老年高血压患者心房颤动急性发作后血栓前状态的改变

目的观察老年高血压患者心房颤动(房颤)急性发作时及药物复律后血栓前状态的改变。方法老年高血压患者急性房颤发作29例(急性房颤组),发作48 h内成功复律,未予抗凝治疗,复律后窦性心律维持时间>1个月。分别于复律前,复律后1、7、14、30天检测血浆纤维蛋白原(Fib)、D-二聚体水平,组织型纤溶酶原激活剂(t-PA)活性和纤溶酶原激活物抑制剂-1(PAI 1)活性。另选高血压合并窦性心律患者30例(窦性心律组),高血压合并永久性房颤,且未予华法林抗凝治疗者30例(慢性房颤组),健康体检者30例(健康对照组),分别检测上述指标。结果急性房颤组和慢性房颤组患者Fib、D-二聚体水平显著高于窦性心律组和健康对照组。急性房颤组患者复律后Fib水平于第7天降至窦性心律组水平,D-二聚体浓度于第7天升至最高峰,其后逐渐下降,但直至复律后第30天仍高于窦性心律组。急性房颤组患者复律前及复律后t-PA及PAI-1活性与健康对照组和窦性心律组比较,差异均无统计学意义。结论老年高血压患者房颤急性发作时存在血栓前状态,并且在复律后仍可持续1个月。

Changes of prethrombotic state after acute attack of atrial fibrillation in elderly hypertensives

Objective To investigate changes of prethrombotic state during acute atrial fibrillation (AF) and after pharmacological cardioversion in elderly hypertensive.Methods Twenty-nine consecutive hypertensive patients with acute AF were studied.Sinus rhythm of them was restored by pharmacological cardioversion within 48 hours of arrhythmia onset without anticoagulant treatment.Plasma levels of fibrinogen,fibrin D-dimer,tissue plasminogen activator(t-PA) and its inhibitor-1(PAI-1) were measured before cardioversion and on days 1,7,14 and 30 after cardio- version.The above indices were compared with those in 30 healthy examinees,30 patients with chronic AF and hypertension without anticoagulant treatment,and 30 patients with hypertension in sinus rhythm.Results Patients with AF had higher concentrations of fibrinogen and fibrin D-dimer than healthy controls and patients with sinus rhythm did (P<0.05).In acute AF pa- tients,after cardioversion,the plasma levels of fibrinogen decreased to those in patients with sinus rhythm by the day 7,the plasma concentrations of D-dimer by the day 30 was still higher than that in patients with sinus rhythm.There was no significant difference in t-PA and PAI-1 between patients with sinus rhythm,healthy controls and acute AF patients before and after cardioversion (P>0.05).Conclusion There were evidences of prethrombotic state in acute AF among elderly patients with hypertension,which persisted up to 30 days after cardioversion.