非瓣膜性心房颤动高凝状态指标及抗栓治疗监测

目的:研究非瓣膜性心房颤动(AF)患者高凝状态指标的检测及抗栓治疗后的变化情况。方法:取临床基本情况匹配的窦性心律患者35例为对照组,非瓣膜性AF患者(慢性AF)45例,随机分入华法林组(26例)和阿司匹林组(19例)。分别测定PT／INR／FIB／APTT,vWF,D-Dimer,t-PA:Ag,PAI-1:Ag等项目。结果:PT／INR／APTT／FIB等常规血凝学指标在AF组和对照组差异无显著性(P>0．05)。AF组D-Dimer显著高于对照组(P=0．042),且有栓塞事件者高于无栓塞事件者(P=0．010)。AF组t-PA:Ag,PAI-1:Ag明显高于对照组(P<0．001),但与栓塞事件无明显相关。华法林抗凝治疗后D—Dimer,显著下降(P=0．004)。阿司匹林组服药后指标改变不显著。结论:常规血凝学项目PT／INR／APTT／FIB不能作为评价AF高凝状态的指标。建议D-Dimer,t-PA:Ag,PAI-1:Ag作为AF高凝状态的指标,且D-Dimer与预后相关;D-Dimer也是抗凝治疗效果监测的良好指标。阿司匹林不能改善血凝指标。

Hypercoagulation Indices of Nonvavular Atrial Fibrillation and Monitoring of Antithrombotic Therapy

Objective:To determine the prothrombotic indices of nonvalvular atrial fibrillation (NVAF), and their changes after an tithrombotic therapy.Methods: The study random divided 45 chronic atrial fibrillation patients to Warfarin group and Asprin group. PT/INR/APTT/FIB and vWF, D - Dimer, t - PA: Ag, PAI - 1: Ag were tested.Then compared clinical status patients recruited in the Control group. Results: PT/INR/APTT/FIB have no significant differents between basline and control group (P > 0.05). NVAF patients have higer. D - Dimer than control group (P= 0.042), it also associated with thrombosis (P = 0.010 ). After OAT, d - dimer drop off greatly. The t - PA: Ag and PAI - 1: Ag of NVAF patients were two times those of control, but it was not associated with thrombosis. After OAT, PAI - 1: Ag raised a lot though t - PA: Ag didn' t change. The changes of Asprin group were not significant . Conclusion: Routine coagulation tests couldn' t be selected as prothrombotic indices of NVAF patients. D - dimer can be a good prothrombotic indice and prognosis thrombosis of NVAF patients; it also a good indice moniter OAT therapy.