尿激酶联合左旋精氨酸治疗急性ST段抬高型心肌梗死的疗效及安全性观察

Efficiency of urokinase combined with L-Arg in the patients with ST-segment elevation myocardial infarction

目的:观察尿激酶溶栓联合左旋精氨酸(L-Arg)治疗急性ST段抬高型心肌梗死的临床疗效及安全性。方法:78例符合溶栓治疗的急性ST段抬高型心肌梗死患者被随机分为常规溶栓治疗组和L-Arg组,每组各39例;L-Arg组于溶栓治疗同时给予L-Arg200mg/kg。分别于治疗前、治疗后24h检测2组患者血浆肌钙蛋白T(cTnT)、乳酸脱氢酶、肌酸激酶同工酶以及超氧化物歧化酶活力;观察2组治疗后的血管再通率和不良事件(梗死后心绞痛、再发心肌梗死、严重心律失常、肺水肿、死亡、出血等)的发生率。结果:L-Arg组血管再通率高于常规溶栓组(76.9%∶71.8%),但差异无统计学意义(P>0.05);L-Arg组较常规溶栓组梗死后心绞痛发生率、再发心肌梗死率、严重心律失常发生率显著下降(P<0.05);而肺水肿、死亡率和出血发生率2组比较,差异无统计学意义(P>0.05)。结论:L-Arg对心肌梗死的缺血再灌注损伤心肌有良好的保护作用,尿激酶溶栓联合L-Arg治疗急性ST段抬高型心肌梗死,能较好的降低冠状动脉再通后并发症的发生。

Objective：To observe the effects and safety of urokinase combined L-Arg in the patients with STsegment elevation myocardial infarction（STEAMI）.Method：A total of 78cases with STEMI were randomly divided into routine therapy group（39cases）and L-Arg group（39cases）,who were treated with L-Arg 200mg· kg-1 as soon as the STEMI patients were admitted before intravenous thrombolysis therapy.Blood samples were taken to measure the levels of cardiac Troponin T（cTnT）,Lactate dehydrogenase（LDH）,MB isoenzyme of cre-atine kinase（CK-MB）and the activity of superoxide dismutase（SOD）before and 24hours after thrombolysis therapy.The reperfusion rate and the incidence of adverse cardiac events（angina after infarction,reinfarction,malignant arrhythmia,pulmonary edema,death,bleeding,and etc）were followed up in 30days.Result：The reperfusion rate in L-Arg group was higher than that in control group（76.9%vs 71.8%,P〈0.05）.The incidence of angina after infarction,reinfarction and malignant arrhythmia in L-Arg group was significantly lower than those in control group（P〈0.05）.However,the incidence of pulmonary edema,death,bleeding was similar between two groups.Conclusion：L-Arg can exert protective effects on myocardium of ischemia-reperfusion injury.U-rokinase combined with L-Arg could decrease the incidence of complications after coronary artery recanalization in patients with ST-segment elevation myocardial infarction.