Andreotti F, Hackett D R, Haider A W, Roncaglioni M C, Davies G J, Beacham J L, Kluft C, Maseri A
Royal Postgraduate Medical School, Hammersmith Hospital, London, U.K.
Thromb Haemost. 1992 Dec 7;68(6):678-82.
Plasma von Willebrand factor, plasminogen activator inhibitor activity and C-reactive protein were assessed as markers of coronary recanalisation in 30 patients with acute myocardial infarction receiving tissue-type plasminogen activator (t-PA). Blood samples were taken before t-PA (time 0), 4-hourly for 24 h and daily up to 72 h. A continuous electrocardiogram was recorded in the first 24 h. Coronary arteriography was performed 90 min and 24 h after the start of t-PA. Patients with a patent infarct artery (n = 17), compared to those with occluded artery (n = 13), showed a fall in von Willebrand factor from 0 to 24 h (p = 0.001), a greater fall in plasminogen activator inhibitor from 24 to 48 h (p = 0.04) and a fall in C-reactive protein from 48 to 72 h (p = 0.002). The accuracy of these indices compared favourably with time to peak plasma MB creatine kinase and > or = 50% resolution of maximal ST-deviation on the electrocardiogram. Thus, changes in plasma von Willebrand factor, plasminogen activator inhibitor and C-reactive protein during the first 3 days of myocardial infarction are indicative of thrombolytic efficacy. Their concordant behaviour may reflect a common regulatory mechanism.
对30例接受组织型纤溶酶原激活剂（t-PA）治疗的急性心肌梗死患者，检测血浆血管性血友病因子、纤溶酶原激活物抑制剂活性和C反应蛋白，作为冠状动脉再通的标志物。在t-PA治疗前（时间0）、治疗后24小时内每4小时以及直至72小时每天采集血样。在最初24小时内记录连续心电图。在t-PA开始治疗后90分钟和24小时进行冠状动脉造影。与梗死动脉闭塞的患者（n = 13）相比，梗死动脉通畅的患者（n = 17）在0至24小时血管性血友病因子下降（p = 0.001），在24至48小时纤溶酶原激活物抑制剂下降幅度更大（p = 0.04），在48至72小时C反应蛋白下降（p = 0.002）。这些指标的准确性与血浆肌酸激酶MB峰值出现时间以及心电图上最大ST段偏移≥50%的缓解情况相比更优。因此，心肌梗死最初3天内血浆血管性血友病因子、纤溶酶原激活物抑制剂和C反应蛋白的变化表明溶栓疗效。它们一致的变化可能反映了一种共同的调节机制。
