摘要目的 探讨抗凝血酶Ⅲ( AT-Ⅲ)活性在急性冠脉综合征(ACS)与稳定型心绞痛(SAP)患者之间的差别,及其在ACS患者中与术前TIMI血流级别之间的关系.方法 前瞻性纳入2011年1至6月急性冠脉综合征患者121例,包括ST段抬高性心肌梗死(STEMI)50例、非ST段抬高性心肌梗死( NSTEMI)32例、不稳定型心绞痛(UAP) 39例,入选同期50例SAP患者作为对照组,应用发色底物法测量血AT-Ⅲ活性.结果 (1)ACS患者AT-Ⅲ活性明显低于SAP患者(P＜0.01).(2)STEMI亚组中,AT-Ⅲ活性水平在犯罪血管术前TIMI血流级别≤2级组明显低于TIMI血流3级组(86％±11％比93％±9％,P＜0.05).(3)NSTEMI/UAP亚组中,AT-Ⅲ活性水平在犯罪血管术前TIMI血流级别≤2级组明显低于TIMI血流3级组(85％±8％比95％±8％,P＜0.01),且在罪犯血管狭窄程度≥70％组明显低于狭窄程度＜70％组(88％±9％比94％±9％,P＜0.01).(4)逐步多元回归分析显示,AT-Ⅲ活性水平是预测ACS患者罪犯血管术前TIMI血流受损的独立因素.结论 AT-Ⅲ活性的测定为早期筛选ACS高危人群提供指导意义.

abstractsObjective To explore the differences of antiprothrombin-Ⅲ ( AT-Ⅲ ) value in patients with acute coronary syndrome (ACS) and stable angina pectoris (SAP) and examine the association of AT-Ⅲ value with preprocedural thrombolysis in myocardial infarction (TIMI) flow in ACS patients.Methods This study prospectively included 121 hospitalized ACS patients between January 2011 to June 2011,including ST-segment elevation myocardial infarction (STEMI,n =50 ), non-ST segment elevation myocardial infarction (NSTEMI,n =32) and unstable angina (UAP,n =39).Meanwhile,50 SAP cases during the same period were selected as the control group.The AT-Ⅲ levels were measured by chromogenic substrate method before coronary angiography for all patients. Results (1) The AT-Ⅲ levels were significantly lower in the ACS patients than those in the SAP cases.(2) In the STEMI subgroup,the AT-Ⅲ levels were markedly lower in the patients with preprocedural TIMI flow grade ≤2 versus those with preprocedural TIMI flow grade 3 (86％ ± 11％ vs 93％ ±9％,P ＜0.05). (3) In the USTEMI/UAP subgroup,the mean levels of AT-Ⅲ were obviously lower in the patients with preprocedural TIMI flow grade ≤ 2 than those with preprocedural TIMI flow grade 3 ( 85％ ± 8％ vs 95％ ± 8％,P ＜ 0.01 ) and were notably lower in the patients with the culprit lesion stenosis ≥70％ versus those with stenosis ＜70％ ( 88％ ± 9％ vs 94％ ± 9％,P ＜ 0.01 ).(4) Multivariable analysis identified AT-Ⅲ value as an independent predictor of impaired preprocedural TIMI flow grade of culprit coronary artery in ACS patients.Conclusions The AT-Ⅲ levels were significantly lower in the ACS patients than those in the SAP patients.The activity of AT-Ⅲ is positively correlated with the TIMI flow grade in ACS patients.In contrast,the activity of AT-Ⅲ is negatively correlated with the severity of culprit vessel stenosis in the patients with NSTEMI.Thus AT-Ⅲ level may be used to distinguish high-risk populations in ACS patients at an early stage.