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目的 :探讨风湿性心脏病二尖瓣狭窄 (风心二狭 )患者左房血栓形成的临床相关因素。方法 :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 (t PA )、组织型纤溶酶原激活物抑制物 1(PAI- 1)及抗凝血酶 (AT- )活性。结果 :33例风心二狭左房血栓形成组与 36例无血栓组比较 ,年龄偏大 ,症状持续时间较长 ,心房颤动发生率高 ;超声心动图显示左房内径较大 ,左室射血分数较低 ,二尖瓣口面积较小 ,明显二尖瓣关闭不全少见 ,左房自发性回声 (SEC)发生率明显增高 ;血液学检查显示红细胞压积较高 ,AT- 活性较低 t PA活性较高 ,PAI- 1活性较低。多元回归分析表明左房 SEC、AT- 活性、年龄、二尖瓣口面积大小是左房血栓形成的独立相关因素。结论 :风心二狭患者左房血栓的形成不仅与血流的局部机械性梗阻淤滞 ,而且与机体抗栓能力的下降有关。
Objective: To investigate the clinically relevant factors of left atrial thrombosis in patients with rheumatic heart disease (mitral stenosis). Methods: Sixty-nine patients with rheumatic heart and two narrowing were examined by thoracic and esophageal echocardiography. The levels of plasma t-PA, PAI-PA, Inhibitor 1 (PAI-1) and antithrombin (AT-) activity. Results: Compared with 36 cases of thrombus-induced thromboembolism group, the age was longer, the duration of symptoms was longer and the incidence of atrial fibrillation was higher. Echocardiography showed that left atrial diameter was larger and left ventricular ejection Low blood score, mitral orifice area is small, obvious mitral regurgitation is uncommon, left atrial spontaneous echocardiography (SEC) was significantly increased; hematological examination showed higher hematocrit, AT-activity is lower t PA activity is higher, PAI-1 activity is lower. Multivariate regression analysis showed that left atrial septum, AT-activity, age, and mitral valve area were independent factors associated with left atrial thrombosis. Conclusions: The formation of left atrial thrombus in patients with rheumatic heart stenosis is not only related to the local mechanical obstruction of blood flow, but also to the decrease of antithrombotic ability.