Huber K, Rosc D, Resch I, Schuster E, Glogar D H, Kaindl F, Binder B R
Department of Cardiology, University of Vienna, Austria.
Thromb Haemost. 1988 Dec 22;60(3):372-6.
A decrease in the fibrinolytic potential, mainly due to an elevation of plasminogen activator inhibitor (PAI), has been described in patients with stable coronary artery disease and a previous myocardial infarction. We investigated plasma levels of PAI and tissue plasminogen activator (t-PA) and their possible circadian variations in patients with unstable coronary artery disease (CAD). Sixty-three patients were studied for at least 2 consecutive days during their stay at the coronary care unit (CCU). Diurnal plasma fluctuations in PAI and t-PA and onset of further myocardial ischemic episodes were monitored. As controls we used 22 age-matched patients submitted to the clinic because of non cardiac chest pain or valvular disease who revealed no evidence of CAD. PAI levels were significantly elevated in patients with unstable CAD (p less than 0.0001) but were not influenced by the extent of underlying CAD, history of previous myocardial infarction, known risk factors for CAD, or by extent of myocardial damage. The circadian variation of PAI levels with peak values between midnight and 6 A.M. found in controls was still present in patients but at a higher level. Preservation of circadian pattern in PAI plasma levels despite myocardial ischemic attacks indicates that elevation of PAI is rather not caused by a reactive phenomenon. On the other hand, elevated PAI levels and episodes of severe myocardial ischemia exhibiting a median time of onset at 10 A.M. seem to be closely related.
在稳定型冠状动脉疾病和既往有心肌梗死的患者中，已发现纤溶潜能降低，主要原因是纤溶酶原激活物抑制剂（PAI）升高。我们研究了不稳定型冠状动脉疾病（CAD）患者血浆中PAI和组织纤溶酶原激活物（t-PA）的水平及其可能的昼夜变化。63例患者在冠心病监护病房（CCU）住院期间连续至少2天接受研究。监测PAI和t-PA的昼夜血浆波动以及进一步心肌缺血发作的发生情况。作为对照，我们使用了22例因非心脏性胸痛或瓣膜疾病就诊于门诊的年龄匹配患者，这些患者未发现CAD证据。不稳定型CAD患者的PAI水平显著升高（p<0.0001），但不受潜在CAD的严重程度、既往心肌梗死病史、已知CAD危险因素或心肌损伤程度的影响。对照组中PAI水平在午夜至上午6点之间达到峰值的昼夜变化在患者中仍然存在，但水平更高。尽管发生心肌缺血发作，但PAI血浆水平仍保持昼夜节律模式，这表明PAI升高并非由反应性现象引起。另一方面，PAI水平升高与严重心肌缺血发作似乎密切相关，严重心肌缺血发作的中位发病时间为上午10点。
