冠心病患者血浆组织因子抗凝血酶复合物水平的变化及其临床意义

目的观察冠心病患者血浆组织因子(TF)、抗凝血酶复合物(TAT)的变化及其临床意义。方法回顾性分析72例临床确诊的冠心病患者,其中急性心肌梗死(AMI)29例、不稳定型心绞痛(UAP)25例、稳定型心绞痛(SAP)18例,并选15例体检健康者为对照组。血浆TF活性测定采用发色底物法,TAT含量测定采用ELISA法。结果(1)AMI组、对照组、SAP组比较,血浆TF分别为(2179+1236)、(1132+473)、(1147+480)ng/L,TAT分别为(257+108)、(73+63)与(71+53)ng/L,AMI组血浆TF活性与UAP组比较,差异无统计学意义(P>005),TAT含量较UAP组明显升高,差异有统计学意义(P<005);(2)UAP组血浆TF活性、TAT含量较健康对照组及SAP组明显升高,差异有统计学意义(P<005);(3)SAP组血浆TF活性、TAT含量与健康对照组比较,差异无统计学意义(P>005)。结论AMI、UAP患者存在异常激活的高凝状态,TF触发的外源性凝血途径,在冠状动脉血栓形成中发挥作用。

Changes of plasma tissue factor and thrombin-antithrombin complex in patients with coronary heart disease

Objective To observe the changes of tissue factor (TF) and thrombin-antithrombin complex (TAT)in patients with coronary heart disease. Methods twenty-nine patients with acute myocardial infarction(AMI) and 25 patients with unstable angina pectoris(UAP) as well as 18 patients with stable angina pectoris(SAP) were studied and 15 healthy volunteers served as control. Plasma TF activity were measured with chromogenic assay and TAT quantities were assayed with ELISA. Results (1)Plasma TF activity and TAT quantities were significantly higher in patients with AMI than those in control group and patients with SAP ( P<0.05). There were no significant changes of plasma TF in AMI compared with those of patients with UAP(P>0.05). Plasma TAT quantities were significantly higher in patients with AMI than those of patients with UAP (P<0.05). (2)Plasma TF activity and TAT quantities were significantly higher in patients with UAP than those in control group and patients with SAP (P<0.05).(3) There were no statistical significances in TF and TAT between SAP patients and control (P>0.05). Conclusions There exists abnormally activated hyper-coagulation state in patients with AMI and patients with UAP. TF is recognized as the initial trigger of the extrinsic coagulation pathway which plays a critical role in the pathogenesis of coronary thrombosis.