摘要
目的:观察不同类型冠心病患者血浆纤溶活性水平的变化,并探讨其临床意义。方法:回顾性分析本院222例冠心病患者血浆组织型纤溶酶原激活物(t-PA)及纤溶酶原激活物抑制物-1(PAI-1)水平。患者分3组:①稳定型心绞痛(SA组)65例;②不稳定型心绞痛(UA组)42例;③急性心肌梗死(AMI组)115例。另选90例健康体检者为对照组。纤溶指标测定采用酶联免疫分析方法。结果:①血浆t-PA抗原浓度:AMI组t-PA浓度中位数(3.28ng/mL)分别显著高于对照组(2.29 ng/mL,P=0.000)、SA组(2.47 ng/mL,P=0.002)和UA组(2.57 ng/mL,P=0.006)。SA组、UA组、对照组之间两两比较差异无统计学意义(P均>0.1)。②血浆PAI-1活性水平:AMI组(38.06 U/mL)和UA组(55.61 U/mL)均显著高于对照组(24.63 U/mL)和SA组(30.33 U/mL),P均=0.000;UA组高于AMI组(P=0.048);SA组与对照组差异无统计学意义(P=0.433)。③血浆PAI-1/t-PA比值:UA组(21.47)显著高于对照组(9.07)、SA组(10.90)和AMI组(12.48),P均=0.000;AMI组明显高于对照组(P=0.001),但与SA组比较差异无统计学意义(P=0.091);SA组与对照组差异无统计学意义(P=0.338)。结论:PAI-1升高导致的纤溶活性下降是急性冠状动脉综合征(ACS)患者血栓形成的一个重要因素,测定血浆PAI-1和t-PA,并计算P/T比值,有助于判断患者纤溶功能状态、甄别ACS和不同类型冠心病。
Objective： To analyze the plasma levels of tissue plasminogen activator （t-PA） and plasminogen activator inhibitor-1 （PAI-1） in patients with coronary heart disease （CHD） and to assess its clinical implications. Methods： A total of 222 CHD patients were enrolled in this retrospective study. Among the study population, 65 patients were with stable angina （SA group）,42 with unstable angina （UA group）,and 115 with acute myocardial infarction （AMI group）. Ninety healthy subjects were assigned as control group. The plasma concentrations of t-PA and PAI-1 were measured by the use of enzyme-linked immunoabsorbent assay. Results （ 1 ） Levels of t-PA antigen： The median t-PA levels in AMI group（ 3.28 ng/mL）were markedly higher than control（2.29 ng/mL, P = 0. 000 ） , SA （2.47 ng/mL, P = 0.002 ） and UA （ 2.57 ng/mL, P = 0. 006 ） , with no statistically significant differences among the later three groups （P 〉0.1 ）. （2） Activity of PAI-1 ：The PAI-1 activity in AMI group（38.06 U/mL） and UA group （55.61 U/mL） were significantly higher than control（24.63 U/mL） and SA group （ 30.33 U/mL） （ all P = 0. 000）. Its level in UA group was higher than AMI group （ P = 0. 048 ） and there was no statistical difference between SA and control group（ P = 0. 433 ）. （3） PAI-1/t-PA ratio ：PAI-1/t-PA ratio was remarkably higher in UA group （21.47）than control （9.07）,SA （10.90） and AMI group （12.48）（ all P = 0. 000 ）. Compared with control group, patients with AMI had markedly increased PAI-1/t-PA ratio （P = 0. 001 ） , but no statistically significance was found when compared with that in SA group （ P = 0. 091 ）. Moreover, there was no statistically significance between SA group and control group（ P = 0. 338 ）. Conclusions ：The present study shows that the reduced fibrinolytic activitity due to elevated PAI-1 level is an important factor for thrombosis in ACS patients. The measurements of plasma PAI-1 and t-PA and the determination of PAI-1/t-PA ratio are helpful in judging fibrinolytic condition and discriminating ACS from stable CHD.
出处
《广州医学院学报》
2007年第3期24-27,共4页
Academic Journal of Guangzhou Medical College
基金
广州市医药卫生科技项目(2004年)
作者简介
杨阳（1979．7-）女，技师，学士。研究方向：动脉粥样硬化和冠心病。
通讯作者：Tel：020-81048161，E—mail：yilu063@yahoo．com．cn
