血小板激活及内皮损伤血液标志物对心房颤动血栓栓塞危险性的评价

目的:研究心房颤动(Af)患者是否存在血小板激活和内皮损伤,探讨其对评价Af血栓栓塞危险性的价值。方法:Af患者共89例,按是否接受了经食管超声心动图(TEE)检查分为两个亚组:①TEE检查亚组:35例,发现左心房和(或)左心耳有血栓者10例,有明确外周动脉血栓栓塞并发症者8例,无血栓者17例;②未检查亚组:54例。另选33例非Af者为对照组。用ELISA法测定两组的血浆可溶性P选择素(sP选择素)、血管性血友病因子(vWF)、D二聚体(DD)水平,用全自动生化分析仪测定平均血小板体积(MPV),对其结果进行对照分析。结果:Af患者血浆sP选择素、vWF、MPV、DD水平显著升高(P<0.05),其中血浆sP选择素、DD、MPV水平在血栓和无血栓者中差异有统计学意义(P<0.05)。且sP选择素与DD水平呈正相关(r=0.311,P<0.05)。结论:Af患者存在有血小板激活及内皮损伤,与其血栓形成及栓塞并发症有一定关系。

Values of platelet activity and endothelial dysfunction markers for estimating risk of thromboembolic complications in atrial fibrillation

Objective:To investigate platelet activation and endothelial damage in patients with atrial fibrillation, and the relation between platelet activation, endothelial damage and embolism complication. Method:Plasma soluble P-selectin ,D-D levels,von Willebrand factor and MPV were respectively determined in patients with AF and 33 with sinus rhythm by enzymelinked immunosorbent assay (ELISA) and automatic hematologic analyzer. Patients underwent the transesophageal echocardiography (TEE), and the thrombi were found in 10 patients. The thrombus group (n=18) included this 10 patients and other 8 patients who suffered from the complications of peripheral embolism. The non-thrombus group included 17 patients who had no thrombus in left atrium(LA)/left atrial appendage(LAA) according to the detection of TEE. Another 54 patients with AF without TEE detection and thromboembolism complication were the AF group. The non-AF group included 33 patients with sinus rhythm. Result: Compared with the normal sinus rhythm group, the plasma level of soluble P-selectin, vWF , D-dimer and MPV were significantly higher (P< 0.05) in patients with atrial fibrillation; and there were also significant differences between thrombus group and non-thrombus group of the soluble P-selectin,D-dimer and MPV(P< 0.05). Soluble P-selectin was positive correlated with D-dimer(r=0.311,P< 0.05). Conclusion:Patients with atrial fibrillation show evidence of platelet activation and endothelial damage, which may correlate with the atrial thrombus and embolism complication.