冠心病患者止凝血与纤溶指标检测的临床意义

目的探讨冠心病患者内皮细胞功能、血小板活化、凝血因子活性、纤溶活性的变化及临床意义。　方法 134例冠心病患者 ,其中急性心肌梗死 (AMI)组 4 9例、不稳定心绞痛 (UA) 19例、稳定性心绞痛 (SA)组 6 6例 ,应用ELISA法检测血管性血友病因子 (vWF :Ag)、P -选择素 (P -selectin)、组织因子 (TF)、组织因子途径抑制物 (TFPI)及D-二聚体 (D -D) ,应用Clauss法检测纤维蛋白原含量 (Fg) ,并比较各指标在冠心病患者与正常对照者 (n =4 0 )的差别。　结果所有冠心病患者的各项止凝血和纤溶指标均高于正常对照组。AMI组和UA组各项指标与正常对照组比较有显著性差异 (P <0 .0 5 ) ;SA组除D -D与正常对照组比较无显著性差异外 ,各项指标与正常对照组比较均有显著性差异 (P <0 .0 5 )。AMI组与UA组比较 ,Fg、vWF :Ag、TFPI、TF有显著性差异 (P <0 .0 5 ) ,而P -selectin二组间无显著性差异 (P >0 .0 5 )。UA组与SA组比较 ,P -selectin、D D二组间有显著性差异P <0 .0 5 ) ,而vWF :Ag、TFPI、TF二组间无显著性差异 (P >0 .0 5 )。　结论冠心病患者存在着内皮细胞损伤、血小板活化、凝血激活和继发性纤溶活性增高 ,且各项指标异常程度与冠心病严重程度相一致 (AMI>UA >SA)

Measurement of Coagulation and Fibrinolytic Markers in Patients with Coronary Artery Disease and Their Clinical Significance

Objective To study the variation of endothelial function, platelet activation, coagulation factors activity, fibrinolytic activity in patients with coronary artery disease (CAD) and their clinical significance. Methods Here 134 CAD patients suffering from acute myocardial infarction (AMI), unstable angina(UA), stable angina (SA) and 44 normal controls were examined in this study. Von Willebrand factor(vWF), P-selectin, tissue factor(TF), tissue factor pathway inhibitor(TFPI) and D-dimer(D-D) were measured with ELISA; fibrinogen was analyzed with Clauss assay. Results The plasma levels of all markers in CAD patients were higher than those of normal controls. The plasma levels of all markers in the acute myocardial infarction(AMI) and unstable angina(UA) groups were significantly different p<0.05) compared with normal controls. There was significant difference in the plasma levels of all markers between stable angina(SA) and normal controls (P<0.05) expect D-D (P>0.05). The plasma levels of Fg, vWF:Ag, TFPI, and TF in AMI group were significantly higher than those in UA group (P>0.05),but the P-selectin levels were the same between two groups (P>0.05).The plasma levels of P-welectin, D-D were significantly higher (P<0.05) and the levels of vWF, TFPI, and TF showed no significant difference(P>0.05)in group UA as compared with group SA. Conclusion The injury of vascular endothelium, activation of platelets, increase of coagulation and secondary hyperfibrinolysis, and abnormality of these markers are correlated with severity of CAD(AMI>UA>SA).