目的： 研究冠心病患者单核细胞凝血/纤溶活性改变与中医辨证分型的关系。方法： 80例冠心病患者分为血瘀证组30例，痰浊证组27例，气滞证组23例，另设健康对照组20例；采用发色底物法分别检测外周血单核细胞(PBMC)促凝活性(PCA)、组织型纤溶酶原激活物(t-PA)及其抑制物(PAI-1)活性。结果：冠心病各组与健康对照组比较，PBMC PCA、PAI-1表达均显著升高，而t-PA表达显著下降(P<0.01)；血瘀证与非血瘀证组(痰浊与气滞组)之间PBMC t-PA、PCA表达有显著差异(P<0.01)，而PAI-1表达无差异(P>0.05)；痰浊证组与气滞证组之间各项指标未见差异(P>0.05)。结论：冠心病患者单核细胞凝血/纤溶活性改变与中医辨证分型之间有一定的相关性，PBMC PCA增高和t-PA降低的程度对区别血瘀证和非血瘀证具有意义，血瘀证患者处于明显的血栓前状态。%To study the relationship between changes of coagulant and fibrinolytic activity of human peripheral blood monocyte (PBMC) in coronary heart disease (CHD) patients and different syndrome-type of Traditional Chinese Medicine (TCM). Methods:80 patients with coronary heart disease were divided into three groups by syndrome differentiation. 30cases of blood stasis (BS), 27cases of phregm-damp(PD) and 23cases of Qi stagnation(QS). 20 healthy persons were enrolled as normal control group. Activity of tissue type plasminogen activator(t-PA) and its inhibitor (API-1) and procoagulant activity (PCA) of PBMC were measured by chromogenic substrate method respectively. Results: PAI-1 activity and PCA expression of PBMC in the CHD group were significantly higher while t-PA activity of PBMC was lower than those in the normal control group (P<0.01). PCA expression of PBMC in the BS group was significantly higher than that in PD and QS groups, PBMC t-PA expression in BS group was lower than that in PD and QS groups (P<0.01). No significant difference of PAI-1 activity of PBMC was found among BS、PD and QS groups (P>0.05). All param3eters were found no significant difference between PD and QS groups (P>0.05). Conclusions: There is a relationship between changes of coagulant and fibrinolytic activity of monocyte in coronary heart disease patients and different syndrome-type of TCM. The increasing level of PBMC PCA and reducing level of PBMC t-PA could be used as referential indices for differentiating BS and NBS(PD and QS). Patients of BS were in the notable prethrombotic state.
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