冠心病患者纤溶活性、血小板功能及内皮素在运动前后的变化及其临床意义

目的研究冠心病患者在运动前后纤溶活性、血小板活化状态及血管内皮功能的变化。方法根据冠状动脉造影结果，选择冠心病患者（ＣＨＤ组）３７例，分为单支及多支病变组；另选健康人２７例为对照组（Ｃ组）。采用次极量运动试验观察上述部分指标在运动前后的变化。结果（１）运动前，组织型纤溶酶原激活剂（ｔＰＡ）、纤溶酶原激活剂抑制因子１（ＰＡＩ１）活性、血浆５羟色胺（５ＨＴ）水平及血小板５ＨＴ２Ａ受体密度，ＣＨＤ组均高于Ｃ组（Ｐ＜０．０５）；血浆内皮素（ＥＴ）１浓度两组差异无显著性（Ｐ＞０．０５）。（２）运动后，ＣＨＤ组ｔＰＡ活性下降（Ｐ＜０．０５），ＰＡＩ１活性上升（Ｐ＜０．０２５）；血浆５ＨＴ水平及血小板５ＨＴ２Ａ受体密度增加（Ｐ＜０．０５）；血浆ＥＴ１浓度上升，与Ｃ组比较差异有显著性（Ｐ＜０．０５）。上述各指标的增高，多支病变组较单支病变组明显（Ｐ＜０．０１～０．００５）。（３）运动前仅ＰＡＩ１活性与心肌缺血面积呈正相关（ｒ＝０．４５２，Ｐ＜０．００５）。结论冠心病患者纤溶活性下降，血小板激活，血管内皮受损，使冠心病患者易发生冠状动脉痉挛及血栓形成。次极量运动使之进一步加重而易诱发冠心病事件。

Changes of fibrinolytic activity platelet function and endothelin induced by exercise test in patients with coronary artery disease

Objective Strenuous exercise or other stress states often predispose coronary artery disease events. The aims of the study were to assess the changes of fibrinolytic activity, platelet activation and endothelial function in patients with coronary artery disease (CAD), and their relations to the severity of coronary artery lesion and extent of myocardial ischemic area.Methods Thirty seven patients with CAD confirmed by coronary angiography (Group CAD), including 15 with multivessel lesion and 22 with single vessel lesion, and 27 healthy persons selected as control (Group C), underwent symptom free multistage treadmill exercise test. During pre and peak exercise, blood samples were taken for the above mentioned parameters. Results (1)Before exercise the tPA, PAI 1 activity, plasma level of 5 HT, density of platelet 5 HT 2A receptor were all higher in Group CAD than those in Group C ( P<0.05); there was no difference of plasma level of ET 1 between the two groups. (2)During exercise in Group CAD, PAI 1 activity, plasma level of 5 HT, density of 5 HT 2A receptor and plasma level of ET 1 increased ( P <0.05), whereas tPA activity decreased ( P <0.05). There was a significant difference of plasma level of ET 1 between Group CAD and Group C. The increase of parameters were more prominent in multivessel lesion patient group than in single vessel lesion patient group ( P <0.01). (3)The PAI 1 activity before exercise displayed a positive correlation with the extent of mycardial ischemic area ( r =0.452, P <0.005). Conclusions In patients with CAD, the fibrinolytic activity is inhibited, the platelet activated, and the endothelium damaged. During strenuous exercise, these changes are enhanced making the disease vessels more susceptible to spasm and thrombus formation and to develop CAD events.