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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(antithrombinⅢmodified,ATM)和D-二聚体(D-D)的动态变化。结果溶栓开始2h后,血浆ATM显著内性增加(87.80μg/L±25.19μg/L,比24.48μg/L±11.62μg/L,P<0.05),4h达峰值(120.87μg/L±31.54μg/L),持续3d以上;血浆D-D于2h即达到峰值(7.76mg/L±2.58mg/L,比2.7mg/L±1.36mg/L,P<0.05),维护8h以上,24h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。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 plasma concentrations of antithrombin Ⅲ -modified (ATM) and D-dimer (DD) were measured by enzyme linked immunosorbent assay (ELISA) Dynamic changes. Results After 2h of thrombolysis, plasma ATM significantly increased (87.80μg / L ± 25.19μg / L, 24.48μg / L ± 11.62μg / L, P <0.05) and peaked at 4h (120.87μg / L ± 31.54 μg / L) for more than 3 days. Plasma DD peaked at 2h (7.76mg / L ± 2.58mg / L, more than 2.7mg / L ± 1.36mg / L, P <0.05) normal. 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.