择期PCI术中静脉应用依诺肝素与普通肝素的比较研究

目的探讨在择期经皮冠状动脉介入(PCI)治疗中静脉应用伊诺肝素的有效性和安全性以及与普通肝素对比的疗效差别。方法将根据入选标准和排除标准选择的患者随机分为2组,对照组42例给予125U/kg的普通肝素;试验组32例给予1mg/kg的伊诺肝素。分别测定活化凝血时间(ACT)或抗Xa因子活性并定义有效达标范围,术后随访观察30d主、次要终点结果。结果对照组在各时段(5,60,120,240min)的ACT分别为(371±39)s,(332±34)s,(258±39)s,(175±24)s,术中有效抗凝达标率为17例(40.5%),其中未达标的25例(59.5%)患者中的24例为抗凝过度(57.1%),其ACT平均为(401±27)s,仅1例患者为ACT均低于300s。试验组伊诺肝素静推5min后,抗Xa因子活性为(0.91±0.27)IU/ml,术后为(0.73±0.22)IU/ml,术中有效抗凝达标率为29例(90.6%)。试验组与对照组相比有效抗凝达标率高(P<0.01)。结论于择期PCI术中静脉应用1mg/kg剂量的伊诺肝素作为抗凝药物是安全有效的,术中不需要监测抗Xa因子活性。在择期PCI术中应用125U/kg剂量的普通肝素存在抗凝过度的情况,但未发现其出血倾向的增加,适当提高普通肝素抗凝强度的用量及范围,则其应用安全有效,术中不需要监测ACT来调整其用量。     

低相对分子质量肝素抗凝时高岭土-血栓弹力图R时间目标值研究

目的 探讨低相对分子质量肝素（low molecular weight heparin,LMWH）抗凝时,高岭土-血栓弹力图R时间目标值.方法 测定不同浓度LMWH抗凝时血液aPTT和R时间,检测94例（131例次）LMWH抗凝患者的高岭土-血栓弹力图R时间和肝素酶-血栓弹力图△R％,比较R时间和△R％判断抗凝效果是否一致.结果 aPTT和R时间均与LMWH浓度（在0～2.0抗Xa u/ml范围）呈正直线相关（P＜0.01）.aPTT为正常值2倍时,LMWH浓度为0.55 ～1.32抗Xa u/ml.抗Xa活性在此范围内的R时间为10.2～16.8 min.131例次LMWH抗凝患者R时间为8.14±5.97min,肝素酶-血栓弹力图△R％为9.06 ±25.26％;R时间和肝素酶△R％判断LMWH抗凝效果符合率为87.8％,两种方法判断效果基本一致（Kappa=0.61,P＜0.001）.结论 LMWH治疗血栓性疾病时,高岭土-血栓弹力图R时间目标值为10.2～ 16.8 min（正常值5～ 10 min）.     

国产与进口低分子肝素在血液透析中抗凝作用的比较

目的比较国产与进口低分子肝素在血液透析中的抗凝效果和安全性。方法60例血液透析病人随机分为2组,透析过程中分别注射单剂量国产和进口低分子肝素。透析时取血检测部分凝血活酶时间(aPTT)、凝血酶原时间(PT)、凝血酶时间(TT)及因子Xa活性;透析结束后观察透析器及管道凝血情况、动脉穿刺点压迫止血时间。结果两组病人体外循环凝血发生率低且无显著差异,患者均无出血倾向。两组患者在动脉穿刺点压迫止血时间、血浆因子Xa水平及aPTT、TT、PT的变化等方面均无显著差异(P>0.05)。结论国产与进口低分子肝素在血液透析中的抗凝效果及安全性基本相同,国产低分子肝素可替代进口低分子肝素。     

应用Sonoclot体外监测低分子肝素及磺达肝癸钠的抗凝作用

目的:探讨Sonoclot凝血仪在分析监测凝血与血小板功能的临床价值。方法:在gb试剂杯加入不同浓度的低分子肝素钠(0～1.6 IU/mL抗Xa因子)、低分子肝素钙(0～1.64 IU/mL抗Xa因子)、磺达肝癸钠(0～1.52μg/mL),抽取10例健康志愿者血样,并加入有药物的试剂杯中,用Sonoclot凝血仪进行检测,检测指标分别包括激活凝血时间(ACT)、凝血速率(CR)和血小板功能(PF)。结果:(1)3种抗凝药物随着浓度的增加,其ACT值逐渐增加,CR值逐渐下降,PF值逐渐下降。(2)对于同一治疗量的3种抗凝药物,低分子肝素钠(1.2 IU/mL抗Xa因子)与低分子肝素钙(1.23 IU/mL抗Xa因子),其ACT、CR、PF 3个参数的比较,P>0.05,无统计学差异。磺达肝癸钠(0.77μg/mL)与低分子肝素钠(1.2 IU/mL抗Xa因子)和低分子肝素钙(1.23 IU/mL抗Xa因子)相比,其ACT、CR、PF 3个参数均有差异性,均P<0.01。结论:Sonoclot凝血仪可以快速检测低分子肝素及磺达肝癸钠的抗凝效果以及对于血小板功能的影响,可以对临床给药剂量和个体化治疗做出指导。     

依诺肝素对冠状动脉介入治疗的患者抗Xa因子活性及不良事件的影响

目的 探讨依诺肝素对行经皮冠状动脉介入治疗(PCI)的患者抗Xa因子活性及术后出血事件和缺血事件的影响.方法 选取2015年6月至2016年10月该院心内科住院的186例行PCI的患者,分为对照组(普通肝素组)94例和观察组(依诺肝素组)93例.监测患者抗Xa因子活性,观察术后48 h发生的出血和缺血事件,30 d随访患者的临床结局.结果 应用依诺肝素5 min,所有患者抗Xa因子活性均可迅速达到0.5IU/mL以上,而在150 min时,抗Xa因子活性出现下降,仅有91.3％患者达标,180 min时抗Xa因子活性仅有79.2％患者达标.两组患者术后48 h内出血事件差异有统计学意义(x2＝4.015,P=0.041),观察组出血事件少于对照组;而缺血事件和临床结局差异均无统计学意义(x2 =0.803、0.327,P=0.749、0.316).结论 PCI术中应用依诺肝素安全有效,不仅能够迅速起到有效的抗凝作用,且不增加缺血事件的发生还能降低围术期的出血事件.     

心脏黏液瘤手术肝素抗凝效果回顾分析

目的 临床研究显示心脏黏液瘤患者肝素相对耐药,回顾性分析心脏黏液瘤手术肝素用量及肝素抗凝不足的对策,并对相关问题进行讨论,以期指导临床抗凝方法.方法 在静脉复合气管内插管全麻和体外循环(CPB)下共实施心脏粘液瘤手术75例.CPB均采用中度低温、中度血液稀释法.首次肝素化经中心静脉(CVP)推注肝素400u/kg,5min后测激活全血凝固时间(ACT)＞480s转机.结果 75例心脏黏液瘤手术,有10例发生肝素抗凝不足,肝素化后ACT,＜480s,占24%,其中12例补充肝素后ACT＞480s,另外6例补充肝素后ACT仍＜480s,给予静脉输注新鲜冰冻血浆后ACT达480s以上.另有3例CPB中ACT很快缩短,再补充肝素后ACT＞480s.18例肝素抗凝不足患者肝素平均用量为(640 210)u/kg.结论 心黏液瘤手术患者中应高度警惕肝素抗凝不足的情况发生.若肝素用量＞500u/kg,CPB前须输入新鲜冰冻血浆,同时再追加肝素.对此类患者手术检测ACT时间点应相对密集.     

低分子量肝素的监测——抗Xa测定方法

众所周知,普通肝素主要抑制止Ⅱa,而低分子量肝素(LMWH)主要抑制Xa故普通肝素用于临床时,实验室监测常用APTT或ACT;而低分子肝素的实验室监测需采取抗Xa的测定。当肾功能受损时,正常肝素与LMWH的半存期均增加,且年老的病人倾向于蓄积肝素。故应监测其抗凝作用。 抗Xa测定方法主要有两种:凝固法和二氨酚显影法。两种方法的原理是相同的:用一定量的牛的因子Xa,加入人的含有肝素或LMWH的血浆,     

抗Xa因子在日间CRRT低分子肝素抗凝监测中的临床应用

目的 探讨抗Xa因子在日间连续性肾脏替代治疗(CRRT)低分子肝素抗凝监测中的临床应用.方法 选择危重症慢性肾脏病5期进行日间CRRT治疗的患者62例,治疗过程中应用低分子肝素抗凝,分为抗凝未达标组、抗凝达标组和抗凝超标组.测定血红蛋白、血小板、抗凝血酶Ⅲ、基础血肌酐值、基础APTT值,对治疗1h抗Xa因子值、治疗1h以及结束时APTT及肌酐下降率进行监测.结果 抗Xa因子三组间比较,差异均有统计学意义,P＜0.05.抗凝达标组抗Xa因子为(0.62±0.37) IU/mL.1 hAPTT抗凝未达标组与超标组比较,差异有统计学意义,P＜0.05;肌酐下降率抗凝未达标组与其他两组比较,差异均有统计学意义,P＜0.05.结论 抗Xa因子为(0.62±0.37) IU/mL时提示治疗安全、有效;抗Xa因子与APTr相比较,抗Xa因子对临床出血事件、血栓形成提示更有效.     

血栓弹力图评价急性心肌梗死患者主动脉内球囊反搏术后凝血状态的临床应用

目的 通过凝血功能、血栓弹力图（TEG）、活化凝血时间（ACT）、抗Xa因子活性检测急性心肌梗死（AMI）患者使用主动脉内球囊反搏（IABP）后的凝血状态,评估肝素残余情况、出血及血栓风险,寻找能更好地评估凝血状态的方法。方法 选取2017年2月—11月湖南省人民医院因AMI需行急诊经皮冠状动脉介入术（PCI）并IABP的患者。比较手术前后血常规及凝血功能的差异性;收集并分析术后血小板（PLT）与血栓弹力图枸橼酸化高岭土激活样品肝素酶杯（CKH-TEG）的相关性;CKH-TEG的R差值（△R）与活化凝血时间（ACT）、抗Xa因子活性的相关性;以抗Xa因子活性为低分子肝素浓度标准绘制△R和ACT的诊断价值综合评估的受试者工作特征（ROC）曲线。结果 CKH-TEG参数中PLT与MA、凝固角呈正相关（r?=0.571和0.681,均P?<0.05）,与K呈负相关（r?=-0.783,P?<0.05）;△R与抗Xa因子活性呈正相关（r?=0.421,P?<0.05）;ACT与抗Xa因子活性无关（r?=0.214,P?>0.05）;ROC曲线分析结果显示,△R的曲线下面积（AUC）为0.814（95% CI：0.732,0.903）,当△R截断值为-0.211时具有最优的诊断价值,敏感性为0.885（95% CI：0.801,0.952）,特异性为0.892（95% CI：0.815,0.957）;ACT的AUC为0.556（95% CI：0.474,0.638）,当ACT截断值为172.99?s时具有最优的诊断价值,敏感性为0.612（95% CI：0.538,0.719）,特异性为0.584（95% CI：0.507,0.673）。△R在评估肝素残留的AUC值大于ACT。结论 IABP术后使用TEG较常规凝血功能凝血状态评估更优,较ACT能更好地评估低分子肝素残余量,对指导肝素类抗凝药物的使用具有临床意义。     

冠脉介入术中选择不同剂量达肝素抗凝的安全性和有效性临床研究

目的评价达肝素在冠脉支架植入术中抗凝的安全性和有效性。方法拟入选300例择期冠脉造影手术后行支架置入术患者,随机分UFH组、达肝素60IU组和达肝素80IU组三个组。收集患者入院时以及冠脉支架置入术后30 d临床资料。达肝素组患者抗凝药注入前、抗凝药注入后5 min、15 min、30 min、1 h、2 h、3 h、4 h监测抗Xa因子活性。结果前50例入组患者中,29例患者随机分到低分子肝素组,其中13例60IU/KG达肝素组入选患者中,3例患者出现术中冠脉内血栓,发生率为23.08%,实验终止,重新设计实验。结论冠脉介入术中60IU/KG剂量的达肝素存在抗凝不足的问题,特别是在复杂冠脉病变的冠脉介入术中。     

新型促凝试剂检测低分子肝素抗凝活性体外研究

目的 探讨活化凝血时间(ACT)新型促凝试剂检测低分子肝素(LMWH)的灵敏性.方法 2009年10月至2010年1月招募30例健康志愿者,抽取血标本依次加入不同剂量LMWH(达肝素钠),最终血标本达肝素钠浓度范围为0.1~1.8 U/ml,分别应用新型促凝剂磁棒与传统促凝剂高岭土测定ACT、纤维蛋白凝结速率(CR)值,对不同达肝素钠浓度与相应的ACT、CR值进行相关性分析并求得回归方程.结果 随达肝素钠浓度增加,用2种促凝剂分别测得的ACT值均逐渐延长而CR值逐渐减小,2种促凝剂的ACT值均与达肝素钠浓度成直线相关关系(P<0.01),CR值均与达肝素钠浓度呈指数相关关系(P<0.01).分析ACT值与达肝素钠浓度的直线回归方程发现,磁棒的直线斜率明显高于高岭土(1097.6 s/U比59.3 s/U,P<0.01).结论新型促凝试剂磁棒对达肝素钠抗凝活性灵敏性较高,有可能用于临床LMWH抗凝活性的床旁检测.

Abstract：

Objective To explore the sensitivity of new activated clotting time (ACT) reagent for laboratory monitoring of low molecular weight heparin (LMWH).Methods Blood samples were collected from 30 healthy volunteers and different doses of LMWH (dalteparin) added. The dalteparin concentration of final blood samples was 0.1-1.8 U/ml. ACT and clot rate (CR) were measured with traditional reagent kaolin and new reagent magbar. Linear regression analysis was performed and a regression equation established between different dalteparin concentrations and their corresponding ACT and CR values.ResultsWith rising dalteparin concentrations, the ACT values became gradually extended and the CR values were gradually reduced by both kaolin and magbar. Analysis of dose-response curves was obtained in vitro. And an excellent linear relationship was observed between the ACT and dalteparin concentrations for two reagents (P<0.01). An exponential relationship was observed between the CR and dalteparin concentrations (P<0.01). Differences in slope of regression curves of ACT were observed with the tested reagents (magbar 1097.6 s/U vs kaolin 59.3 s/U, P<0.01).Conclusion This in vitro study has shown that the sensitivity of new ACT test reagent (magbar) is good for laboratory monitoring of dalteparin. The new reagent magbar may be used for bedside monitoring of anticoagulant activity of LMWH.     

替罗非班对冠脉综合征患者经皮冠状动脉介入治疗后凝血功能的调控作用

目的研究替罗非班术后辅助干预对冠脉综合征患者经皮冠状动脉介入术(PCI)治疗后凝血功能的调控作用。方法选取我院2010年12月至2013年12月冠脉综合征患者98例,随机分为观察组与对照组两组,每组49例。观察组患者在PCI术后给予替罗非班辅助干预,对照组患者在PCI术后不给予辅助干预。比较两组患者手术前后血小板聚集率(PAg T)、活化凝血时间(ACT)、抗凝血酶(AT)、可溶性CD40配体(s CD40L)、基质金属蛋白酶-9(MMP-9)、高敏C反应蛋白(hs-CRP)等因子变化情况,比较两组患者术后部分凝血酶原时间(a PTT)、凝血酶原时间(PT)和凝血酶时间(TT)等凝血指标水平。结果观察组患者PAg T水平较对照组显著较低(P0.05),ACT和血浆AT水平较对照组显著较高(P0.05);观察组患者的s CD40L、Hs-CRP、MMP-9等血清炎性因子水平较对照组显著较低(P0.05);观察组患者术后a PTT、PT、TT等凝血指标较对照组无差异(P0.05)。结论冠脉综合征患者PCI介入治疗后给予替罗非班干预能抑制血小板聚集,有加强抗血小板的作用,患者血清中炎性因子水平降低,血管内皮功能得到改善。     

肝素介导的老年冠心病患者肝细胞生长因子的释放

目的:旨在研究普通肝素、低分子肝素对老年冠心病患者血浆肝细胞生长因子(hepatocyte growth factor,HGF)的作用.方法:54名老年冠心病患者随机分成3组:静脉普通肝素组、皮下普通肝素组、皮下低分子肝素组,3组用药前、后不同时间分别测定血浆HGF及血管内皮细胞生长因子(vascular endothelial growth factor,VEGF)的浓度.结果:静脉应用普通肝素后,可引起血浆HGF快速、明显的升高,用药10 min后达高峰,约为用药前的48倍;皮下应用肝素后,亦可引起血浆HGF快速、明显的升高,用药2～3 h达高峰,与用药前相比分别为:普通肝素组约为4倍,低分子肝素组约为5倍.结论:肝素应用可引起血浆HGF明显升高,这证实了肝素抗凝作用以外的生物学作用,通过HGF的升高,对心血管疾病的修复有积极意义.     

肝素抗凝治疗急性冠脉综合征的对比研究

目的观察不同抗凝方案治疗急性冠状动脉综合征（ACS）的疗效和安全性。方法入选对象为不稳定性心绞痛或非Q波心肌梗死患者，入选前48h以内至少有一次心绞痛发作，ST段无抬高。将120例入选病例随机分为静脉滴注普通肝素（UH）组和皮下注射低相对分子质量肝素（LMWH）组，UH组以UH240u／kg·d^-1分两次静脉滴注，连续10d，维持aPTT于60-85s或ACT于250-300s（正常值1．5-2．5倍）。LMWH组予LMWH5000μ，每日两次，皮下注射，连续10d。观察终点：随访治疗30d内发生急性心肌梗死、心脏性或非心脏性死亡和药物治疗无法控制的心绞痛需血运重建例数。住院治疗至少10d，随访至治疗后30d。结果两组用药期间平均胸痛发作次数差异无显著性，但肝素组有更多的患者需口服硝酸甘油缓解胸痛；死亡率、复合终点事件（死亡、心肌梗死和药物治疗无法控制的心绞痛）在LMWH组明显下降。LMWH组出血事件明显少于UH组。结论LMWH皮下注射与连续静脉滴注UH疗效相似，LMWH可明显减少急性冠状动脉综合征30d后死亡和复合心脏事件的发生，发生出血事件较少，应用更为方便安全。     

经皮冠状动脉介入围术期出血和缺血事件的相关因素分析

目的观察并分析经皮冠状动脉介入术（PCI）围术期应用欣维宁治疗出血及缺血事件的相关因素,探讨围术期理想的抗栓治疗方案。方法131例急性冠状动脉综合征患者PCI术前均给予阿司匹林、波立维、低分子肝素治疗,术前至少6h开始泵入欣维宁,术中给予普通肝素抗凝,手术结束即刻检测活化凝血时间（ACT）。观察患者住院期间出血及缺血事件并对其进行分析。结果131例患者中有39例心肌梗死溶栓试验（TIMI）出现不明显出血（29．8％）,无大出血及少量出血;10例患者发生缺血事件（7．6％）。出血事件与欣维宁输注速度和ACT水平均明显相关（OR=2．854,1．271—6．406,P=0．011;OR=3．069,1．356—6．949,P=0．007）,而与缺血无关（P〉0．05）;高的欣维宁输注速度[i〉0．18ml／（kg·h）]出血发生率高（P：0．008）,ACT≥350s出血发生率明显增高（P=0．005）。结论在PCI围术期进行多重抗栓治疗时,出血事件与欣维宁输注速度和ACT水平有明显的关系,可根据ACT水平及欣维宁输注速度调整用药方案。     

A randomized comparative study of using enoxaparin instead of unfractionated heparin in the intervention treatment of coronary heart disease

Several international multicenter studies have demonstrated that low molecular weight heparin (LMWH) was more effective than unfractionated heparin (UFH) in treating acute coronary syndrome (ACS).1-4 However, it remains uncertain whether LMWH can be used in patients undergoing percutaneous coronary intervention (PCI) instead of UFH. In an expert consensus on the use of LMWH in the catheter laboratory published in 2002,5 there were two recommendations which limited the use of LMWH in…     

Comparison of tirofiban combined with dalteparin or unfractionated heparin in primary percutaneous coronary intervention of acute ST-segment elevation myocardial infarction patients

Background  Primary percutaneous coronary intervention (PCI) is the best treatment of choice for acute ST segment elevation myocardial infarction (STEMI). This study aimed to determine the clinical outcomes of tirofiban combined with the low molecular weight heparin (LMWH), dalteparin, in primary PCI patients with acute STEMI.

Methods  From February 2006 to July 2006, a total of 120 patients with STEMI treated with primary PCI were randomised to 2 groups: unfractionated heparin (UFH) with tirofiban (group I: 60 patients, (61.2±9.5) years), and dalteparin with tirofiban (group II: 60 patients, (60.5±10.1) years). Major adverse cardiac events (MACE) during hospitalization and at 4 years after PCI were examined. Bleeding complications during hospitalization were also examined.

Results  There were no significant differences in sex, mean age, risk factors, past history, inflammatory marker, or echocardiography between the 2 groups. In terms of the target vessel and vascular complexity, there were no significant differences between the 2 groups. During the first 7 days, emergent revascularization occurred only in 1 patient (1.7%) in group I. Acute myocardial infarction (AMI) occurred in 1 (1.7%) patient in group I and in 1 (1.7%) in group II. Three (5.0%) patients in group I and 1 (1.7%) in group II died. Total in-hospital MACE during the first 7 days was 4 (6.7%) in group I and 2 (3.3%) in group II. Bleeding complications were observed in 10 patients (16.7%) in group I and in 4 patients (6.7%) in group II, however, the difference was not statistically significant. No significant intracranial bleeding was observed in either group. Four years after PCI, death occurred in 5 (8.3%) patients in group I and in 4 (6.7%) in group II. MACE occurred in 12 (20.0%) patients in group I and in 10 (16.7%) patients in group II.

Conclusions  Dalteparin was effective and safe in primary PCI of STEMI patients and combined dalteparin with tirofiban was effective and safe without significant bleeding complications compared with UFH. Although there was no statistically significant difference, LMWH decreased the bleeding complications compared with UFH.

     

In vitro anticoagulation monitoring of low-molecular-weight heparin

Background Although low-molecular-weight heparin has replaced unfractionated heparin to become the primary anticoagulation drug for treatment of acute coronary syndrome, there is no convenient bedside monitoring method. We explored the best laboratory monitoring method of low-molecular-weight heparins （enoxaparin, dalteparin, and nadroparin） by use of the Sonoclot coagulation analyzer to monitor the activated clotting time.
Methods A total of 20 healthy volunteers were selected and 15 ml of fasting venous blood samples were collected and incubated. Four coagulants, kaolin, diatomite, glass bead, and magnetic stick, were used to determine the activated clotting time of the low-molecular-weight heparins at different in vitro anti-Xa factor concentrations. A correlation analysis was made to obtain the regression equation. The activated clotting time of the different low-molecular-weight heparins with the same anti-Xa factor concentration was monitored when the coagulant glass beads were applied.
Results The activated clotting time measured using the glass beads, diatomite, kaolin, and magnetic stick showed a linear correlation with the concentration of nadroparin （r = 0.964, 0.966, 0.970, and 0.947, respectively）. The regression equation showed that the linear slopes of different coagulants were significantly different （glass beads 230.03 s/IU, diatomite 89.91 s/IU, kaolin 50.87 s/IU, magnetic stick could not be calculated）. When the concentration of the anti-Xa factor was the same for different low-molecular-weight heparins, the measured activated clotting time was different after the application of the glass bead coagulant.
Conclusions The glass bead coagulant is most feasible for monitoring the in vitro anticoagulation activity of nadroparin The different effects of different low-molecular-weight heparins on the activated clotting time may be related to the different anti-11a activities.     

不稳定性心绞痛患者冠脉介入手术前后血清肝细胞生长因子水平的改变及意义

目的探讨不稳定性心绞痛患者经皮冠脉介入治疗（PCI）术前术中及术后血清肝细胞生长因子（HGF）水平的改变及意义。方法70例不稳定性心绞痛患者根据是否介入治疗分成PCI组（49例）和非PCI组（21例）,两组在PCI或冠脉造影术中均应用普通肝素,PCI组术后用低分子肝素7d。分别在术前、术中、术后即刻、术后24h及7d以免联免疫法测定血清HGF的水平。PCI组于术前和术后24h检测肌钙蛋白I（cTnI）。结果PCI组术前HGF水平显著高于非PCI组（13566ng／L±3769ng／L vs1736ng／L±604ng／L,P〈0,01）,PCI组和非PCI组术后即刻HGF水平均比术前显著升高,（11457ng／L±2298ng／L vs 967ng／L±349ng／L,P〈0．01）,但两组间比较HGF的改变无统计学意义。PCI术后第7天时cTnI阳性组血清HGF水平仍显著高于非PCI组（P〈0．01）,而cTnI阴性组已降至手术前水平。结论严重冠脉病变的不稳定性心绞痛患者伴有外周血HGF水平升高;PCI术后cTnI阳性组血清HGF水平的延迟降低与心肌微梗死有一定的关系。