【摘要】 目的:探讨合并Ⅱ型糖尿病(NIDDM)急性心肌梗死(AMI)患者中医介入溶栓治疗对改善纤溶受抑及临床预后的作用:方法:分正常对照组20例,治疗组分非糖尿病AMI组23例,非中医介入NIDDM+AMI组22例,中医介入NIDDM+AMI组24例。中医介入患者按证属与溶栓同步给与生脉或参附注射液,与抗凝治疗同步给于葛根素注射液。检测各组患者组织型纤溶酶原激活剂(t-PA),纤溶酶原激活物抑制剂-1(PAI-1),及D-二聚体(D-dimer)的血浆水平并计算PAI-1/D-dimer百分比。观察中医介入溶栓治疗后纤溶的指标和临床预后:结果:Ⅱ型糖尿病AMI患者PAI-1显著高于对照组及非糖尿病AMI组P<0.05,D-dimer上升幅值则显著低于非糖尿病AMI组P<0.05,PAI-1/D-dimer比值百分数也分别显著高于对照组及非糖尿病AMI组P<0.01。中医介入NIDDM+AMI组,中医介入溶栓后,PAI-1,D-dimer及PAI-1/D-dimer的纤溶及临床指标与非糖尿病AMI组比较无显箸差异,P>0.05,非中医介入NIDDM+AMI组的纤溶及临床指标与非糖尿病组比较有显著差异,P<0.05:结论:中医介入治疗可改善Ⅱ型糖尿病患者纤溶受抑状态及临床预后。D-dimer及PAI-1/D-dimer百分比能反映Ⅱ型糖尿病AMI患者纤溶受抑状态及对治疗及预后的影响。更多还原

【Abstract】 Objective: To study the status of fibrinolytic inhibition in patients of acute myocardiac infarction (AMI) complicated with type Ⅱ diabetes mellitus ( NIDDM ) and to evaluate the effect of Chinese traditional medicine ( C . T. M)combined with the general thrombolysic therapy to the fibrinolytic status and clinical prognosis. Methods: The subjects were divided into control group with 20 cases of health people and treatment groups with 23 cases of none NIDDM + AMI patients, 22 cases of MDDM + AMI patients without using C.T.M, 24 cases of NIDDM + AMI patients using C.T.M. The C.T.M in replenishing qi and invigorating pulse-beat had been used with the general thrombolysic therapy synchronously and the treatment of activating blood circulation and dissipated blood stasis had been followed. The plasma level of tissue type plasminogen activator (t-PA), plasminogen activator inhibitor type-1 (PAI -1 )and plasma D-dimer were detected by using Elisa technique.The index of status in fibrinolysis was detected with the plasma level of PAI -1 , D-dimer and the rate of PAI -1/ D-dimer in percentage.This indexes was used to evaluated the status of fibrinolytic inhibition and the clinical outcome. Result The plasma level of PAI-1 was significantly higher in NIDDM + AMI patients than that was in control group or none NIDDM + AMI patients, p<0.05, but the plasma level of D-dimer raised from basic level was significantly lower in NIDDM + AMI patients than that was in none NIDDM + AMI patients, p < 0.05. The rate of PAI -I/ D-dimer in percentage was signifi- cantly higher in NIDDM + AMI patients than that was in control group and none NIDDM + AMI patients, p < 0.01. After thrombolysis there were no significant difference in MDDM + AMI patients intervened with C.T.M comparing with none NIDDM + AMI patients in the indexes of fibrinolysis, and in the clinical outcome, p > 0.05. Conclusion: The status of fibinolytic inhibition and the clinical outcome could be improved with the throm-bolysic therapy intervened with C. T. M.The plasma level of D-dimer combined with the rate of PAI -1/ D-dimer in percentage, could be used to evaluated the effect of the chinese traditional medicine to the fibrinolytic status and the clinical prognosis.更多还原