冠心病患者凝血机制的变化及其临床意义

目的检测冠心病患者血浆组织因子(TF)、组织因子途径抑制物(TFPI)水平及国际标准化比值(INR)、活化部分凝血活酶时间(APTT)的变化,探讨其在冠心病诊治中的临床意义。方法冠心病患者96例(冠心病组),非冠心病患者25例(对照组),冠心病组分为急性心肌梗死组(33例)、不稳定性心绞痛组(33例)和稳定性心绞痛组(30例)。冠心病患者又按Gensini积分分为A组、B组和C组,每组32例。分析各组TF、TFPT、INR和APTT的变化。结果冠心病组患者TF、TFPI、TF/TFPI高于对照组,INR、APTT低于对照组;急性心肌梗死组患者TF、TFPI、TF/TFPI显著高于不稳定性心绞痛组及稳定性心绞痛组患者,INR、APTT明显低于不稳定性心绞痛组及稳定性心绞痛组患者。C组患者TF、TF/TFPI明显高于B组和A组,INR、APTT低于B组和A组患者;INR与TF/TFPI呈负相关(r=-0.302,P=0.003),INR与APTT呈正相关(r=0.349,P=0.01)。结论冠心病患者TF、TFPI、TF/TFPI、INR、APTT水平在一定程度上反映了病情的严重程度,其中TF/TFPI能反映冠心病患者的凝血状态,对冠心病患者的危险分层和治疗有一定的临床意义。

The change of clotting mechanism in patients with coronary heart disease and its clinical significance

Objectives To investigate the changes of plasma tissue factor(TF),tissue factor pathway inhibitor(TFPI),activated partial thromboplastin time(APTT) and international normalized ratio(INR) in patients with coronary heart disease(CHD) and explore their clinical significance in diagnosis and treatment of CHD.Methods Ninety-six patients with CHD were divided into three groups:acute myocardial infarction(AMI) group,unstable angina pectoris(UAP) group and stable angina pectoris(SAP) group.According to Gensini score system,they were divided into groups A,B and C.Twenty-five non-CHD patients served as control.The changes of TF,TFPI,TF/TFPI,INR and APTT in different groups were analyzed.Results The concentrations of plasma TF,TFPI and TF/TFPI were higher in the CHD group than in the control group,but the INR and APTT in the CHD group were lower.The concentrations of plasma TF,TFPI and TF/TFPI were higher in the AMI patients than in patients with UAP and SAP,while the INR and APTT were exactly the opposite.The concentrations of plasma TF and TF/TFPI were higher in group C than in group A and group B,while INR and APTT were lower in group C than in group A and group B.INR was negatively correlated with TF/TFPI(r=-0.302,P=0.003) and positively correlated with APTT(r=0.349,P=0.01).Conclusions To a certain extent,the concentrations of plasma TF,TFPI,TF/TFPI,INR and APTT in CHD group may reflect the severity of the illness,and TF/TFPI can also reflect the state of blood coagulation in CHD patients,it has certain clinical significance in risk stratification and treatment of CHD.