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目的 :探讨风湿性心脏病 (风心病 )血栓前状态及血栓形成机制 ,各因素的作用及其相互关系。方法 :经食管超声心动描记术 ( TEE)检查风心病患者 2 4 2例 ,确定心腔内云雾状回声、血栓形成、左心房增大情况。同时检测 2 0例云雾状回声患者、2 0例血栓形成患者和 2 0名正常人的血液血管性血友病因子相关抗原 ( v WF:Ag)、血小板激活标记物 -血小板α颗粒膜蛋白 ( GMP- 14 0 )、抗凝血酶 活性 ( AT- :C)、D-二聚体 ( D- Dimer)水平。结果 :风心病患者 93 .8%发现云雾状回声 ,血栓形成 3 3 .5 % ;其中心房颤动者与窦性心律者比较血栓形成差异有显著性 ( P<0 .0 0 1)。血液学指标 :v WF:Ag、GMP- 14 0、AT- :C、D-二聚体 ,云雾状回声组、血栓组与正常组比较均有显著性差异 ( P<0 .0 0 1) ,云雾状回声组与血栓组之间差异示有显著性。结论 :TEE是发现云雾状回声和血栓形成的最有效方法 ,结合血液学多项指标变化可作为血栓前状态及早期诊断血栓的有用指标
Objective: To investigate the prethrombosis state and the mechanism of thrombosis in rheumatic heart disease (rheumatic heart disease), the role of each factor and their relationship. Methods: Tracheal echocardiography (TEE) was used to examine 242 cases of patients with rheumatic heart disease and to determine the echogenicity, thrombosis and enlargement of left atrium in the heart cavity. At the same time, 20 cases of cloud-like echoes, 20 cases of thrombosis and 20 normal subjects were detected for vWF: Ag, platelet activation marker-platelet α-granule membrane protein GMP-140), antithrombin activity (AT-: C), D-dimer (D-dimer) levels. Results: 93.8% of patients with rheumatic heart disease found cloud-like echogenicity and thrombus formation was 35.5%. There was a significant difference in thrombosis between those with atrial fibrillation and sinus rhythm (P <0.01). Hematology indicators: v WF: Ag, GMP-140, AT-: C, D-dimer, cloud echo group, thrombosis group compared with the normal group were significantly different (P < , There was a significant difference between the cloud echo group and the thrombus group. CONCLUSION: TEE is the most effective method for detecting cloud-like echogenicity and thrombosis. Combining with the changes of a number of hematological indexes, TEE can be used as a useful index for prethrombosis and early diagnosis of thrombus