摘要
为探讨风湿性心脏病二尖瓣狭窄左房血栓形成临床相关因素 ,对 6 9例风心二狭患者行经胸及食管超声心动图检查 ,并用发色底物显色法测定血浆组织型纤溶酶原激活物活性 (t PA) ,组织型纤溶酶原激活物抑制物 1(PAI- 1)活性 ,抗凝血酶 (AT- )活性 .结果显示风心二狭左房血栓形成者与无血栓形成者比较年龄偏大 ,症状持续时间较长 ,心房纤颤发生率高 .超声心动图上可见血栓形成者左房内径较大 ,左室射血分数低下 ,二尖瓣口面积较小 ,明显二尖瓣关闭不全情况少见 ,且左房血栓形成者均有左房自发性回声 (SEC) ,发生率明显高于无左房血栓形成者 .血凝学检查左房形成血栓者红细胞压积 (Hct)较高 ,AT- 活性低于无左房血栓形成者 (P<0 .0 1) ,而纤溶活力左房血栓形成者反而高于无左房血栓形成者 ,表现为 t PA活性较高 ,PAI- 1活性相对较低 (P<0 .0 5) .多元回归分析表明左房 SEC、AT- 活性、年龄、二尖瓣口面积是左房血栓形成的独立相关因素 .说明风心二狭患者左房血栓的形成不仅与血流的机械性梗阻 ,而且与机体抗栓能力的下降有关 .
To determin the risk factors of left atrial(LA) thrombosis in patients with predominant mitral stenosis based on patient clinical characteristics echocardiographic findings and coagulation studies,transthoracic and transesophageal echocardiography were performed in 69 patients with predominant rheumatic mitral stenosis. Serum tissue type plasminogen(t PA) activity,plasminogen activator inhibitor 1(PAI 1) activity and antithrombin Ⅲ(AT Ⅲ) activity were measured by the chromogenic substrate method.Of the 69 patients,33 patients (group I) had LA thrombus,36 patients (group Ⅱ) had no LA thrombus.Univariate analysis revealed that patients in group I were older,had longer duration of symptoms and higher incidence of atrial fibrillation than in group Ⅱ.Echocardiographic studies showed that patients with LA thrombus had a larger LA diameter,lower left ventricular ejection fraction (EF),a smaller mitral valve orifice and a lower incidence of significant MR.Patients in group 1 all had LA spontaneous echo contrast. The incidence of LA spontaneous echo contrast in group I was significantly higher than in group Ⅱ.Blood coagulation studies revealed that patients in group I had a higher hematocrit,antithrombin Ⅲ,PAI 1 activity and higher tPA activity ( P <0.05).Logistic regression analysis revealed that LA spontaneous echo contrast,antithrombin Ⅲ,age,mitral valve area were the independent risk factors for LA thrombosis.It was concluded that LA thrombosis in predominant mitral stenosis is related not only with mechanical obstruction but also with deficiency of body thromboresistance.
出处
《科技通报》
北大核心
2001年第3期59-63,共5页
Bulletin of Science and Technology
