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目的:评价中老年非瓣膜病心房颤动(房颤)患者的凝血-纤溶功能。方法:选择92例中老年非瓣膜病房颤患者(房颤组)和60例窦性心律者(对照组),采用免疫比浊法测定血浆D-二聚体(D-Dimer)水平,采用酶联免疫吸附双抗体夹心法(ELISA法)测定血浆组织型纤溶酶原激活物(t-PA)及纤溶酶原激活剂抑制物1(PAI-1)水平。单因素分析方法分析两组间各指标的差异,对可能影响D-Dimer、t-PA、PAI-1水平的性别、年龄和血清肌酐、尿酸、血糖、甘油三酯、胆固醇等因素采用协方差方法分析。结果:①单因素分析,房颤组D-Dimer[(0.16±0.10)mg.L-1]、t-PA[(42.58±30.28)μg.L-1]和PAI-1[(86.03±21.43)μg.L-1]水平均显著高于对照组[(0.10±0.08)mg.L-1,(26.02±13.84)μg.L-1和(64.94±24.35)μg.L-1]。房颤组PAI-1/t-PA比值略高于对照组(P>0.05)。②多因素分析调整影响因素后,房颤组D-Dimer(P=0.047)、t-PA(P=0.264)和PAI-1(P=0.001)水平仍高于对照组,但t-PA差异无显著性(P>0.05)。结论:中老年非瓣膜病房颤患者存在凝血-纤溶系统失衡,血液处于高凝、低纤溶状态。
Objective: To evaluate the coagulation-fibrinolytic function in patients with non-valvular atrial fibrillation (AF) in middle-aged and elderly patients. Methods: Ninety-two elderly AF patients with atrial fibrillation (AF group) and 60 patients with sinus rhythm (control group) were enrolled in this study. Plasma D-Dimer level was measured by immunoturbidimetry. The level of t-PA and PAI-1 in plasma was determined by enzyme-linked immunosorbent assay (ELISA). Univariate analysis was used to analyze the differences between the two groups. Covariance was used for the factors such as gender, age, serum creatinine, uric acid, blood glucose, triglyceride and cholesterol, which might affect the level of D-Dimer, t-PA and PAI- Methodological analysis. RESULTS: ① In univariate analysis, D-Dimer [(0.16 ± 0.10) mg.L-1], t PA (42.58 ± 30.28) μg.L-1 and PAI-1 [(86.03 ± 21.43 ) μg.L-1] were significantly higher than those in the control group [(0.10 ± 0.08) mg.L-1, (26.02 ± 13.84) μg.L-1 and (64.94 ± 24.35) μg.L-1], respectively. The PAI-1 / t-PA ratio in AF group was slightly higher than that in control group (P> 0.05). (2) Multivariate analysis The levels of D-Dimer (P = 0.047), t-PA (P = 0.264) and PAI-1 (P = 0.001) were still higher in AF group than those in control group No significant (P> 0.05). Conclusion: The coagulation-fibrinolytic system is unbalanced in patients with atrial fibrillation in middle-aged and elderly patients with non-valvular disease. The blood is hypercoagulable and fibrinolytic.