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目的观察急性冠状动脉综合征(ACS)患者急性期和恢复期凝血、抗凝血及血管内皮细胞功能有关指标,探讨ACS不同时期血液状态的变化。方法选取ACS患者62例,其中急性心肌梗死(AM I)30例,不稳定型心绞痛(UA)32例;恢复期58例,为急性期组随访观察患者。同时选取54例正常对照。抽取外周抗凝静脉血,测凝血酶原时间(PT)、凝血酶时间(TT)、部分凝血活酶时间(APTT)和纤维蛋白原(Fg)、血管性血友病因子(vWF)、6-酮-前列腺素F1α(6-k)、抗凝血酶-Ⅲ抗原(AT-ⅢAg)、抗凝血酶-Ⅲ活性(AT-ⅢA),就结果进行统计分析。结果急性期PT、TT和APTT有所缩短,但差异无显著性;恢复期APTT稍延长,PT与TT几乎无差别,两组Fg均显著升高;与急性期相比,恢复期的APTT显著延长。急性期AT-ⅢAg、AT-ⅢA和6-k显著降低,vWF显著增高,恢复期差异无显著性;与急性期相比,恢复期的AT-ⅢAg和AT-ⅢA显著上升,vWF显著下降,6-k稍有上升。结论ACS患者急性期和恢复期,均应给予抗凝、降纤等干预性治疗,同时亦应注意维护血管内皮细胞功能;vWF和6-k可以作为间接反映血管内皮细胞功能的指标。
Objective To observe the indexes of coagulation, anticoagulation and function of vascular endothelial cells in acute and convalescent patients with acute coronary syndrome (ACS), and to explore the changes of blood state in different periods of ACS. Methods Sixty-two ACS patients were selected, including 30 AMI patients and 32 unstable angina pectoris (UA) patients. The recovery period was 58 and was followed up in patients with acute phase. At the same time select 54 cases of normal control. Peripheral anticoagulant venous blood samples were collected to measure PT, TT, APTT and Fg, vWF 6 (6-k), antithrombin-Ⅲ antigen (AT-ⅢAg) and antithrombin-Ⅲ activity (AT-ⅢA) were measured and the results were statistically analyzed. Results The PT, TT and APTT were shortened in acute phase, but the difference was not significant. APTT was slightly prolonged in convalescent phase, almost no difference was found between PT and TT, and Fg in both groups was significantly increased. Compared with acute phase, APTT in convalescent phase was significantly extend. The levels of AT-ⅢAg, AT-ⅢA and 6-k in acute phase were significantly lower and vWF was significantly higher in recovery phase than those in acute phase. The levels of AT-ⅢAg and AT-ⅢA in convalescent phase were significantly increased, 6-k slightly increased. Conclusions ACS patients should be given anticoagulation and fibrinolysis preventive treatment in both acute and convalescent periods. VWF and 6-k may also serve as an indirect indicator of vascular endothelial function.