心房颤动患者血浆TAT水平变化对评价血栓栓塞危险性的临床价值

目的 :探讨心房纤颤 (AF)患者血液凝血系统分子标志物凝血酶 抗凝血酶Ⅲ (TAT)浓度变化及其对评价房颤患者血栓栓塞危险性的价值。方法 :45例慢性房颤患者中 9例通过经食道超声心动图 (TEE)检出左房血栓或有栓塞病史 ,为血栓阳性组 ,余 3 6例房颤患者为阴性组 ,另选临床情况相似的 2 1例窦律患者作为对照组 ,各组均分别采用酶联免疫双抗体夹心法 (ELISA)和发色底物法测定血浆TAT、D D浓度和AT Ⅲ活性 ,对其结果进行分析比较。结果 :AF患者无论是否伴有血栓 ,其TAT及D D含量均明显高于正常窦律组(P <0 0 5 ) ,AT Ⅲ活性明显低于正常窦律组 (P <0 0 5 )。血栓组患者TAT、D D水平较血栓阴性组明显升高(P均 <0 0 5 )。房颤患者TAT与D D水平呈正相关性 (rs=0 3 0 6,P <0 0 5 )。结论 :房颤患者可引起凝血系统的激活 ;检测房颤患者血浆中TAT可成为评估房颤患者血栓栓塞危险性的有价值的一种方法

Clinical value of thrombin-antithrombin Ⅲ for evaluating embolic risk in patients with atrial fibrillation

Objective: To study the alteration of plasma cogulation system molecular marker thrombin-antithrombin Ⅲ(TAT) levels and clinical value of this marker in evaluating embolic risk in patients with atrial fibrillation(AF).Methods: Plasma TAT,D-D levels and AT-Ⅲ activity were respectively determined in 45 patients with AF and 21 volunteers with sinus rhythm by enzymelinked immunosorbent assay(ELISA) and spectrophotometric assay.45 patients with AF were divided into 2 groups:Thrombus group included 9 patients with thrombus in left atrium identified by transesophageal echocardiography(TEE) or thromboembolism history.The rest of 45 patients(n=36) was non-thrombus group.21 patients with various heart disease and sinus rhythm were the control group.Results: Compared with the control group,the levels of TAT,D-D in patients with AF increased significantly(P<0.05),and AT-Ⅲ activity decreased(P<0.05).There were also significantly differences in the levels of TAT and D-D between thrombus group and non-thrombus group.TAT was positive correlated with D-D(r s=0.306,P<0.05) in AF patients.Conclusion: AF can result in activation of coagulation system.There are hypercoagulable state and depressed anticoagulative activity.To detect plasma TAT levels may become a new means in evaluating embolic risk in AF patients.