小剂量尿激酶治疗不稳定性心绞痛的疗效和安全性临床观察

Clinical observation of curative effect and security in patients with unstable angina pectoris after thrombolytic therapy by low dose urokinase

目的 观察小剂量尿激酶治疗不稳定性心绞痛(U AP)患者的疗效和安全性 .方法 选择 UAP患者 5 0 (男42 ,女 8)例 ,随机分为溶栓组和对照组 ,对照组不应用尿激酶 ,余治疗与溶栓组完全相同 .患者于治疗前后各取肘静脉血 10 m L,应用自动凝血系统检测仪及发色底物法分别检测PT,APTT,Fg含量、t- PA及 PAI活性 .同时对治疗前后心绞痛发作频率、心电图改变、出血并发症及心血管意外发生情况等进行临床观察 .结果 1溶栓组 UAP患者心绞痛再发率比对照组明显地降低 (P<0 .0 5 ) ,且显效率明显高于肝素对照组 (P<0 .0 1) ;心电图改善无效率降低 (P<0 .0 5 ) ,显效率升高 (P<0 .0 5 ) ;两组出血并发症发生率及心血管意外发生率无差异 .2溶栓组 U AP患者溶栓后 PT,APTT较溶栓前显著延长 (P<0 .0 1) ,t- PA活性上升 (P<0 .0 1) ,PAI活性下降 (P<0 .0 1) ,Fg含量明显降低 (P<0 .0 1) ;对照组除 PT,APTT延长外 (P<0 .0 5 ) ,余指标治疗前后无统计学差异 ;溶栓组和肝素对照组治疗后各指标比较 ,除 PT,APTT无差异外 ,余指标均存在统计学意义 .结论 1有急性血栓形成的UAP患者进行小剂量尿激酶溶栓治疗可以改善临床症状 ,且不增加恶性事件发生率 ,提示在特定的 UAP亚组中进行合理的溶栓治疗 ,具有一定的可行性 .2 U AP?

AIM To observe clinical curative effect and security in certain subgroup patients with Unstable Angina Pectoris (UAP) after thrombolytic therapy by low dose urokinase. METHODS Fifty patients (male 42 and female 8) with UAP were chosen and subdivided randomly into thrombolytic therapy group and control group. Except the injection of urokinase, the same procedure was done in the two groups. Before and after the therapy, 10 mL elbow vein blood was adopted to determine PT, APTT, Fg levels by automatic coagulative system detector, and t PA, PAI activities by chromoegnic substances. At the same time, angina recurrence rates, ECG changes, bleeding complications and cardiac events were also observed. RESULTS ① Angina recurrence rate decreased obviously ( P <0.05) and ECG improvement rate increased ( P <0.05) compared with heparin control group after thrombolytic therapy. There was no statistical difference in bleeding complications and cardiac events between thrombolysis group and heparin control group. ② In the thrombolytic therapy group, PT, APTT prolonged significantly ( P <0.01), plasma t PA activity increased significantly ( P <0.01) and plasma PAI activity?Fg level decreased significantly ( P <0.01) after thrombolysis. In the heparin control group, PT, APTT prolonged ( P < 0.05 ) while no statistics difference was found in the other parameters. Between the two groups, there were no differences in PT, APTT while statistics differences ( P <0.05) were found in t PA, Fg, PAI after the therapy. CONCLUSION ① The alterations of clinical outcome after thrombolysis suggests that suitable thrombolytic therapy by low dose urokinase can be good to certain subgroup patients with UAP. ② The changes of coagulative function and fibrinolytic activity might suggest that thrombolytic therapy can affect endogenous fibrinolytic system and coagulative system, so as to enhance thrombolytic effectiveness and prevent rethrombosis. ③ The prolongation of PT and APTT might clue to the reduction of morbidity of bleeding complications.