急性心肌梗塞溶栓前后凝血纤溶指标的变化及临床意义

目的　探讨急性心肌梗塞 (AMI)患者溶栓治疗对其凝血纤溶功能的影响及临床意义。方法　选择 1 2h内急性心肌梗塞患者 3 0例 ,用重组链激酶 (r SK) 1 5 0万U进行溶栓治疗 ,并按临床判断再通标准将其分为溶栓再通组和未通组 ,观察其溶栓前后血浆组织型纤溶酶原激活物 (t PA)、纤溶酶原激活抑制物 (PAI)活性 ,D 二聚体 (D Dimer)及纤维蛋白原 (Fg)含量变化。结果　溶栓再通组溶栓后血浆t PA活性较溶栓前明显升高 ,PAI活性明显减低 ,而未通组溶栓前后t PA、PAI活性无明显变化。两组溶栓后血浆D Dimer较溶栓前均有明显升高 ,且组间升高程度无显著差异。结论　①溶栓后t PA活性升高 ,PAI活性减低可能预示冠脉再通。②溶栓后D Dimer含量升高提示溶栓后有凝血酶的进一步激活 ,但该项指标不能视为溶栓效果的判定标准

Changes and clinical significance of coagulant and fibrinolytic function before and after thromboyltic therapy in patients with acute myocardial infarction

Objective To explore the effects and clinical significance of thrombolysis with intravenous recombinant streptokinase on coagulant and fibrinolytic function in acute myocardial infarction. Methods Thirty patients with acute myocardial infarction were recruited and underwent thromboyltic therapy with intravenous r SK within 12 hours after onset. The patency of infarct related coronary artery was assessed by uniform clinical criteria. According to the patency or nonpatency of their infarct related coronary artery the patients were divided into two groups. The activity of plasma tissue type plasminogen activator (t PA), plasminogen activator inhibitor (PAI) and the concentration of D Dimer and fibrinogen (Fg) were determined before and after thrombolysis, respectively.Results ①In patients with patency, the plasma activity of t PA increased significantly after thrombolysis as compared with that before thrombolysis. On the other hand, the activity of PAI was reduced obviously. In patients without patency, the activity of t PA and PAI had no significant change. ②The concentration of D Dimer was significantly higher in the two patient groups after thrombolysis than before thrombolysis, but there was no significant difference between the two groups.Conclusion ①The plasma activity of t PA increased significantly and PAI reduced obviously after thrombolysis, suggesting that the above two parameters might predict the patency. ②The D Dimer was high after thrombolysis. This indicates that function of coagulantion could be further activated after thrombolysis. They may not be used as the criteria of the effect of thrombolysis