重组人尿激酶原与尿激酶对急性心肌梗死患者纤溶系统影响的比较

Effects of Pro-UK on Coagulation and Fibrinolysis Compared with UK in Patients with Acute Myocardial Infarction

目的 对比观察注射用重组人尿激酶原(Pro- UK)对全身纤溶系统的影响。方法 将114 例符合溶栓标准的急性心肌梗死患者随机给予不同剂量的Pro UK或尿激酶(UK)进行溶栓。其中Pro -UK 30 mg及40 mg组26 例,50 mg组29例,60 mg组28例;UK组31例。观察溶栓前和溶栓开始后2、24、48 h血浆纤溶酶原(PLG)、D 二聚体(D D)、组织型纤溶酶原激活物(t PA)、纤溶酶原激活物抑制物(PAI)、纤维蛋白原(Fib)的变化以及出血并发症,并于溶栓开始后90 min进行冠状动脉造影,比较Pro UK和UK组溶栓后的血管开通率。结果 各用药组溶栓开始后2 h的PLG及PAI活性较溶栓前显著降低(P<0.01),而D D和t PA活性较溶栓前显著升高(P<0.01);UK组溶栓开始后2 h Fib较溶栓前显著降低(P<0.01),而Pro UK各剂量组Fib降低不明显;以上所有变化在溶栓开始后24 h基本恢复;溶栓开始后2 h Pro UK各剂量组的Fib明显高于UK组(P<0.01),其他时间点各用药组之间的所有观测指标均无显著差异;各用药组之间梗死相关血管开通率和出血并发症均无显著差异;溶栓开始后2 h梗死相关血管开通组的PAI显著低于未开通组(P<0.01),其他指标无显著差异。结论 UK溶栓后对全身纤溶系统激活较明显,与UK比较Pro -UK对全身纤溶系统无明显激活作用。

Objective To observe the effects of Pro-UK on coagulation and fibrinolysis compared with UK in patients with acute myocardial infarction. Methods 114 patients with acute myocardial infarction who accorded with the indications of thrombolytic therapy were randomly divided into four groups (Pro-UK 30 & 40 mg: 26 cases; 50 mg: 29 cases ; 60 mg: 28 cases; UK: 31 cases). Plasminogen(PLG), D- dimer (D-D), tissue-type Plasminogen Activator(t-PA), Plasminogen Activator Inhibitor(PAI) and fibrinogen (Fib) were measured immediately before and 2,24,48 h after thrombolysis initiation. The effect of the thrombolytic therapy and patient's bleeding complications were also observed. Results 2 h after thrombolytic therapy, PLG and PAI of each group were significantly lower(P<0.01), D-D and t-PA were significantly higher than that before thrombolytic therapy in each group(P<0.01); Fib of UK group 2 h after therapy became significantly lower than that before therapy(P<0.01), but the changes in Pro-UK groups were not significant, all changes recovered 24 h after therapy; 2 h after thrombolytic therapy, Fib of Pro-UK groups were significantly higher than that of UK group(P<0.01), the results at other times were no significantly different; there were no significant differences between each group in terms of therapeutic effects and bleeding syndrome; 2 h after therapy, PAI of reperfusion group was significantly lower than that of non-reperfusion group(P<0.01), other results were not significantly different. Conclusions There is significant effect on the activation of systemic fibrinolysis in UK group, but Pro-UK has little effect on the systemic fibrinolysis.