急性心肌梗塞溶栓疗法对血浆凝血活性影响的研究
【摘要】 目的
探讨溶栓疗法对血浆凝血活性的影响。方法
连续监测37例急性心肌梗塞病人，不管是否接受溶栓治疗，于确定诊断后定期从外周静脉采血，酶联免疫双抗体夹心法测定血浆凝血酶修饰抗凝血酶Ⅲ(antithrombin Ⅲmodified, ATM)和D-二聚体(D-D)的动态变化。结果
溶栓开始2小时后，血浆ATM显著性增加(85.80±24.59 μg/L比23.22±10.59 μg/L，P＜0.05)，4小时达峰植(116.98±33.65 μg/L)，持续3日以上；血浆D-D于2小时即达到峰值(6.75±2.41 mg/L比2.59±1.27 mg/L，P＜0.05)，维持8小时以上，24小时以后恢复正常。在溶栓组病人，不同采血时刻血浆ATM和D-D的平均值呈明显正相关。未溶栓组病人血浆ATM和D-D浓度未见显著性变化。结论
溶栓疗法激活凝血系统，与血栓溶解的标志物(D-D)呈明显正相关。本研究应用的抗栓措施和抗栓剂不足以抑制凝血系统的激活，早期应用有效抗血栓药物可能抑制凝血系统的激活，减少血栓再闭塞的发生。 Studies related to coagulation activation after thrombolytic therapy in acute myocardial infarction
XU Juntang*, HU Dayi, WENG Xinzhi, et al.* Beijing Red Cross Chaoyang Hospital, Beijing 100020 【Abstract】 Objective
This study was designed to dynamically observe the changes of haemostasis before and after thrombolytic therapy.Methods
Consecutive 37 patients presenting with acute myocardial infarction were included, 28 of which matched with the inclusion criteria for thrombolysis. Upon the diagnosis of acute myocardial infarction established, blood sampling was performed periodically, and plasma ATM (antithrombin Ⅲ modified) and D-D (D-Dimer) determined by ELISA.Results
Plasma ATM levels increased significantly (85.80±24.59 μg/L vs 23.22±10.59 μg/L, P＜0.05) 2 hours after thrombolytics administration, peaked 4 hours later at 116.98±33.65 μg/L, sustained for at least 3 days. Plasma D-D peaked in 2 hours (6.75±2.41 mg/L vs 2.59±1.27 mg/L， P＜0.05) and returned progressively to normal 12 hours after thrombolysis. A positive correlation was present between plasma ATM and D-D levels in thrombolytic patients. In patients without thrombolysis, no significant changes were found in plasma ATM and D-D levels during the whole monitoring period.Conclusion
