尿激酶溶栓治疗急性脑梗死时凝血酶抗凝血酶Ⅲ复合物的变化

Changes in thrombin antithrombin Ⅲ complex after thrombolytic treatment of acute brain infarction with urokinase

观察急性脑梗死患者尿激酶 (urokinase,UK)静脉溶栓治疗对机体凝血系统的影响。方法 以血浆凝血酶抗凝血酶Ⅲ复合物 (thrombin antithrombinⅢcomplex ,TAT)作为凝血系统激活及凝血酶生成的分子标志物 ,对急性脑梗死患者 2 0例入院时 ,UK静脉滴注 30min后即刻、2h、4h、6h、8h、1d、3d及 7d血浆TAT进行动态观察 ,并与正常健康对照组 19名进行比较。结果 急性脑梗死患者UK溶栓治疗前TAT中位数为 5 .4μg L ,2 5～ 75百分位数为 4.0和 8.4μg L ,较正常对照组〔(3.1± 1.1) μg L)〕显著增高 (P <0 .0 1)。TAT在溶栓治疗后即刻 (中位数 12 .8μg L)及治疗后 2h(中位数 15 .4μg L)较治疗前均有明显升高 (P <0 .0 1) ,4h以后已基本恢复至溶栓治疗前水平 (P >0 .0 5 ) ,但 7d时 (中位数 6 .7μg L)仍高于正常人 (P <0 .0 1)。 1例溶栓治疗后 8h出现血管再闭塞 ,其TAT下降后再次出现明显增高。结论 急性脑梗死患者凝血酶活性增加 ,UK溶栓治疗导致TAT短暂性进一步增高 ;溶栓治疗后的血管再闭塞可能与TAT增高有关。

Objective To observe the influence of intravenous thrombolytic therapy with urokinase (UK) on thrombin antithrombin Ⅲ complex (TAT) in patients with acute brain infarction.Methods TAT which served as molecular marker of thrombin activation were serially evaluated on admission and 0 h,2 h,4 h,6 h,8 h,24 h,3 days and 7 days after intravenous drip of UK 1.0～1.5 million units over 30 min in 20 patients with acute brain infarction which was treated within 6 hours of symptom onset,and was compared with the values in 19 normal control subjects.Results The median pretreatment TAT level in patients with acute brain infarction was 5.4 μg/L,which was significantly elevated in comparison with controls〔(3.1±1.1) μg/L,P<0.01〕.A statistically significant elevation of TAT (medians = 12.8 and 15.4μg/L) was observed 0 h and 2 h after UK infusion over 30 min.There was no statistically significant alteration of the TAT levels after 4 h as compared with pretreatment levels.But increased TAT level (6.7 μg/L) was still present on 7th day after the thrombolysis,as compared with controls(P<0.01).Reocclusion in one patient was documented at 8 h by transcranial Doppler ultrasonography study and the TAT level after reocclusion increased further again.Conclusions Thrombin activity is increased in patients with acute brain infarction and increased further temporarily after UK intravenous thrombolysis.TAT might be a useful marker for identifying patients with reocclusion.