摘要
目的 研究低分子肝素 (LMWH)对于不稳定型心绞痛 (UAP)患者纤溶系统的活性以及冠状动脉舒缩状态的影响。方法 选择初发劳力型和恶化型心绞痛患者 ,入选前 48h内有一次以上的心绞痛发作 ,发作时心电图缺血性ST段下降≥ 1mm。把患者随机分为低分子肝素组和对照组。对照组使用硝酸甘油、硝苯吡啶、β-阻滞剂等 ;低分子肝素组在上述治疗的基础上加用低分子肝素钙 ,每日 2次 ,每次0 4ml,皮下注射 ,连续 7日。在治疗前后分别采集空腹静脉血 ,测定血浆D -二聚体、内皮素 (ET)和降钙素基因相关肽 (CGRP)的水平。结果 低分子肝素组治疗后血浆D -二聚体水平较治疗前显著升高 (P<0 0 1 ) ,与对照组治疗后相比亦有显著差异 (P <0 0 2 )。对照组治疗前后血浆D -二聚体无显著变化。低分子肝素组治疗后血浆ET水平较治疗前明显降低 (P <0 0 0 5 ) ,并且与对照组治疗后相比亦有显著下降 (P <0 0 5 )。两组治疗后CGRP都有轻度升高 ,但无统计学意义。结论 低分子肝素可促进纤溶系统的活性 ,溶解冠状动脉内血栓 ,同时还可调节机体血管活性肽水平 。
Objective To estimate the influence of LMWH on activation of fibrinolytic system and coronary vasomotion in patients with unstable angina pectoris.Methods Patients with at least one attack of ischemic chest pain caused by unstable angina pectoris within 48 hours prior to the treatment,with ST desent ≥1 mm,were enrolled .They were randomized to the LMWH group and the placebo group.The later was treated with nitrates,beta blockers and nifedipine.Besides above drugs the LMWH group was treated with Fraxiparine 0.4ml, twice daily subcutaneously for 7 days .Collect the fasting b1ood before and after the treatment to assay the plasma D-dimer, endothelin (ET) and calaitonin gene related peptide(CGRP).Results In LMWH group,the 1evel of plasma D-dimmer markedly increased after the treatment(P<0.01),Compared to that of the placebo was also markedly increased(P<0.02).There was no difference in D-dimer of the placebo group before and after the treatment . The LMWH signifincantly decreased the 1evel of plasma ET( P<0.005)and the ET was Lower with LMWH than with placebo(P<0.05).The plasma CGRP slightly increased in both groups after the treatment,but without Statistical significence.Conclusion The LMWH can improve the activation of fibrinolytic system .In turn plasmin degrades fibrin causing thrombo1ysis.It also adjust the 1evel of plasma circulating peptides to dilate coronary artery.
出处
《兰州医学院学报》
2004年第2期17-19,7,共4页
Journal of Lanzhou Medical College
