中老年非瓣膜病心房颤动患者凝血-纤溶功能的变化

目的：评价中老年非瓣膜病心房颤动（房颤）患者的凝血-纤溶功能。方法：选择92例中老年非瓣膜病房颤患者（房颤组）和60例窦性心律者（对照组），采用免疫比浊法测定血浆D-二聚体（D-Dimer）水平，采用酶联免疫吸附双抗体夹心法（ELISA法）测定血浆组织型纤溶酶原激活物（t-PA）及纤溶酶原激活剂抑制物1（PAI-1）水平。单因素分析方法分析两组间各指标的差异，对可能影响D-Dimer、t-PA、PAI-1水平的性别、年龄和血清肌酐、尿酸、血糖、甘油三酯、胆固醇等因素采用协方差方法分析。 结果：①单因素分析，房颤组D-Dimer［（0.16±0.10)mg·L^-1］、t-PA［（42.58±30.28)μg·L^-1］和PAI-1［（86.03±21.43)μg·L^-1］水平均显著高于对照组［(0.10±0.08)mg·L^-1，(26.02±13.84)μg·L^-1和(64.94±24.35)μg·L^-1］。房颤组PAI-1/t-PA比值略高于对照组（P>0.05）。②多因素分析调整影响因素后，房颤组D-Dimer　（P=0.047）、t-PA（P=0.264）和PAI-1（P=0.001）水平仍高于对照组，但t-PA差异无显著性(P>0.05)。结论：中老年非瓣膜病房颤患者存在凝血-纤溶系统失衡，血液处于高凝、低纤溶状态。

Changes of coagulation and fibrinolysis in middle-old aged patients with nonvalvular atrial fibrillation

Objective To evaluate the changes of coagulation and fibrinolysis function in the middle-old aged patients with nonvalvular atrial fibrillation.Methods The levels of D-Dimer and tissue-type plasminogen activator(t-PA) and plasminogen activator inhibitor-1(PAI-1) were detected in 92 middle-aged patients with nonvalvular atrial fibrillation(AF group) and 60 patients with sinus rhythm(control group) by immune turbidimetry and enzyme linked immunoadsorbent assay(ELISA).Univariate analysis was used to determine the differences between two groups,and covariance analysis was used to determine the factors which might affect coagulation and fibrinolysis indexes.Results ①The plasma levels of D-Dimer (0.16±0.10)mg·L~(-1)] and t-PA (42.58±(30.28)μg·L~(-1)]) and PAI-1 (86.03±21.43)μg·L~(-1)] in AF group were significantly higher than those in the control group((0.10±)0.08)mg·L~(-1),(26.02±13.84)μg·L~(-1),(64.94±24.35)μg·L~(-1)](P<0.05 or P<0.001).The ratio of PAI-1 /t-PA in AF group was higher than that in control group slightly.②After adjustment of the factors which included sex,age and plasma creatinine,uric acid,blood sugar,triglyceride and cholesterol,the levels of(D-Dimer)(P=0.047),t-PA(P=0.264)and PAI-1(P=0.001)in AF group were higher than those in the control group.Conclusion The middle-old aged patients with nonvalvular atrial fibrillation lose their balance of coagulation and fibrinolysis in the state of hypercoagulated and hypofibrinolysis.