急性冠状动脉综合征患者血小板功能及血尿酸和纤维蛋白原含量与预后的关系

目的　观察急性冠状动脉综合征 (ACS)患者血小板最大聚集率 (MPAR)及血尿酸 (UA)和纤维蛋白原 (FIB)含量并探讨其与预后的关系。方法　急诊入院ACS患者 2 6 8例 ,其中不稳定型心绞痛 (UAP)患者 1 2 2例 (A组 ) ;急性心肌梗死 (AMI)患者 1 4 6例 (B组 ) ,B组再分为存活组 (B1组 ) 1 32例和死亡组 (B2组 ) 1 4例 ;同期正常对照组 2 82人 (C组 )。测定A、B两组入院后 2h的MPAR、UA、FIB和C反应蛋白 (CRP)含量并与C组比较 ,探讨其相互关系。结果　A、B组入院后 2hMPAR、UA、FIB和CRP含量与C组比较均有显著性升高 (P <0 0 1 ) ;A、B组入院后 3周MPAR、FIB和CRP含量与入院后 2h比较均有显著性下降 (P <0 0 5 ) ,但UA含量差异均无统计学意义 (P >0 0 5 ) ;B组血清肌酸磷酸激酶 (CK)峰值较A、C组均有显著性升高 (P <0 0 1 )。结论　ACS患者MPAR、UA和FIB含量均明显高于正常人 ,其含量高低与发生急性心肌梗死时的病情、梗死面积及预后呈明显正相关 ;而充分的抗凝及抗血小板治疗可使MPAR和FIB含量明显下降。

Correlation between the prognosis and platelet function and the plasma levels of uric acid and fibrinogen in patients with acute coronary syndromes

Objective To investigate the correlation between the prognosis and the max platelet aggregation (MPAR), the plasma levels of uric acid (UA) and fibrinogen (FIB) in patients with acute coronary syndromes (ACS). Methods 268 patients with acute coronary syndrome were divided into two groups: group A included 122 patients with unstable angina pectoris (UAP) while group B included 146 patients with acute myocardial infarction (AMI). In Group B, 132 patients (group B1) survived and 14 patients (group B2) died during hospitalization. Group C included 282 normal people who received physical examination at the same time. Comparison between the 3 groups were made in terms of MPAR, plasma level of UA, FIB and C-reative protein (CRP) at 2 hours and 3 weeks after hospitalization. Results The MPAR, the plasma levels of UA, FIB and CRP in patients of group A and B at 2 hours after hospitalization were very significantly higher than that of group C (P<0.01). The MPAR, the plasma levels of FIB and CRP in patients of group A and B at 2 hours after hospitalization were significantly higher than that of 3 weeks later (P<0.05) but there were no difference in the plasma levels of UA (P>0.05) between the 2 groups. The peak level of creatine kinase (CK) was obtained in Group B compared with Group A and Group C (P<0.01). Conclusion The MPAR, plasma levels of UA and FIB in ACS patients were significantly higher than that of normal people and were found to be directly proportinal to or correlated with the size of the infarction area and the prognosis. Sufficient anti-coagulation and anti-platelet treatment can lowere the MPAR and the plasma level of FIB.