血浆纤溶酶原激活物抑制剂：复发性心肌梗死的危险因素。

Plasminogen activator inhibitor in plasma: risk factor for recurrent myocardial infarction.

作者信息

Hamsten A, de Faire U, Walldius G, Dahlén G, Szamosi A, Landou C, Blombäck M, Wiman B

出版信息

Lancet. 1987 Jul 4;2(8549):3-9. doi: 10.1016/s0140-6736(87)93050-9.

Abstract

Measurements of haemostatic function and metabolic and angiographic indices of risk were included in a prospective cohort study of variables predictive of recurrences within 3 years in 109 unselected men with a first myocardial infarction (MI) before the age of 45. In the course of follow-up, 16 patients had at least one reinfarction (fatal recurrences in 9 and nonfatal in 7) and 1 died suddenly. High plasma concentrations of the fast-acting plasminogen activator inhibitor were independently related to reinfarction along with dyslipoproteinaemia involving VLDL and HDL, poor left ventricular performance, and multiple-vessel coronary artery disease. Besides being independently associated with reinfarction in the present population, high triglyceride levels were possibly connected with a predisposition to thrombosis through a coexisting high level of plasminogen activator inhibitor. The data indicate that reduced fibrinolytic capacity due to increased plasma levels of the plasminogen activator inhibitor predisposes to reinfarction in a complex interplay with atherogenic factors, multiple coronary lesions, and compromised left ventricular function.

摘要

对109名45岁以前首次发生心肌梗死（MI）的未经过挑选的男性进行了一项前瞻性队列研究，其中包括止血功能、代谢及血管造影风险指标的测量。在随访过程中，16例患者至少发生了一次再梗死（9例为致命性复发，7例为非致命性复发），1例猝死。快速作用的纤溶酶原激活物抑制剂的高血浆浓度与再梗死独立相关，同时伴有涉及极低密度脂蛋白（VLDL）和高密度脂蛋白（HDL）的血脂异常、左心室功能不佳以及多支冠状动脉疾病。除了在当前人群中与再梗死独立相关外，高甘油三酯水平可能通过同时存在的高水平纤溶酶原激活物抑制剂而与血栓形成倾向有关。数据表明，由于血浆纤溶酶原激活物抑制剂水平升高导致的纤溶能力降低，在与致动脉粥样硬化因素、多处冠状动脉病变以及受损的左心室功能的复杂相互作用中，易引发再梗死。