高原肺水肿患者血浆纤溶系统变化及卡托普利的影响

目的　观察高原肺水肿 (HAPE)患者血浆纤溶系统的变化及卡托普利对其的影响 ,探讨其发病机制。方法　 72例高原肺水肿患者分为卡托普利组 (35例 )和常规组 (37例 ) ,并以 2 0名健康志愿者作为对照。所有患者治疗前、后均测定血浆组织型纤溶酶原激活物 (tPA)及纤溶酶原激活物抑制物 (PAI 1)的活性。结果　血浆tPA含量卡托普利组 (A组 )治疗前、后分别为 (0 4 0± 0 14 )× 10 3 IU/L、(0 5 8± 0 13)× 10 3 IU/L ,常规组 (B组 )治疗前、后分别为 (0 39± 0 19)× 10 3 IU/L、(0 4 9± 0 16 )×10 3 IU/L ,正常对照组 (C组 )为 (0 5 9± 0 17)× 10 3 IU/L ;A、B两组治疗前、后比较差异均有显著性(P <0 0 1、<0 0 5 ) ;血浆PAI 1含量A组治疗前、后分别为 (6 6± 1 8)× 10 3 AU/L、(4 9± 1 5 )×10 3 AU/L ,B组治疗前、后分别为 (6 6± 1 6 )× 10 3 AU/L、(5 8± 1 7)× 10 3 AU/L ,C组为 (4 9± 1 3)×10 3 AU/L。A、B两组治疗前、后比较差异均有显著性 (P <0 0 1、 <0 0 5 )。结论　HAPE患者纤溶系统呈失衡性改变 ,卡托普利有恢复其平衡的治疗作用。

Changes of plasma fibrinolysis system and the effect of captopril in high altitude pulmonary edema

OBJECTIVE: To investigate the changes of plasma fibrinolysis system and the effect of captopril in patients with high altitude pulmonary edema. METHODS: The plasma levels of tissue plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1) were measured before and after treatment in the captopril-group (group A, 35 cases) and the routine-group (group B, 37 cases) of patients with HAPE, while 20 healthy volunteers served as the control (group C). RESULTS: The plasma level of tPA was (0.40 +/- 0.14) x 10(3) IU/L in group A vs (0.39 +/- 0.19) x 10(3) IU/L in group B before treatment, and (0.58 +/- 0.13) x 10(3) IU/L vs (0.49 +/- 0.16) x 10(3) IU/L after treatment, and (0.59 +/- 0.17) x 10(3) IU/L in group C. The differences were significant both before and after treatment between group A and group B (P < 0.01, P < 0.05). While PAI-1 was (6.6 +/- 1.8) x 10(3) AU/L in group A vs (6.6 +/- 1.6) x 10(3) AU/L in group B before treatment, and (4.9 +/- 1.5) x 10(3) AU/L vs (5.8 +/- 1.7) x 10(3) AU/L after treatment, and (4.9 +/- 1.3) x 10(3) AU/L in group C. The differences were significant both before and after treatment between group A and group B (P < 0.01, P < 0.05). CONCLUSION: Patients with HAPE may present a disturbance of the fibrinolysis system, which could be reversed by captopril.