类 

分 类 号：R541.4[医药卫生—心血管疾病]