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目的探讨D-二聚体在急性心肌梗死时冠状动脉血栓自溶再通的演变及意义。方法选择4所医院急性心肌梗死(AMI)患者80例,根据治疗方式及冠状动脉造影结果,将患者分为药物溶栓再通组(A组,29例),血栓自溶再通组(B组,30例)及非溶栓组(C组,21例)。各组在治疗前后1、2、4、8、24和48h检测D-二聚体、肌酸激酶同工酶(CK-MB)、肌钙蛋白I、凝血酶原时间等。A组采用重组组织型纤溶酶原激活剂进行静脉溶栓治疗,B组、C组静脉滴注等量生理盐水。结果 3组患者发生AMI后CK-MB和肌钙蛋白I水平均显著增高,与C组比较,A组D-二聚体浓度1、2、4、8h显著升高[(4.31±0.94)mg/L vs(0.89±0.12)mg/L,(5.21±1.06)mg/L vs(1.55±0.43)mg/L,(7.56±1.53)mg/L vs(0.93±0.12)mg/L,(4.33±0.99)mg/L vs(0.61±0.17)mg/L],B组D-二聚体浓度1、2h显著升高[(3.69±0.86)mg/L vs(0.89±0.12)mg/L,(2.39±0.66)mg/L vs(1.55±0.43)mg/L];与B组比较,A组D-二聚体浓度2、4、8、24h显著升高(P<0.05,P<0.01)。C组在相同时间点无显著变化。结论治疗AMI时,D-二聚体浓度变化在药物溶栓再通与血栓自溶再通有显著不同,可作为判断溶栓疗效的指标。
Objective To investigate the evolution and significance of D-dimer recanalization of coronary artery thrombosis after acute myocardial infarction. Methods Eighty patients with acute myocardial infarction (AMI) were selected from four hospitals. Patients were divided into two groups: group A (n = 29), group B Group, 30 cases) and non thrombolysis group (C group, 21 cases). D-dimer, creatine kinase (CK-MB), troponin I, prothrombin time were detected in each group before, 1, 2, 4, 8, 24 and 48 hours after treatment. Group A received recombinant tissue plasminogen activator for intravenous thrombolysis, and group B and group C received intravenous infusion of normal saline. Results Compared with group C, the levels of CK-MB and troponin I in group A were significantly increased after AMI (P <0.05), and the concentration of D-dimer in group A was significantly increased at 1, 2, 4 and 8 hours [(4.31 ± 0.94) mg / L vs (0.89 ± 0.12) mg / L vs (5.21 ± 1.06) mg / L vs (1.55 ± 0.43) mg / L vs (7.56 ± 1.53) mg / L vs ± 0.99 mg / L vs 0.61 ± 0.17 mg / L, respectively. The D-dimer concentration in group B was significantly increased at 1 and 2 hours (3.69 ± 0.86 mg / L vs 0.89 ± 0.12 mg / L, (2.39 ± 0.66) mg / L vs (1.55 ± 0.43) mg / L]. Compared with group B, the concentration of D-dimer in group A increased significantly at 2,4,8 and 24 hours (P < ). There was no significant change in group C at the same time point. Conclusions In the treatment of AMI, the change of D-dimer concentration is significantly different between drug thrombolytic recanalization and thrombolysis and recanalization, which can be used as an index to judge the effect of thrombolytic therapy.