脑梗死患者凝血、抗凝、纤溶指标改变及低分子肝素治疗研究

目的　观察脑梗死患者血浆凝血、抗凝、纤溶指标凝血酶元时间 (PT)、白陶土部分凝血活酶时间 (KPTT)、抗凝血酶Ⅲ (ATⅢ )、组织型纤溶酶元激活物 (tPA)及其抑制物 (PAI)变化和低分子肝素 (LMWH)对其影响及疗效评定。方法　将 80例脑梗死患者随机分为两组 ,分别给予LMWH和常规药物治疗 ,检测治疗前后上述指标改变并评定LMWH疗效。结果　脑梗死患者较正常对照KPTT缩短 (P <0 .0 5 ) ,ATⅢ、tPA显著下降 (P <0 .0 1) ,PAI显著升高 (P <0 .0 1) ;LMWH治疗后tPA较治疗前显著升高 (P <0 .0 5 ) ,ATⅢ升高及PAI下降较常规治疗组有显著差异(P <0 .0 5及P <0 .0 1) ;LMWH治疗组显效率明显高于常规治疗组 (P<0 .0 1) ,未发现明显副作用。结论　脑梗死急性期存在血浆凝血、抗凝、纤溶功能异常 ;LMWH可影响血浆KPTT、ATⅢ、tPA、PAI水平 ,调节凝血、抗凝及纤溶系统平衡 ;应用LMWH治疗脑梗死有效、安全

A study on the changes in of plasma coagulative,anticoagulative, fibrinolytic activities in patients with cerebral infarction and the therapy with low molecular weight heparin

Objectives To observe the changes in plasma coagulative,anticoagulative and fibrinolytic activity parameters including prothrombin time(PT),kaolin partial thromboplastin time(KPTT),antithrombin-Ⅲ(ATⅢ),tissue plasminogen activator(tPA) and plasminogen activator inhibitor(PAI) in patients with acute cerebral infarction.To observe the effect of low molecular weight heparin (LMWH) on them and to evaluate the curative effect of LMWH.Methods Eighty cerebral infarction patients were divided into two groups.One group was given routine drug treatment and another was given LMWH treatment at the same time.Plasma PT,KPTT,ATⅢ,tPA,and PAI were determined before and after treatment and compared with the normal controls.Then the curative effect of LMWH was assessed.Results There was obvious decrease in KPTT(P<0.05),ATⅢ and tPA(P<0.01) and significant increase in PAI in cerebral infarction patients as compared with those in normal controls (P<0.01).After LMWH treatment,tPA activity was much higher than that before treatment.Increase in ATⅢ and decrease in PAI were significantly different between two treatment groups.The therapeutic efficacy of LMWH treatment group was superior to that of the routine treatment group.No serious side effect was found.Conclusion There are functional abnormalities in plasma coagulative,anticoagulative and fibrinolytic parameters during acute cerebral infarction.LMWH may affect the levels of KPTT,ATⅢ,tPA and PAI and regulate the equilibrium of coagulation-fibrinolysis system.The LMWH is useful and safe in therapy of acute cerebral infarction.