脑梗死患者溶栓前后血浆纤维蛋白原水平与早期再梗死的关系

目的探讨急性缺血性卒中患者在尿激酶溶栓前后，血浆纤维蛋白原（Fg）水平与早期再梗死的关系。方法接受动静脉尿激酶溶栓治疗的脑梗死患者216例，剔除无效和出血病例后共204例。按疗效标准分为溶栓后早期再梗死组（15例）和溶栓成功组（189例），用Clauss法经全自动血凝分析仪对两组患者溶栓前后血浆Fg含量的动态变化进行了监测，并分析其与溶栓后早期再梗死的关系。结果①溶栓前再梗死组低密度脂蛋白、全血低切黏度，均高于成功组，差异有统计学意义（P〈0．05，P〈0．01）。②再梗死组患者溶栓前血浆Fg为（6．1±0．7）g／L，成功组为（4．1±0．3）g／L；溶栓后24h，再梗死组Fg为（5．2±0．4）g／L，成功组为（3．8±0．5）g／L，两组比较差异均有统计学意义（P〈0．05）。③15例再梗死患者中，10例再梗死发生于溶栓后12～24h。④溶栓后，再梗死组的血浆Fg水平下降幅度较小，并于溶栓后12h开始回升，24h达到最高峰，发生再梗死时的平均如水平超过正常值上限（4．0g／L）；成功组血浆Fg水平下降幅度明显，大约12h左右达最低，此后一直保持在正常范围。结论血浆如水平增高是尿激酶溶栓后早期再梗死的危险因素之一。

Relationship between plasma fibrinogen levels before and after urokinase thrombolysis and early reinfarction in patients with acute cerebral infarction

Objective To investigate the relationship between the plasma fibrinogen （Fg） levels before and after urokinase thrombolysis and the early reinfarction in patients with acute ischemic stroke. Methods A total of 216 patients with cerebral infarction received urokinase thrombolysis, 204 of them were selected for study after excluding the invalid and hemorrhagic cases. After thrombolysis, the patients were divided into an early reinfarction group （n = 15 ） and a successfully thrombolytic group （n = 189 ） according to the effect of treatment. The dynamic changes of plasma Fg levels before and after thrombolysis in both groups were measured with the Clauss method using an automatic blood analyzer, and the relationship between the plasma Fg level and early reinfarction after thrombolysis was analyzed. Results ①The plasma Fg level before thrombolysis was 6. 1 ±0. 7 g/L in the reinfarction group, and 4. 1 ±0. 3g/L in the successfully thrombolytic group; ②24 hours after thrombolysis, the Fg level was 5.2 ± 0.4 g/L in the reinfarction group, and 3.8 ± 0. 5 g/L in the successfully thrombolytic group. There were statistical significanoes between the two groups （P 〈 0. 05 ）. ③10 of the 15 patients with reinfarction, the reinfarction occurred at 12 to 24 hours after the thrombolysis. ④The levels of plasma Fg decreased slightly in the reinfarction group after thrombolysis, and began to increase 12 hours after thrombolysis, then reached to the peak at 24 hours. The average level of Fg exceed the upper normal limit（4. 0g/L） when the reinfarction occurred. The decreasing extent of the plasma Fg level was significant in the successfully thrombolytic group, and it reached the lowest at about 12 hours. Hereafter, it maintained under the upper normal limit. Conclusion Increase of plasma Fg level may be one of the risk factors for the early reinfarction after urokinase thrombolysis.