风湿性心脏病伴左房血栓患者围术期凝血-纤溶系统标志物水平的变化及临床意义  

Changes and clinical significance of perioperative coagulation-fibrinolysis system markers levels in patients with rheumatic heart disease and concomitant left atrial thrombus

作　　者：宋仁义 黄晖 孔勇 SONG Ren-yi;HUANG Hui;KONG Yong(Department of Cardiology,Guidong People′s Hospital of Guangxi Zhuang Autonomous Region,Wuzhou 543001,Guangxi,China)

机构地区：[1]广西壮族自治区桂东人民医院心内科,广西梧州市543001

出　　处：《广西医学》2022年第20期2342-2347,共6页Guangxi Medical Journal

基　　金：广西贺州市科学研究与技术开发计划项目(贺科攻1910009)。

摘　　要：目的分析风湿性心脏病(RHD)伴左房血栓患者围术期凝血-纤溶系统标志物水平的变化及临床意义。方法选取90例RHD伴左房血栓患者作为血栓组,90例无左房血栓的RHD患者作为无血栓组。血栓组患者接受心脏瓣膜置换术及左房血栓清除术,无血栓组患者只接受心脏瓣膜置换术。比较两组患者入院时左室收缩末期内径(LVESD)、左房内径、二尖瓣口面积(MVO),以及血浆凝血酶-抗凝血酶复合物(TAT)、凝血酶调节蛋白(TM)、纤溶酶-α_(2)-抗纤溶酶复合物(PAP)、组织型纤溶酶原激活剂-纤溶酶原激活物抑制剂-1复合物(t-PAI-C)水平。分析血栓组患者入院时、术毕、术后7 d血浆TAT、TM、PAP、t-PAI-C水平变化。术后随访2年,根据预后情况将血栓组患者分为预后不良组和预后良好组,比较两组术后7 d血浆TAT、TM、PAP、t-PAI-C水平。结果入院时,血栓组患者的LVESD、左房内径大于无血栓组,而MVO小于无血栓组,血浆TAT、TM、PAP及t-PAI-C水平均高于无血栓组(均P<0.05)。术毕,血栓组患者血浆TAT、TM、PAP及t-PAI-C水平高于入院时(均P<0.05);术后7 d,血栓组患者上述指标水平均较术毕时降低(均P<0.05)。随访期间血栓组有8例患者预后不良,术后7 d时,预后不良组患者的血浆TAT、TM、PAP水平均高于预后良好组(均P<0.05)。结论RHD伴左房血栓患者血浆TAT、TM、PAP及t-PAI-C水平均较无左房血栓的RHD患者高,且术后短时间内凝血-纤溶系统标志物仍处于高水平。RHD伴左房血栓患者的预后可能与术后凝血-纤溶系统状态有关。Objective To analyze the changes and clinical significance of perioperative coagulation-fibrinolysis system markers levels in patients with rheumatic heart disease(RHD)and concomitant left atrial thrombus.Methods A total of 90 patients with RHD and concomitant left atrial thrombus were selected as thrombus group,and 90 RHD patients without left atrial thrombus as non-thrombus group.The patients in the thrombus group received heart valve replacement and left atrial thrombectomy,while the patients in the non-thrombus group only received heart valve replacement.The left ventricular end-systolic dimension(LVESD),left atrial diameter,mitral valve orifice area(MVO),as well as plasma thrombin-antithrombin complex(TAT),thrombomodulin(TM),plasmin-α_(2)-antiplasmin complex(PAP),tissue plasminogen activator-plasminogen activator inhibitor-1 complex(t-PAI-C)levels at admission were compared between the two groups.The changes of plasma TAT,TM,PAP,and t-PAI-C levels of patients in the thrombus group at admission,the end of operation,and 7 days after operation were analyzed.The patients were followed up for 2 years after operation,and they were assigned to the adverse prognosis group or the favorable prognosis group according to prognostic conditions.The levels of plasma TAT,TM,PAP,and t-PAI-C 7 days after operation were compared between the two groups.Results At admission,the thrombus group yielded greater LVESD and left atrial diameter,whereas smaller MVO,and higher levels of plasma TAT,TM,PAP,and t-PAI-C as compared with the non-thrombus group(all P<0.05).At the end of operation,the levels of plasma TAT,TM,PAP,and t-PAI-C were higher than those at admission(all P<0.05).After 7 days of operation,the thrombus group exhibited decreased levels of aforementioned indices as compared with at the end of operation(all P<0.05).There were 8 cases with adverse prognosis in the thrombus group during follow-up.After 7 days of operation,the adverse prognosis group yielded higher levels of plasma TAT,TM,and PAP as compared with the favorab

关 键 词：风湿性心脏病 左房血栓 凝血-纤溶系统 凝血酶-抗凝血酶复合物 凝血酶调节蛋白 纤溶酶-α_(2)-抗纤溶酶复合物 组织型纤溶酶原激活剂-纤溶酶原激活物抑制剂-1复合物 

分 类 号：R541.2[医药卫生—心血管疾病]