摘要
目的:观察一种新的含有tPA和scuPA的纤溶酶原激活剂-人组织型纤溶酶原激活剂(HTU-PA)对急性心肌梗死的溶栓效果。方法:用HTU-PA对21例急性心肌梗死患者进行溶栓治疗,并与国产尿激酶(46例)和链激酶(54例)比较。溶栓90分钟后行冠状动脉造影(CAG),同时动态检测包括PT、APTT、纤维蛋白原、纤溶酶原、FDP、D二聚体、a_2-抗纤溶酶原、PAP、F1+2、PAI、tPA等血液学指标至溶栓后24小时。结果:HTU-PA组临床血管再通率为95％,CAG显示达TIMI3级血流者占76.2％。因溶栓失败或不良反应而引起的5周病死率、轻度出血和严重出血并发症3组间差异不显著。与链激酶组和尿激酶组相比,tPA水平增高显著(P<0.01),血浆浓度高峰持续时间约6小时,PAI明显增高(10～20倍),PT、APTT、纤维蛋白原的变化无显著差异(P>0.05)。TAT的变化与临床再通同步。结论:HTU-PA具有比第一代溶栓剂更长的半寿期和更强的血栓溶解力,但由于纤维蛋白原水平降幅较大,故仍需注意出血的危险性。
Objective: To investigate the thrombolytic effect of a new a type of plasminogen activator, human tissue urokinase type plasminogen activator(HTU-PA) which is constructed with both scuPA and tPA, in patients with acute myocardial infarction(AMI). Methods: 21 AMI patients were treated with HTU-PA, comparing with 46 treated with urokinase(UK) and 54 treated with streptokinase(SK). Arteri-ography was performed 90 minutes after thrombolytic treatment and several thrombolytic and fibrinolytic parameters including PT, APTT, plasmin concentrations of fibrinogen(Fbg), plasminogen(PLG) , FDPs, D-dimer(D-D), α2-antiplasmin(a2-AP), PAP, F1+2, PAI and tPA were dynamically analyzed through a 24-hour period after the therapy. Results: The revascularization rate was 95% in the HTU-PA group and coronary arteriography(CAG) showed that the coronary blood flow of 76.2% of these patients reached TI-MI third degree. The differences of the five-week mortality resulting from treatment failure or adverse effects, and the incidence of mild and severe haemorrhage were not statistically significant among these groups. In the HTU-PA group, the tPA level was remarkably increased with its peak sustaining for 6 hours, while the PAI level rose 10-20 times. Meanwhile, the TAT levels changed synchronously with clinical revascularising signs. Conclusion: HTU-PA has a longer half-life and stronger thrombolytic capability that other two thrombolytics. However, the significant reduction in plasma fibrinogen level indicates that there still exists a risk of haemorrhagic complication in HTU-PA therapy.
出处
《血栓与止血学》
2002年第3期102-104,109,共4页
Chinese Journal of Thrombosis and Hemostasis
关键词
急性心肌梗死
纤溶酶原激活剂
人组织型
溶栓治疗
疗效观察
Plasminogen activator Human tissue urokinase type Myocardial infarction Throm-bolytic effect
