D-二聚体在急性心肌梗死时冠状动脉血栓自溶再通的演变及意义

目的探讨D-二聚体在急性心肌梗死时冠状动脉血栓自溶再通的演变及意义。方法选择4所医院急性心肌梗死(AMI)患者80例,根据治疗方式及冠状动脉造影结果,将患者分为药物溶栓再通组(A组,29例),血栓自溶再通组(B组,30例)及非溶栓组(C组,21例)。各组在治疗前后1、2、4、8、24和48h检测D-二聚体、肌酸激酶同工酶(CK-MB)、肌钙蛋白I、凝血酶原时间等。A组采用重组组织型纤溶酶原激活剂进行静脉溶栓治疗,B组、C组静脉滴注等量生理盐水。结果 3组患者发生AMI后CK-MB和肌钙蛋白I水平均显著增高,与C组比较,A组D-二聚体浓度1、2、4、8h显著升高(4.31±0.94)mg/L vs(0.89±0.12)mg/L,(5.21±1.06)mg/L vs(1.55±0.43)mg/L,(7.56±1.53)mg/L vs(0.93±0.12)mg/L,(4.33±0.99)mg/L vs(0.61±0.17)mg/L],B组D-二聚体浓度1、2h显著升高(3.69±0.86)mg/L vs(0.89±0.12)mg/L,(2.39±0.66)mg/L vs(1.55±0.43)mg/L];与B组比较,A组D-二聚体浓度2、4、8、24h显著升高(P<0.05,P<0.01)。C组在相同时间点无显著变化。结论治疗AMI时,D-二聚体浓度变化在药物溶栓再通与血栓自溶再通有显著不同,可作为判断溶栓疗效的指标。

Evolution of D-dimer in coronary artery reperfusion following acute myocardial infarction and its significance

Objective To study the evolution of D-dimer in coronary artery reperfusion following AMI and its significance.Methods Eighty AMI patients admitted to our hospital from 2001to2010 were divided into group A(n=29),group B(n=30),and group C(n=21).The therapeutic effect was assessed according to their coronary angiography.Serum D-dimer level was measured before and 1,2,4,8,24,48 hafter treatment.Serum CK-MB and troponin I levels were also measured.Thrombogen time and thromboplastin time were recorded.Patients in group A received intravenous thrombolysis treatment with recombinant tissue activator and those in groups B and C received intravenous normal saline drip.Results The serum CK-MB and troponin I levels were significantly higher in 3groups following AMI.The serum D-dimer level was significantly higher in group A than in group C at 1,2,4,8h(4.31±0.94mg/L vs 0.89±0.12mg/L,5.21±1.06mg/L vs 1.55±0.43mg/L,7.56±1.53mg/Lvs 0.93±0.12mg/L,4.33±0.99mg/Lvs 0.61±0.17mg/L,P<0.05,P<0.01),in group B than in group C at 1and 2h(3.69±0.86mg/L vs0.89±0.12mg/L,2.39±0.66mg/L vs 1.55±0.43mg/L,P<0.05,P<0.01),and in group A than in group B at 2,4,8,24h(P<0.05,P<0.01).No significant difference in serum D-dimer level was found in group C at the same time points.Conclusion The serum D-dimer level is significantly different in AMI patients when they receive thrombolysis and autolysis treatment for coronary artery reperfusion,and can thus be used as an indicator of thrombolysis.