【摘要】 目的 :探讨合并糖耐量减低 (IGT)的急性冠状动脉综合征 (ACS)患者纤溶受抑状态及其对治疗和预后的影响。方法 :非糖尿病 ACS组 39例 ,IGT+ACS组 37例 ,非胰岛素依赖性糖尿病 (NIDDM) +ACS组 36例 ;同时设正常对照组 2 0例 ,检测各组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 二聚体的血浆水平 ,并计算 PAI 1/ D 二聚体百分比。观察各组急性心肌梗死 (AMI)患者的临床及预后。结果 :IGT+ACS及 NIDDM+ACS组的 PAI 1显著高于正常对照组和 ACS组 (P均 <0 .0 5 ) ,而 D 二聚体上升幅值则显著低于 ACS组 (P<0 .0 5 ) ,两组 PAI 1/ D 二聚体比值也均显著高于正常对照组及 ACS组(P均 <0 .0 1)。两糖代谢异常组溶栓再通比例显著低于 ACS组 (P<0 .0 1) ,泵衰竭的发生率显著高于 ACS组(P<0 .0 5 )。结论 :IGT的 ACS患者存在纤溶受抑状态。 D二聚体血浆水平结合 PAI 1/ D二聚体比值能反映患者纤溶受抑的状态及预后。更多还原

【Abstract】 Objective: To study the status of fibrinolytic inhibition in patients with acute coronary syndrome(ACS) complicated with impaired glucose tolerance (IGT) and to evaluate the effect of fibrinolytic inhibition on treatment and prognosis. Methods: The subjects were divided into three groups included 39 patients with ACS without diabetes mellitus, 37 patients with IGT+ACS and 36 patients with ACS+ noninsulindependent diabetes mellitus (NIDDM). Twenty healthy people were randomized to be control group. The plasma levels of tissue type plasminogen activator(tPA), plasminogen activator inhibitor type1 (PAI1) and plasma Ddimer were detected by enzyme linked immunoadsorbent assay(ELISA) technique. The index of status of fibrinolysis was detected with the plasma levels of PAI1, Ddimer and the ratio of PAI1/Ddimer. This index was used to evaluate the status of fibrinolytic inhibition and the clinical out come in patients with AMI. Results: Plasma level of PAI1 was significantly higher in IGT+ACS patients and NIDDM +ACS patients than that in ACS( P <0 05), but the plasma level of Ddimer raised from basic level was significantly lower in IGT+ACS patients and NIDDM +ACS patients than that in ACS( P <0 05). The ratio of PAI1/Ddimer was significantly higher in IGT+ACS patients and NIDDM +ACS patients than that in ACS or in control group( P <0 01). For AMI patients in treatment groups, the rate of reperfusion after the thrombolytic was significantly lower and the rate of incidences in pump failure was significantly higher in IGT+ACS patients and NIDDM +ACS patients than that in ACS, too( P <0 01 and P <0 05) . The incidences of serious arrhythmia, reinfarction and death were also higher in IGT+ACS patients and NIDDM +ACS patients. Conclusion: The fibrinolytic inhibition is existed in IGT+ACS group patients . The plasma level of Ddimer combined with the ratio of PAI1/Ddimer could be used to be the evidence and to be the index to evaluate the status of fibrinolytic inhibition and prognosis.更多还原