急性心肌梗死中微粒的促凝特性研究  

Study on the procoagulant characteristics of microparticles in acute myocardial infarction

作　　者：徐斌[1] 孟奭帅[2] Xu Bin;Meng Shishuai(The Second Department of Cardiology,Harbin First Hospital,Harbin 150001,Heilongjiang,China;Department of Critical Care Medicine,the First Affiliated Hospital of Harbin Medical University,Harbin 150001,Heilongjiang,China)

机构地区：[1]哈尔滨市第一医院心内二科,黑龙江哈尔滨150001 [2]哈尔滨医科大学第一附属医院重症医学科,黑龙江哈尔滨150001

出　　处：《中华危重病急救医学》2024年第7期723-727,共5页Chinese Critical Care Medicine

基　　金：黑龙江省卫生健康委科研项目(20230303010362)。

摘　　要：目的探讨急性心肌梗死(AMI)患者循环微粒特点及其发挥促凝作用的可能机制。方法采用前瞻性病例对照研究方法,选择2023年6月至11月哈尔滨市第一医院心内二科收治的冠心病患者作为研究对象,根据患者是否发生AMI分组。入组当天计算患者弥散性血管内凝血(DIC)评分;同时收集患者空腹静脉血,检测D-二聚体、纤维蛋白降解产物(FDP)水平及主要凝血因子活性;采用微粒捕获法测定循环微粒水平;通过组织因子(TF)依赖的凝血因子FⅩa生成实验检测携带组织因子的微粒(TF^(+)MP)水平。采用Spearman相关法分析各项指标之间的相关性。结果最终共纳入52例冠心病患者,AMI组和非AMI组各26例。两组患者性别、年龄、体质量指数(BMI)、基础疾病、吸烟史及入院前治疗情况差异均无统计学意义,说明两组基线资料均衡,具有可比性。与非AMI组比较,AMI组患者DIC评分及D-二聚体、FDP水平均明显升高〔DIC评分(分):3(3,4)比3(2,3),D-二聚体(mg/L):8.80(6.84,15.66)比2.13(1.64,3.86),FDP(mg/L):30.13(19.30,52.54)比20.00(13.51,28.37),均P<0.01〕,说明AMI患者凝血活化程度更严重;AMI组患者凝血途径主要凝血因子消耗较非AMI组更多〔FⅡ:59.45%(49.65%,71.25%)比63.65%(49.98%,73.22%),FⅤ:96.95%(73.50%,112.78%)比105.05%(73.48%,131.48%),FⅦ:42.30%(36.98%,51.98%)比53.40%(46.58%,69.88%),FⅩ:60.90%(48.22%,80.82%)比73.50%(56.80%,85.98%),FⅪ:82.45%(62.90%,99.10%)比92.40%(73.90%,114.25%),FⅫ:29.90%(12.42%,42.38%)比34.65%(16.32%,48.20%),均P<0.05〕。AMI组循环中TF^(+)MP水平明显高于非AMI组〔nmol/L:0.13(0.06,0.20)比0.08(0.04,0.15),P<0.05〕;而AMI组与非AMI组循环微粒水平差异无统计学意义〔nmol/L:1.24(0.71,3.77)比1.35(0.73,2.14),P>0.05〕。相关性分析显示,冠心病患者循环中TF^(+)MP水平与凝血指标DIC评分(r=0.307,P=0.027)、D-二聚体(r=0.696,P<0.001)、FDP(r=0.582,P<0.001)均呈较强的正相关性,与凝血级联外源性途径凝血因�Objective To investigate the characteristic of circulating microparticle in patients with acute myocardial infarction(AMI)and its possible mechanism of promoting coagulation.Methods A prospective case-control study was conducted.The patients with coronary heart disease admitted to the second department of cardiology in Harbin First Hospital from June to November 2023 were enrolled,and they were grouped according to whether the patients occurred AMI or not.On the day of admission,disseminated intravascular coagulation(DIC)score was calculated.At the same time,fasting venous blood was collected,and the levels of D-dimer,fibrin degradation product(FDP)and the activities of major coagulation factors were detected.The level of circulating microparticle was determined by microparticle trapping method.The microparticle carrying tissue factor(TF^(+)MP)level was detected by tissue factor(TF)dependent FⅩa production assay.Spearman correlation method was used to analyze the correlation among the indicators.Results A total of 52 patients with coronary heart disease were enrolled,including 26 patients in AMI group and 26 patients in non-AMI group.There was no significant difference in gender,age,body mass index(BMI),underlying diseases,smoking history,and pre-admission treatment of patients between the two groups,indicating that the baseline data of the two groups were balanced and comparable.Compared with the non-AMI group,the DIC score and D-dimer,FDP levels in the AMI group were significantly increased[DIC score:3(3,4)vs.3(2,3),D-dimer(mg/L):8.80(6.84,15.66)vs.2.13(1.64,3.86),FDP(mg/L):30.13(19.30,52.54)vs.20.00(13.51,28.37),all P<0.01],indicating that the degree of coagulation activation in AMI patients was more severe.The consumption of major coagulation factors in the coagulation pathway in the AMI group was heavier than that in the non-AMI group[FⅡ:59.45%(49.65%,71.25%)vs.63.65%(49.98%,73.22%),FⅤ:96.95%(73.50%,112.78%)vs.105.05%(73.48%,131.48%),FⅦ:42.30%(36.98%,51.98%)vs.53.40%(46.58%,69.88%),FⅩ:60.90%(48.22%

关 键 词：携带组织因子的微粒 微粒 急性心肌梗死 凝血紊乱 

分 类 号：R542.22[医药卫生—心血管疾病]