纤溶系统标志物的变化在不同临床类型冠心病诊疗中的应用

目的 通过检测不同临床类型冠心病（CHD）患者血浆中D-二聚体（D-D）、纤维蛋白原（Fg）、纤维蛋白原降解产物（FDP）含量和抗凝血酶Ⅲ（AT-Ⅲ）、蛋白C（PC）、蛋白S（PS）活性的动态变化,探讨其在冠心病诊疗中的临床意义.方法 回顾性分析126例临床确诊的冠心病（CHD）患者,其中稳定型心绞痛（SAP）42例,不稳定型心绞痛（UAP）45例,急性心肌梗死（AMI）39例,并选40例健康体检者为对照组.用STA-R全自动凝血仪分别测定上述项目的血浆含量和活性,并进行比较分析.结果 AMI组较UAP组、SAP组及对照组,血浆AT-Ⅲ、PC 、PS活性明显降低,有显著性差异（P＜0.01）,血浆Fg、FDP、D-D含量明显升高,有显著性差异（P〈0.01）;UAP组较SAP组及对照组,血浆AT-Ⅲ、PC 、PS活性明显降低,有显著性差异（P＜0.01）,血浆Fg、FDP、D-D含量明显升高,有显著性差异（P＜0.01）；SAP组与正常对照组比较,血浆AT-Ⅲ、PC 、PS活性和Fg、FDP、D-D含量均无显著性差异（p0.05）.结论 不同临床类型冠心病（CHD）患者血浆纤溶系统失衡,其中AMI和UAP患者存在异常激活的高凝状态.其发病机制可能有血栓因素的参与,联合测定上述标志物,有利于冠心病的早期诊断、临床分型及疗效观察.

Clinical application of the changes of fibrinolysis markers in diagnosis and treatment of various types of coronary heart disease

Objective To investigate the clinical significance of fibrinolysis markers in the diagnosis and treatment of coronary heart disease by testing the dynamic change of D-dimer （D-D）, fibrinogen （Fg）, fibrinogen degradation products （FDP）, antithrombin Ⅲ （AT-Ⅲ）, protein C（PC）, protein S（PS） activity from plasma of patients with different clinical types of coronary heart disease（CHD）. Methods Retrospective analysis was conducted on 126 cases of patients with clinically diagnosed CHD, in which 42 cases with stable angina （SAP）, 45 cases with unstable angina pectoris （UAP）, 39 cases with acute myocardial infarction （AMI）, and 40 cases of healthy subjects were selected as a control group, each of these plasma concentrations and activity of the above-mentioned indexes were measured and compared based on STA-R automated coagulation analyzer. Results Compared with the UAP, SAP and control groups, the AMI group had reduced plasma activity of AT-Ill, PC, PS with significant differences （P〈0.0I）, while elevated plasma level of Fg, FDP, D-D with significant differences（P〈0.01）; compared with SAP group and control groups, the UAP group had reduced plasma activity of AT-Ⅲ, PC, PS with significant differences （P〈0.01） and the reduced plasma level of Fg, FDP, D-D with significant differences （P〈0.01）; compared with the control group, the SAP group＇s plasma activity of AT-Ⅲ, PC, PS and the plasma level of Fg, FDP, D-D were not significantly different （P〉0.05）. Conclusions The plasma fibrinolysis system in patients with different clinical types of CHD loses its balance, there exists abnormal activation of hypercoagulable state in patients with AMI and UAP, thrombotic factors may he involved in the pathogenesis. Combined determination of these markers is conductive to the early diagnosis, clinical classification and monitoring the effect of treatment of coronary heart disease.