急性冠脉综合征患者血浆纤维蛋白原、D-二聚体水平检测及氯吡格雷的干预研究

目的探讨急性冠脉综合征（ACS）患者血浆纤维蛋白原（Fib）、D-二聚体水平变化,及氯吡格雷的干预治疗作用。方法选择健康成人40例,冠心病患者125例,其中80例急性冠脉综合征（ACS）患者（急性心肌梗死（AMI）32例、不稳定型心绞痛（UA）48例）和稳定性心绞痛（SA）患者45例,ACS患者随机分成氯吡格雷组（40例）;常规治疗组（40例）,分别检测血浆Fib、D-二聚体水平变化。结果 UA、AMI、ACS组血浆Fib及D-二聚体水平明显高于SA组及正常对照组,差异有统计学意义（P〈0.01）;AMI组血浆Fib及D-二聚体水平明显高于UA组,差异有统计学意义（P〈0.05,P〈0.01）;氯吡格雷组和常规治疗组治疗后Fib及D-二聚体水平均显著下降（P〈0.05,P〈0.01）,且氯吡格雷组下降水平优于常规治疗组（P〈0.05）。结论血浆Fib及D-二聚体指标水平高低与ACS严重程度密切相关,氯吡格雷可以有效降低血浆Fib及D-二聚体指标水平,抑制血栓形成,稳定斑块。

Detection of Plasma Levels of Fibrinogen and D- dimer and Effect of Clopidogrel on Patients with Acute Coronary Syndrome

Objective To explore the changes of plasma fibrinogen and D-dimer levels and the role of clopidogrel in intervention treatment of patients with ACS.Methods Forty healthy adults and 125 patients with coronary heart disease(including 80 patients with ACS and 45 patients with SA) were enrolled in this study.The 80 ACS patients(including 32 patients with and AMI and 48 patients with UA) were randomly divided into clopidogrel group and routine treatment group(each n=40).The changes of plasma fibrinogen and D-dimer levels in all patients were determined.Results The levels of plasma fibrinogen and D-dimer in groups of UA,AMI and ACS were significantly higher than those in SA group and normal controls,and the difference was statistically significant among them(P<0.01).The levels of plasma fibrinogen and D-dimer in AMI group were significantly higher than those in UA group,and the difference was statistically significant(P<0.05,P<0.01).After the treatment,the levels of plasma fibrinogen and D-dimer decreased significantly in both clopidogrel group and routine treatment group(P<0.05,P<0.01),and moreover,the level in clopidogrel group was lower than that in routine treatment group(P<0.05).Conclusions The levels of plasma fibrinogen and D-dimer are closely related to the severity degree of ACS.Clopidogrel can effectively reduce the levels of plasma fibrinogen and D-dimer,inhibit the formation of thrombus and stabilize the plaques.