| Acute myocardial infarction (AMI) is one of the emergent cardiovascular diseases that are threatening people's health seriously. Because of its high mobility and serious complication, it has been paid much attention to. Thrombomodulin (TM), the receptor of thrombin, is one of the transmemberane glycoprotein on the surface of endothelium. TM can be divided into three parts. They are out of membrane, transmembrane and the part in the cytoplasm. TM is one of the most important members of protein C. Protein C plays an important role in the anticoagulation system in the blood and is activated by thrombin. When coagulation system is activated, large amounts of thrombinogen are activated into thrombin. After production, thrombin can also combine with its receptor which is TM on the surface of endothelium, then its effect to activate PC can be promoted by more than 1000-20000 times. TM fallen from2002endothelium only has weak effect, so it is regarded as one of the important factors of partial anticoagulation. Because TM distributes mainly on the endothelial surface of arteries, veins and capillaries, et al, people consider it as one of biochemical markers of endothelial injuries. In normal conditions, there is only a low concentration of TM in the blood, but it will increase if endothelium is widely damaged. The degree of the increase is postulated parallel to the range and degree of the endothelium damages.Objective: The objective of this study was to observe the serial changes of TM and vWF in the patients with AMI who were treated by thrombolytic agents and to investigate the diagnostic effect of TM in thrombolytic therapy and its guiding effect to further therapy. The study would also examine the effect of TM in verifying endothelium damages in AMI and reperfusion injury after thrombolytic therapy in patients with AMI.Method: 29 consecutive AMI patients who were treated by thrombolytic therapy were recruited in this study. All of the patients received transvenous recombined streptokinase (r-sk) within the first 12 hours after symptom onset and the diagnosis of AMI were based on the criteria of WHO about AMI in 1979. Enzyme Linked Immunosorbent Assay (ELISA) was used to test the TM concentrations of blood samples from all of the patients before2002therapy and at 1 hour, 2 hours, 4 hours, 6 hours, 24 hours, 48 hours, 72 hours after thrombolytic therapy. The activities of serum vWF were also tested at the same time points. 20 health people were also included in the study to get the normal ranges of the two parameters.Results: (1) There was no statistical difference between the concentration of TM before therapy of AMI patients and that of health people (p>0.05). All of the patients with AMI were classified into two groups based on the results of thrombolytic therapy. The first group was the patients who got successful reperfusion. There were 1 9 patients in this group, so the successful reperfusion rate was 65. 5%( 19/29). The concentration of TM in this group began to increase from 1 hour after initiation of intravenous r-SK and peaked at 4 hours, then recovered to normal 24 hours after thrombolytic therapy. The second group included 10 patients who had not got successful reperfusion. The concentration of TM in this group increased only from 4 hours and peaked between 6 and 24 hours. (2) There was significant difference between the concentration of TM at 1 hour and that of before therapy (p<0.05). In the first group, there were 17 patients who had increased TM concentration at 1 hour in 19 patients (89.5%). (3) It took 1.6 hours for the elevated ST segment to lower more than 50% and 1.8 hours for patients'symptom to disappear. (4) The activities of vWF in AMI patients when admitted were significantly higher than those of health people (p<0.05) and peaked between 6 and 24 hours after thrombolytic therapy.Conclusions: (1) TM can be an ideal predictive factor of successful reperfusion after thrombolytic therapy in patients with AMI. The change of TM concentrations at 1 hou...
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