【摘要】 目的探讨华法林溶解左心耳血栓的机制。方法慢性非瓣膜性房颤患者18例,经食管超声心动图(TEE)检查证实有左心耳血栓形成,华法林治疗3~6个月,观察其对左心耳血栓的影响,测定治疗前后血浆纤维蛋白原(Fg)、血管性血友病因子(vWF)、D二聚体(DD)、血小板颗粒膜糖蛋白140(GMP140)、凝血酶抗凝血酶Ⅲ复合物(TAT)和纤溶酶原激活物抑制物1(PAI1);应用TEE测定治疗前后左心耳血流速度和左室射血分数。结果华法林治疗(INR210±014)后,9444%患者左心耳血栓消失;与治疗前比较,血浆DD明显减低〔(182±083)mg/Lvs(133±041)mg/L,P<005〕;左心耳充盈血流速度〔(4271±1470)cm/svs(5622±1753)cm/s,P<005〕和排空血流速度〔(3215±1405)cm/svs(4536±1682)cm/s,P<005〕显著增加,左室射血分数增加〔(053±016)vs(058±016)P<001〕。结论华法林抗凝治疗可使非瓣膜性房颤患者左心耳血栓溶解消失,其机制可能是华法林抑制凝血系统后,抗凝纤溶活性相对增强使血栓溶解,左心耳血流动力学改善。更多还原

【Abstract】 Objective To study the mechanism of left atrial appendage thrombi resolution after anticoagulation with warfarin. Methods Eighteen chronic nonvalvular atrial fibrillation patients with left atrial appendage thrombus, diagnosed by transesophageal echocardiography (TEE), were treated by warfarin for 3~6 months. Plasma fibrinogen (Fg), vov Willebrand factor (vWF), D-dimer (DD), thrombin-antithrombin complexes (TAT) and plasminogen activator inhibitor-1(PAI-1)were measured before and after treatment. Blood flow velocity in left atrial appendage and left ventricle ejection fraction was measured by TEE. Results Left atrial appendage thrombus had been completely resolved in 94.44% of patients after therapy with warfarin (INR 2.10±0.14). Plasma DD level decreased 〔(1.82±0.83)mg/L vs (1.33±0.41)mg/L, P<0.05〕, and left atrial appendage emptying velocity〔(32.15±14.05)cm/s vs (45.36±16.82)cm/s, P<0.05〕, filling velocity〔(42.71±14.70)cm/s vs (56.22±17.53)cm/s, P<0.05〕 and left ventricular ejection fraction (0.53±0.16 vs 0.58±0.16, P<0.01) increased significantly comparing with those baseline data. Conclusions Warfarin therapy could resolve left atrial appendage thrombus in patients with chronic nonvalvular atrial fibrillation. The coagulation system may be inhibited and the anticoagulation-fibrinolysis system may be relatively enhanced by warfarin therapy. Improved haemodynamics of left atrial appendage may help regression of thrombus.更多还原