心力衰竭患者血凝状态及内皮功能变化的观察和治疗探讨

为探讨心力衰竭(CHF)时高凝状态和血栓形成过程中凝血因子、内皮功能和缩血管活性激素的发病学意义,本研究观察了28例CHF患者血浆Ⅷ因子相关抗原(ⅧR:Ag)、抗凝血酶Ⅲ抗原(ATⅢ:Ag)、内皮素(ET)和血管紧张素Ⅱ(ATⅡ)的变化,结果显示,CHF组较正常组血浆ⅧR:Ag、ET和ATⅡ水平明显增高(P分别<0.05和0.01),ET分别与ⅧR:Ag和ATⅡ显著正相关,提示CHF患者有凝血因子、内皮功能和缩血管活性激素的异常,它们之间关系密切并共同参与高凝倾向和血栓形成的病理过程.卡托普利治疗可使CHF患者通过抑制血管紧张素转换酶,使ATⅡ下降,但同时又使血浆ET和ⅧR:Ag水平显著下降,此可能是其发挥良好的血液动力学和神经内分泌效应、改善心功能及血管内皮功能影响血液高凝状态的另一重要参与机制.

Clinical Observations and Treatment of Coagulation and Endothelial Function in Patients with Chronic Heart Failure

Plasma level of ⅢR:Ag>ET and AT I were studied in 28 patients with chronic heart failure. The result showed that the plasma level of ⅧR:Ag, ET and AT Ⅱ in CHF patients were higher than that in normal control group(P<0. 05 and 0. 01 respectively). ET was correlated positively with ⅧR:Ag and AT Ⅱ , indicating the abnormalities of coagulant, endothelial function and vasocontractive hormone, and their participating in the pathogenic course of hypercoagulable state and thrombosis together. Captopril can inhibit angiotensin transmerase in patients with CHF,so as to decrease the level of AT Ⅰ ; and simultaneously decrease plasma level of ET and ⅧR:Ag. This may be another mechanism of captopril in hemodyanamics and neuro-endocrinology to improve cardiac and endothelial function which influence hypercoagulable state.