【摘要】 目的　探讨急性冠状动脉综合征（ＡＣＳ） 患者内皮组织纤溶酶原激活剂（ｔＰＡ） 储备功能的变化规律。方法　３５ 例ＡＣＳ患者， 其中急性心肌梗死１５ 例和不稳定心绞痛２０ 例，于入院当日和入院后第１０ 天采集静脉血样以测定纤溶、凝血指标，以评价内皮ｔＰＡ储备功能；同时做静脉闭塞试验以确定最大内皮ｔＰＡ释放，并与稳定性心绞痛（ＳＡＰ） 和正常人作对比。结果　ＡＣＳ患者ｔＰＡ含量、纤溶酶原激活剂抑制物１（ＰＡＩ１）活性、Ｄ二聚体含量、凝血酶抗凝血酶Ⅲ复合物（ＴＡＴ） 含量均较ＳＡＰ和正常人明显为高；最大内皮ｔＰＡ释放于入院当日降低为（２．２ ±０．８） μｇ／Ｌ（同ＳＡＰ组比较，Ｐ＜ ０．０１），第１０ 天恢复至（４．５ ±１．２） μｇ／Ｌ（ 同ＳＡＰ组比较，Ｐ＞ ０．０５） 。结论　ＡＣＳ患者全身纤溶紊乱持续时间较长，但内皮ｔＰＡ储备功能仅在急性阶段下降，随后恢复正常。说明血管内血栓形成与内皮纤溶功能紊乱的联系要比全身纤溶指标的变化更为密切，在ＡＣＳ患者早期纠正内皮纤溶功能异常更为重要。更多还原

【Abstract】 Objective To study the changes of the endothelial tissue plasminogen activator (tPA) reserve capacity in patients with acute coronary syndromes (ACS). Methods Veinous blood was sampled for determination of markers of the fibrinolytic system and hypercoagulability at admission and on the 10th day in patients with acute coronary syndrome (ACS), including acute myocardial infarction (AMI) in 15 and unstable angina pectoris (UAP) in 20. An occlusion test to determine the maximal endothelial tPA release was performed in order to evaluate the endothelial tPA reserve capacity. 20 patients with stable angina pectoris ( SAP) and 12 normal subjects served as control. Results Patients with ACS had higher levels of tPA mass concentration, PAI 1 activity, D dimers mass concentration and TAT mass concentration at admission and on the 10th day as compared with those in SAP and normal subjects. Maximal endothelial tPA release was initially reduced to (2.2±0.8) μg/L ( P <0 01,vs patients with SAP), but the levels recovered on the 10th day of follow up to (4.5±1.2) μg/L ( P >0.05, vs patients with SAP). Conclusion Endothelial tPA reserve capacity is reduced only during the acute phase and becomes normalized during follow up. The alterations of plasma markers of systemic fibrinolysis persist longer in patients with ACS. The results demonstrated that the intravascular thrombus formation may relate more to the disturbance of endothelial fibrinolysis than to markers of the systemic fibrinolytic system. It is very important to correct the disturbances of endothelial fibrinolysis during the acute phase of ACS.更多还原