冠心病患者血浆组织因子、组织因子途径抑制物水平及抗凝血酶-Ⅲ活性的研究

目的 :检测不同类型冠心病 (CHD)患者血浆组织因子 (TF)、组织因子途径抑制物 (TFPI)抗原水平及抗凝血酶 Ⅲ(AT Ⅲ)活性的变化并探讨其临床意义。方法 :TF抗原 (TF Ag)、TFPI抗原 (TFPI Ag)均采用双抗夹心ELISA法测定 ,AT Ⅲ活性采用发色底物法。结果 :急性心肌梗死 (AMI)组、不稳定型心绞痛 (UAP)组和稳定型心绞痛 (SAP)组TF抗原水平治疗前后均显著高于对照组 (P <0 .0 5 ) ,陈旧性心肌梗死(OMI)组治疗前后与对照组水平接近 (P >0 .0 5 ) ;各组治疗前后TFPI抗原水平均高于对照组 (P <0 .0 5 ) ;各组治疗前AT Ⅲ活性均显著低于对照组 (P <0 .0 5 ) ,治疗后 ,AMI组和UAP组AT Ⅲ活性升高至对照组水平 (P >0 .0 5 ) ,SAP组和OMI组仍低于对照组 (P <0 .0 5 )。结论 :AMI及心绞痛患者发作期 ,外源性凝血途径被启动 ,TF过度表达 ,TFPI反馈性增高 ,AT Ⅲ活性因被过多拮抗和消耗而降低 ,血液处于高凝状态。

Changes of the Levels of Plasma Tissue Factor and Tissue Factor Pathway Inhibitor and the Activity of Plasma Antithrombin-Ⅲ in Patients with Coronary Heart Disease

Objective: To determine the levels of plasma tissue factor (TF) and tissue factor pathway inhibitor (TFPI) and the activity of plasma antithrombin-Ⅲ(AT-Ⅲ) in patients with coronary heart disease (CHD).Method: TF and TFPI antigen (TFAg and TFPIAg) were measured by double antibody sandwich enzyme linked-immunosorbent assay,AT-Ⅲ activity (AT-Ⅲ A) was determined with chromogenic peptide substrated method.Results: The plasma levels of TF Ag in Acute myocardial infarction (AMI),unstable angina pectoris (UAP) and stable angina pectoris (SAP) patients are higher than that in controls ( P <0.05). after treatment the TF Ag value in AMI,UAP and SAP patients are decreased,but higher than that in controls(p<0.05). In AMI,UAP,SAP and old myocardial infarction (OMI) patients,the plasma levels of TFPI Ag did′t change respectively and are in a steady high level,the plasma activities of AT-Ⅲ are lower that in controls,after treatment,the AT-Ⅲ value in AMI and UAP patients is increased to normal range,the AT-Ⅲ value in SAP and OMI patients is increased but is in steady low level.Conclusion: During the onset of angina pectoris and AMI,tissue factor pathway is initiated and decrease the activity of plasma AT-Ⅲ,the blood is in hypercoagulable state.