不稳定型心绞痛患者凝血纤溶活性及冠状动脉斑块形态的关系及其临床意义
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The Association And Signification Between Coagulative-Fibrinolytic Activity And Angiographic Morphology Of Coronary Lesions In Patients With Unstable Angina Pectoris
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    摘要:

    目的探讨不稳定性心绞痛患者不同形态斑块的稳定性及对疾病转归的预测价值。方法85例不稳定性心绞痛患者根据冠状动脉造影结果分为I型病变组(21例)、Ⅱ型病变组(45例)、Ⅲ型病变组(19例),40例冠状动脉造影排除冠心病者为对照组,均测定血浆Ⅶ因子凝血活性及组织型纤溶酶原激活物、纤溶酶原激活物抑制物、纤维蛋白原和D二聚体值;其中56例不稳定型心绞痛患者随诊一年,观测预后。结果不稳定性心绞痛患者血浆凝血纤溶因子较正常对照组明显异常,其中Ⅱ型病变组Ⅶ因子凝血活性、纤维蛋白原、纤溶酶原激活物抑制物较其他两组明显升高、组织型纤溶酶原激活物有所下降(p<0.05);D二聚体改变无显著性(p>0.05)。一年内急性心肌梗塞和心源性猝死的发生率亦明显高于其它两型(p<0.01)。结论冠状动脉造影不同形态斑块凝血纤溶活性明显不同,可以作为判断不稳定型心绞痛斑块稳定性及疾病转归的重要手段。

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    Aim To explore the stability of different morphologic types of plaque and its predict value in unstable angina. Methods 85 unstable angina patients and 40 control subject underwent coronary angiography.According to the morphologic types of plaque,the patients with unstable angina were divided into type I(smooth borders) group(n=21) and type Ⅱ (irregular lesions) group(n=45) and type Ⅲ(long lesions) group(n=19).The plasma factor Ⅶ clotting activity and the plasma concentrations of tissue type plasminogen activator(tPA),plasminogen activator inhibitor(PAI),fibrinogen(FG) and D-dimer were measured respectively.56 unstable angina patients were follow-up one year. Results The plasma coagulative and fibrinolytic parameters of the unstable angina group was more extraordinary than those of the control group.In unstable angina group,the coagulative activity of type Ⅱ group was higher than type I and type Ⅲ group(p<0.05) and cardiac events such as acute myocardial infarction and sudden cardiac death were also higher within one year(p<0.01). Conclusion Each morphologic types of plaque were different in both coagulative and fibrinolytic activity and can be used to judge the stability of unstable angina's plaque and to predict prognosis.

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王峻,姜德谦,方臻飞,张志辉,沈向前,胡信群.不稳定型心绞痛患者凝血纤溶活性及冠状动脉斑块形态的关系及其临床意义[J].中国动脉硬化杂志,2005,13(6):767~770.

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  • 收稿日期:2004-05-03
  • 最后修改日期:2005-11-20
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