急性心肌梗死患者尿FPA和血浆D-dimer动态变化

目的：探讨急性心肌梗死（ＡＭＩ）患者尿纤维蛋白肽Ａ（ＦＰＡ）和血浆Ｄ－二聚体（Ｄ－ｄｉｍｅｒ）的动态变化及其临床意义。方法：收集３０例ＡＭＩ患者入院后１～３ｄ的晨尿及血标本进行ＦＰＡ和Ｄ－ｄｉｍｅｒ水平动态检测，并与正常值进行比较。结果：①ＡＭＩ患者尿ＦＰＡ水平均明显高于正常值（Ｐ＜０．００１），第１天最高；②ＡＭＩ患者血浆Ｄ－ｄｉｍｅｒ水平均明显高于正常值且逐渐升高，第３天达最高值；③溶栓治疗后，血浆Ｄ－ｄｉｍｅｒ最高值提前至发病后第２天。结论：①尿ＦＰＡ是反映体内凝血系统激活状态及血栓形成的早期敏感指标之一，可作为ＡＭＩ早期诊断常规检查项目；②血浆Ｄ－ｄｉｍｅｒ反映体内高凝状态和血栓形成。溶栓治疗后峰值提前，可作为ＡＭＩ早期诊断及判断溶栓疗效的参考指标。

The dynamic changes of urine FPA and plasma D-dimer in patients with AMI and their clinical significance

Objective: To investigate the dynamic changes of urine fibrinopeptide (FPA) and plasma Ddimer in 30 patients with AMI. Method: The urine and blood of AMI patients were collected every morning for 3 days after admission for determination of urine FAP and plamsa Ddimer.The values obtained were compared with normal values.8 of them received thrombolytic therapy. Results: :The urine FPA levels of the first three days after the attacks of AMI were obviously higher than normal. The peak levels were on the first day. The plasma Ddimer levels of the first three days after the attacks of AMI were obviously higher than normal and increased gradully until the peak levels were reached on the third day. The peak levels of plasma Ddimer in thrombolytic group, which were on the second day,appeared early than those in nonthrombolytic group. Couclusion: The urine FPA is an early sensitive marker to monitor the activation of the coagulative system and the formation of thrombus. It is useful for the early diagnosis of AMI and can be measured as a routine item for patients with AMI. Plasma Ddimer is one of the markers of the activated coagulative and fibrinolytic systems. The peak levels in thrombolytic group preceded those in nonthrombolytic group by one day. So it can be considered as an marker for the early diagnosis of AMI and evaluating the efficacy of thrombolytic therapy.