血栓前状态标志物的变化在心绞痛及心肌梗死的预警价值  

Early warning value of changes in prethrombotic status markers in angina pectoris and myocardial infarction

作　　者：蔡景润 李高波[1] 冯伯仑 CAI Jing-run;LI Gao-bo;FENG Bo-lun(Department of Emergency,Yuebei People’s Hospital,Shaoguan 512026,China)

机构地区：[1]粤北人民医院急诊科,广东韶关512026

出　　处：《中国处方药》2023年第9期10-13,共4页Journal of China Prescription Drug

基　　金：韶关市卫生健康科研项目(Y20165)。

摘　　要：目的探讨血栓前状态标志物对冠心病(CHD)心绞痛和急性心肌梗死的预警价值。方法选取2020年4月~2021年4月收治的236例冠心病患者,依据类型不同分为SAP组(稳定型心绞痛,88例)、UAP组(不稳定型心绞痛,72例)、AMI组(急性心肌梗死,76例)、另选取同期住院的60例无器质性心脏病患者为对照组。于入院次日清晨采集各组空腹肘静脉血样5 ml,测定血管性血友病因子抗原(vWF)、抗凝血酶Ⅲ(AT-Ⅲ)、血浆纤维蛋白原(Fg)、血小板α-颗粒膜蛋白-140(GMP-140)、血栓前体蛋白(TpP)、D-二聚体(D-dimer)、组织型纤溶酶原激活剂(t-PA)与纤溶酶原激活抑制物-1(PAI-1)水平。观察各组指标差异及SAP组、UAP组、AMI组不同心功能患者的指标差异。结果SAP组、UAP组、AMI组血浆vWF、Fg、GMP-140、TpP与D-dimer水平均高于对照组且呈递增趋势,AT-Ⅲ水平均低于对照组且呈递减趋势,多组间比较及组间两两比较差异均有统计学意义(P<0.05)。SAP组、UAP组与AMI组心功能NYHAⅢ~Ⅳ级患者血AT-Ⅲ水平低于心功能NYHAⅠ~Ⅱ级患者,vWF、Fg、GMP-140、TpP、D-dimer、t-PA与PAI-1均高于心功能NYHAⅠ~Ⅱ级患者,差异有统计学意义(P<0.05)。结论冠心病心绞痛和心肌梗死患者均有不同程度血栓形成倾向,血栓前状态标志物检测对冠心病心绞痛和心肌梗死的诊治具有一定临床价值,可以反映患者病情严重程度,可为预警血栓形成提供可靠生化指标依据。Objective To investigate the early warning value of prethrombotic status markers for angina pectoris and acute myocardial infarction in coronary heart disease(CHD).Methods From April 2020 to April 2021,236 patients with coronary heart disease admitted to our hospital were selected and divided into SAP group(stable angina,88 patients),UAP group(unstable angina,72 patients),AMI group(acute myocardial infarction,76 patients)and 60 patients without organic heart disease who were hospitalized at the same time as the control group according to their types.5 ml fasting elbow venous blood samples were collected from each group in the early morning of the next day of admission,and vascular hemophilia factor antigen(vWF),antithrombin Ⅲ(AT-Ⅲ),plasma fibrinogen(Fg),plasma plateletα-granule membrane protein-140(GMP-140),thrombospondin(TpP),D-dimer,tissue-type fibrinogen activator(t-PA)and fibrinogen activation inhibitor-1(PAI-1)levels.The differences in the indexes of each group and the differences in the indexes of patients with different cardiac functions in the SAP,UAP and AMI groups were observed.Results The plasma vWF,Fg,GMP-140,TpP and D-dimer levels in the SAP,UAP and AMI groups were higher than those in the control group and showed an increasing trend,while AT-Ⅲlevels were lower than those in the control group and showed a decreasing trend,the differences were statistically significant(P<0.05).AT-Ⅲlevel of three groups of cardiac function NYHA classⅢ~Ⅳpatients were lower than patients with cardiac function NYHAⅠ~Ⅱgrade.vWF,Fg,GMP-140,the TpP,D-dimer,t-PA and PAI 1 levels of patients with cardiac function NYHA classⅢ~Ⅳwere higher than cardiac function NYHA classⅠ~Ⅱpatients,the differences were statistically significant(P<0.05).Conclusion Patients with coronary angina and myocardial infarction have different degrees of thrombosis or tendency,and the detection of pre-thrombotic status markers has certain clinical value for the diagnosis and treatment of coronary angina and myocardial infarction,w

关 键 词：冠心病心绞痛 急性心肌梗死 血栓前状态标志物 预警价值 

分 类 号：R542.22[医药卫生—心血管疾病] R541.4[医药卫生—内科学]