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目的探讨溶栓疗法对血浆凝血活性的影响。方法连续监测35例急性心肌梗死患者,于确诊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(antithrombinⅢ modified,ATM)和D二-聚体(D-D)的动态变化。结果溶栓开始2 h后,血浆ATM显著性增加(87.80±25.19)μg/L,比(24.48±11.62)μg/L,(P<0.05),4 h达峰值(120.87±31.54)μg/L,持续3 d以上;血浆D-D于2 h即达到峰值(7.76±2.58)mg/L,比(2.7±1.36)mg/L,(P<0.05),维护8 h以上,24 h以后恢复正常。在溶栓组患者,不同采血时刻血浆ATM和D-D的平均值呈明显正相关。未溶栓组患者血浆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。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。
Objective To investigate the effect of thrombolytic therapy on plasma coagulation activity. Methods Thirty - five patients with acute myocardial infarction were continuously monitored. Peripheral venous blood samples were collected periodically after diagnosis. The levels of plasma thrombin - modified antithrombin Ⅲ modified (ATM) and D - dimer (DD) were measured by enzyme linked immunosorbent assay (ELISA) ) Of the dynamic changes. Results After 2 h of thrombolysis, plasma ATM significantly increased (87.80 ± 25.19) μg / L, (24.48 ± 11.62) μg / L, (P <0.05) and peaked at 4 h (120.87 ± 31.54) μg / L (P <0.05). The plasma DD reached the peak value of 7.76 ± 2.58 mg / L at 2 h (P <0.05), maintained for more than 8 h and returned to normal after 24 h. In the thrombolytic group, there was a significant positive correlation between plasma ATM and D-D at different blood sampling times. Plasma concentrations of ATM and D-D did not change significantly in patients without thrombolysis. Conclusion Thrombolytic therapy activates the coagulation system and has a positive correlation with thrombolytic markers (D-D). Early use of effective anti-thrombotic drugs may inhibit the activation of the coagulation system and reduce the occurrence of thrombus reocclusion.