尿激酶联合脂质体携载前列地尔治疗急性心肌梗死

Urokinase Combined with Liposomal Alprostadil in the Treatment of Acute Myocardial Infarction

目的观察脂质体携载前列地尔(Lipo-PG E1)联合尿激酶(UK)治疗急性心肌梗死(AMI)对梗塞相关动脉(IRA)及心肌再灌注的作用。方法随机将52例ST段抬高的AMI患者分成治疗组和对照组各26例。两组均用UK溶栓。治疗组在应用UK前10 min开始加用Lipo-PG E1(0.5μg.kg-1),对照组则用等容量的脂肪乳剂(Lipo-PG E1的溶剂)。所有患者均行心电、血压监测,连续记录24 h标准12导或18导心电图(ECG),测定溶栓后90及180 min ECGST段恢复比率;溶栓后90 min行冠状动脉造影确定IRA心肌梗死溶栓试验(TIMI)血流分级;并检测溶栓治疗前后血浆α颗粒膜蛋白140(GMP-140)及内皮素(ET)含量。结果治疗组和对照组IRA开通率分别为73.1%和42.3%(P<0.05),溶栓后90及180 min ST完全恢复比率治疗组显著高于对照组,对于TIMI血流2或3级的患者,治疗组也有更高的ST完全恢复比率(分别为73.7%和33.3%)(P<0.05)。溶栓后血浆ET及GMP-140含量治疗组显著低于对照组。结论Lipo-PG E1联合UK治疗AMI能促进梗塞血管(心外膜血管)及梗死心肌(微血管)的再灌注。

Objective To study the effect of urokinase （UK） combined with liposomal alprostadil（ Lipo-PG E1 ） in the treatment of acute myocardial infarction （ AMI ） and the influence of the management on the infarct-related artery （IRA） and myocardial reperfusion. Methods Fifty-two patients with AMI showing ST-segment elevation were randomly divided into 2 equal groups： the trial group and the control group. Patients of both groups received thrombolytie treatment with UK. 10 min before the UK treatment, patients of the trial group were given each additionally 0.5 μg·kg^-1 of Lipo-PG E1 dissolved in 0.9% sodium chloride solution administered intravenously within 2 h. Patients of the control group were given each an equivalent amount of the solvent of Lipo-PG E1 administered in the same manner as described above. ECG and blood pressure were monitored in each of the patients in the 2 groups, including a 24 h continuous recording of the standard 12-lead （or 18-lead） ECG. The restoration rate of the ST-segment in the ECG was determined 90 and 180 min after the thrombolytie treatment. Coronary angiography was performed 90 min after the beginning of the thrombolytie treatment to determine the grading of the forward blood flow of the infarct-related artery （IRA） in the thrombolysis test in myocardial infarction （TIMI）. Plasma levels of alpha granule membrane protein 140 （GMP-140） and endothelin （ET） were determined before and after the thrombolytie treatment. Results The IRA patency rates in patients of the trial group and control group were 73. 1% and 42.3%, respectively（ P 〈 0.05 ）. The rate of complete （≥ 70% ） ST-segment restoration in patients of the trial group 90 and 180 min after the thrombolysis was also significantly higher than that in patients of the control group. The rates of complete restoration of the ST-segment in patients of the trial group and control group showing grade 2 to grade 3 blood flow in the TIMI were 73.7% and 33.3% , respectively（ P 〈 0.05 ）. The plasma levels of ET and GMP-140 were significantly lower in patients of the trial group than those in patients of the control group. Conclusion Lipo-PG E1 combined with UK was shown to promote reperfusion of the infarct-related artery （ epicardial flow） and infarcted myocardium （microvasculature）.