重组链激酶溶栓治疗后急性心肌梗死患者纤溶活性及血管活性物质的改变

Changes of Plasma Fibrinolytic Activities and Vasoactive Substances in Patients With Acute Myocardial Infarction After Thrombolytic Therapy by Recombinant Streptokinase

目的：探讨重组链激酶溶栓治疗后急性心肌梗死患者血浆纤溶活性及血管活性物质的改变及其相互关系。方法：以发光底物显色及放射免疫法测定３７例急性心肌梗死患者血浆组织型纤溶酶原激活物（ｔ－ＰＡ）及其抑制物（ＰＡＩ）、降钙素基因相关肽（ＣＧＲＰ）、内皮素、血管紧张素Ⅱ及醛固酮含量。结果：溶栓组和对照组相比ｔ－ＰＡ上升，ＰＡＩ下降，ｔ－ＰＡ／ＰＡＩ及ＣＧＲＰ上升，溶栓后２小时达高峰，６小时维持较高水平，２４小时回降。两组急性心肌梗死患者血浆内皮素、血管紧张素Ⅱ、醛固酮持续升高达正常值的３～４倍。结论：溶栓后血浆ｔ－ＰＡ／ＰＡＩ及ＣＧＲＰ迅速升高表现出同步消长关系。所有急性心肌梗死患者内皮素、血管紧张素Ⅱ、醛固酮持续升高，三者表现出正反馈调节。

Objective:To study the changes of plasma fibrinolytic activities and vasoactive substances and the interaction between these substances in patients with acute myocardial infarction(AMI) after thrombolytic therapy by recombinant streptokinase(r SK). Methods:Plasma tissue type plasminogen activator(t PA) and plasminogen activator inhibitor(PAI) activities,calcitonin gene related peptide(CGRP),endothelin(ET),angiotensinⅡ(AngⅡ),and aldosterone(ALD)levels were determined respectively by chromoegnic substances and radioimmunoassay. Results:As compared with the control group,t PA activities increased,PAI decreased,t PA/PAI and CGRP increased in thrombolytic therapy group.The activity changes of t PA and PAI reached peak value at 2 hour,remained higher levels at 6 hour and declined at 24 hour after the thrombolytic therapy.Plasma ET,AngⅡ,and ALD in AMI patients increased persistantly with a value as 3—4 times as the normal. Conclusion:After thrombolytic therapy by r SK plasma t PA/PAI and CGRP increase rapidly and synchronously.Plasma ET,AngⅡ,ALD of thrombolytic and control groups increase persistantly by a positive feedback mechanism with each other.