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目的 观察急性心肌梗死 (AMI)患者脂蛋白的 (a) [LP(a) ]与凝血和纤溶功能的关系以及尿激酶溶栓治疗对其影响。方法 采用酶联免疫吸附双抗体夹心法 (ELISA)检测 2 0例AMI、30例稳定型心绞痛 (SAP)、8例不稳定型心绞痛(UAP)患者和 2 0例健康人以及AMI溶栓后的血清LP(a)、血浆D -二聚体 (DD)、纤维蛋白单体 (FM)和组织型纤溶酶原激活剂(t-PA)浓度。结果 AMI、UAP和SAP患者的LP(a)、DD和FM较对照组明显增高 ,而t-PA明显降低 (P <0 0 1) ;AMI合并心衰、心源性休克和严重心律失常以及梗死面积较大者的LP(a)、DD和FM均显著增高 ,t-PA下降。AMI溶栓后梗死相关动脉(IRA)再通者的FM和LP(a)明显下降 ,DD和t-PA在早期明显升高。未溶栓组的LP(a)与DD呈正相关 (r=0 47,P <0 0 1) ,与t-PA呈负相关 (r=0 5 2 ,P <0 0 1)。溶栓未通组的LP(a)与DD呈正相关 (r=0 38,P <0 0 1)。溶栓再通组的LP(a)与t-PA呈正相关 (r=0 37,P <0 0 5 )。结论 冠心病患者 ,特别是急性心肌缺血患者体内存在凝血活性增强 ,纤溶活性下降 ,与升高的LP(a)一起可加重其病理生理过程。尿激酶 (UK)溶栓治疗对AMI患者可产生有利的影响 ,能在一定程度上纠正凝血和纤溶功能紊乱 ;AMI溶栓后早期出现DD和t-PA浓度明显升高可能提示IRA再通。
Objective To investigate the relationship between (a) [LP (a)] and coagulation and fibrinolysis in patients with acute myocardial infarction (AMI) and the effect of urokinase thrombolysis on them. Methods Twenty patients with AMI, 30 patients with stable angina pectoris (SAP), 8 patients with unstable angina pectoris (UAP) and 20 healthy controls were enrolled in the study. Serum LP (a), plasma D-dimer (DD), fibrin monomer (FM) and tissue-type plasminogen activator (t-PA) concentrations. Results LP (a), DD and FM in patients with AMI, UAP and SAP were significantly higher than those in control group, but t-PA was significantly lower (P <0.01); AMI with heart failure, cardiogenic shock and severe arrhythmia and LP (a), DD and FM were significantly higher in infarcted area and t-PA decreased. After AMI thrombolysis infarction related artery (IRA) recanalization of FM and LP (a) decreased significantly, DD and t-PA increased significantly in the early. There was a positive correlation between LP (a) and DD in the group without thrombolysis (r = 0 47, P 0 01) and a negative correlation with t PA (r 0 52, P 0 01). There was a positive correlation between LP (a) and DD in thrombolytic group (r = 0 38, P <0.01). The thrombolysis recanalization group LP (a) and t-PA was positively correlated (r = 0 37, P <0 05). Conclusion In patients with coronary heart disease, especially in patients with acute myocardial ischemia, coagulation activity is enhanced and fibrinolytic activity is decreased. Together with the elevated LP (a), it may aggravate the pathophysiological process. Urokinase (UK) thrombolytic therapy can have beneficial effects on patients with AMI, to a certain extent, to correct the coagulation and fibrinolytic disorders; AMI thrombolytic early DD and t-PA concentrations significantly increased may prompt IRA recanalization .