急性心肌梗塞患者溶栓前后血栓标志物和血小板活化状态研究

目的探讨急性心肌梗塞患者溶栓前后外周血中血栓标志物(D-二聚体D-D,血管性假血友病因子vWF)水平变化和血小板活化状态标志物血小板α颗粒膜糖蛋白CD62P及溶酶体膜糖蛋白CD63的阳性表达率与血管再通的关系。方法采用免疫比浊法和流式细胞术分别测定39例急性心肌梗塞患者溶栓前后和36例健康对照者外周血中D-D、vWF水平和CD62P及CD63的阳性表达率。结果急性心肌梗塞患者再通组和未通组溶栓前D-D、vWF水平和CD62P、CD63的阳性表达率均明显高于对照组(P<0.01),再通组和未通组溶栓前各项指标比较均无统计学意义(P>0.05)。再通组溶栓后D-D、vWF水平和CD62P、CD63的阳性表达率均明显低于溶栓前组(P<0.01),未通组溶栓后D-D水平明显低于溶栓前组,差异有统计学意义(P<0.05);而vWF水平和CD62P、CD63的阳性表达率却高于溶栓前组,后两者还有统计学意义(P<0.05)。结论血栓标志物D-D、vWF和CD62P、CD63表达水平在一定程度上可反映溶栓成功与否,其水平可作为临床判断溶栓后血管再通的辅助指标。

Investigation of the Markers of Thrombosis and the State of Platelet Activation Before and After Thrombolytic Therapy in Acute Myocardial Infarction

Objective To examine the changes of d-dimer(D-D) and von Willebrand factor(vWF),the markers of thrombosis in peripheral blood,as well as the expression of P-selectin(CD62P) and CD63,and the markers of platelet activation before and after thrombolytic therapy in acute myocardial infarction(AMI),along with their relationship to reperfusion of the coronary arteries.Method Levels of D-D and vWF were examined by scatter turbidimetry.The expression of CD62P and CD63 was evaluated by flow cytometry.Peripheral blood samples were taken from 39 patients of AMI(dividing into reperfusion group and un-reperfusion group) and 36 healthy donars(the control group).Result The levels of D-D and vWF as well as the expression of CD62P and CD63 in AMI patients before therapy showed no difference between the reperfusion group and the un-reperfusion group,but were significantly higher than those of the control group(P < 0.05).And after treatment,the data above of the reperfusion group were obviously lower than those before treatment(P < 0.05).But in the un-reperfusion group,only D-D level dropped significantly(P < 0.05),while the vWF level as well as the CD62P and CD63 expression were increased,with the latter two indicating statistical significance(P < 0.05).Conclusion All the four markers of thrombosis and the state of platelet activation,levels of D-D and vWF along with CD62P and CD63 expression,could reflect the effects of thrombolytic therapy to a certain extent,so as to provide assistance to clinical estimation of coronary reperfusion.