摘要
目的：比较急性心肌梗死（ＡＭＩ）患者应用链激酶（ＳＫ）、重组链激酶（ｒＳＫ）、尿激酶（ＵＫ）和重组组织型纤溶酶原激活物（ｒｔＰＡ）溶栓治疗期间凝血与纤溶系统的变化，探讨凝血与纤溶指标的变化同溶栓疗效间的关系。方法：对４３例经溶栓治疗（ＳＫ８例，ｒＳＫ１３例，ＵＫ１６例，ｒｔＰＡ６例）及１４例未经溶栓治疗的ＡＭＩ患者分别于治疗前及治疗后４、１２、２４、４８小时和１周共６次，分别检测凝血酶原时间（ＰＴ）、活化部分凝血活酶时间（ＡＰＴＴ）、纤维蛋白原（ＦＧ）、Ｄ二聚体、纤溶酶原（ＰＬＧ）、α２抗纤溶酶（α２ＡＰ）、组织型纤溶酶原激活物（ｔＰＡ）和组织型纤溶酶原激活物抑制物（ＰＡＩ１）等指标的活性或含量。结果：溶栓组冠脉再通２６例（６０．５％）、应用ＳＫ、ｒＳＫ、ＵＫ、ｒｔＰＡ溶栓治疗后，均会导致ＰＴ、ＡＰＴＴ的明显延长，ｔＰＡ活性、Ｄ二聚体含量的明显增高，ＰＬＧ、α２ＡＰ、ＰＡＩ１活性与ＦＧ含量的明显降低（与溶栓前比较，Ｐ均＜０．０１）。但这种变化为时较短，至溶栓后１２小时，各项指标已出现不同程度的恢复，ｔＰＡ与ＰＡＩ１已回至溶栓前水平。ＳＫ与ｒＳＫ对凝血与纤溶系统的影响略高于ＵＫ，ｒｔＰＡ对ＦＧ含量影响最小。冠?
Objective:To compare the clinical effects of strepkinase (SK),recombinant strepkinase (rSK),urokinase (UK),recombinant tissuetype plasminogen activator (rtPA) on fibrinolytic and coagulation system during the thrombolysis treatment in patients with acute myocardial infarction (AMI).Methods:The levels of prothrombin time (PT),activated partial thromboplasmin time (APTT),fibrinogen (FG),plasminogen (PLG),α 2antiplasmin (α 2AP),tissue plasminogen activator (tPA),tissue plasminogen activator inhibitor1(PAI1) were measured in 43 AMI patients with (SK: n =8;rSK: n =13;UK: n =16;rtPA: n =6 ) and without ( n =14) thrombolytic therapy before and at 4,12,24,48 hours,and 1 week after treatment.Results:After thrombolytic treatment 26 cases (60 5%) had coronary artery reperfusion.Following thrombolytic therapy with SK,rSK,UK,rtPA,plasma PT and APTT were significantly prolonged;tPA activities and DDimer levels were significantly increased;PAI1,PLG,α 2AP activities and FG levels were significantly decreased (all P <0 01,compare to pretreatment values).But those changes were short,and tPA and PAI1 activities returned to the levels prior to treatment at 12 hours after thrombolytic therapy.The effects of SK and rSK on fibrinolytic and coagulation system were relatively greater than that of UK,and rtPA on FG showed the least effect.In addition,plasma tPA activity in patients with patency was higher than those without patency pretreatment,but PAI1 activity was on the contrary (all P <0 05).Conclusions:After therapy with SK or rSK,UK or rtPA,the fibrinolytic activity is markedly increased together with reduction in coagulation activity,and changes in coagulation and fibrinolytic activities might associate with clinical results with thrombolysis.
出处
《中国危重病急救医学》
CSCD
1999年第1期21-23,共3页
Chinese Critical Care Medicine
关键词
溶栓疗法
凝血系统
链激酶
尿激酶
心肌梗塞
acute myocardial infarction\ \ thrombolysis\ \ coagulation system\ \ fibrinolytic system\ \ strepkinase
urokinase\ \ recombinant strepkinase
recombinant tissuetype plasminogen activator
