Wu Wo-dong, Xu Yun-hong, Tan Pei-yi
Department of Cardiology, Guangzhou Second Municipal People's Hospital, Guangzhou 510150, Guangdong, China.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2003 Aug;15(8):472-5.
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.
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+noninsulin-dependent diabetes mellitus (NIDDM). Twenty healthy people were randomized to be control group. The plasma levels of tissue type plasminogen activator (t-PA), plasminogen activator inhibitor type-1 (PAI-1) and plasma D-dimer were detected by enzyme linked immunoadsorbent assay (ELISA) technique. The index of status of fibrinolysis was detected with the plasma levels of PAI-1, D-dimer and the ratio of PAI-1/D-dimer. This index was used to evaluate the status of fibrinolytic inhibition and the clinical out come in patients with AMI.
Plasma level of PAI-1 was significantly higher in IGT+ACS patients and NIDDM +ACS patients than that in ACS(P<0.05), but the plasma level of D-dimer 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 PAI-1/D-dimer 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, re-infarction and death were also higher in IGT+ACS patients and NIDDM +ACS patients.
The fibrinolytic inhibition is existed in IGT+ACS group patients. The plasma level of D-dimer combined with the ratio of PAI-1/D-dimer could be used to be the evidence and to be the index to evaluate the status of fibrinolytic inhibition and prognosis.
研究急性冠状动脉综合征（ACS）合并糖耐量受损（IGT）患者纤溶抑制状态，并评估纤溶抑制对治疗及预后的影响。
将研究对象分为三组，包括39例无糖尿病的ACS患者、37例IGT + ACS患者和36例ACS + 非胰岛素依赖型糖尿病（NIDDM）患者。随机选取20名健康人作为对照组。采用酶联免疫吸附测定（ELISA）技术检测血浆组织型纤溶酶原激活物（t-PA）、纤溶酶原激活物抑制剂-1（PAI-1）水平及血浆D-二聚体水平。用PAI-1、D-二聚体血浆水平及PAI-1/D-二聚体比值检测纤溶状态指标。该指标用于评估急性心肌梗死（AMI）患者的纤溶抑制状态及临床结局。
IGT + ACS患者和NIDDM + ACS患者的血浆PAI-1水平显著高于ACS患者（P < 0.05），但IGT + ACS患者和NIDDM + ACS患者从基础水平升高的血浆D-二聚体水平显著低于ACS患者（P < 0.05）。IGT + ACS患者和NIDDM + ACS患者的PAI-1/D-二聚体比值显著高于ACS患者或对照组（P < 0.01）。对于治疗组中的AMI患者，IGT + ACS患者和NIDDM + ACS患者溶栓后的再灌注率显著更低，泵衰竭发生率也显著高于ACS患者（P < 0.01和P < 0.05）。IGT + ACS患者和NIDDM + ACS患者严重心律失常、再梗死及死亡的发生率也更高。
IGT + ACS组患者存在纤溶抑制。血浆D-二聚体水平联合PAI-1/D-二聚体比值可作为评估纤溶抑制状态及预后的依据和指标。
