静脉溶栓治疗急性心肌梗死对血小板功能的激活

Effects of intravenous thrombolysis for acute myocardial infarction on platelet activation and vascular function

目的 急性心肌梗死 (AMI)是心血管急症这一 ,链激酶 (SK)、尿激酶 (UK)同属第一代溶栓剂 ,在我国AMI临床治疗中应用广泛。本研究的目的在于比较SK与UK静脉溶栓对血小板、内皮细胞功能、肾素活性的影响及其临床意义。方法 选择符合 1979年WHO诊断标准的AMI患者 4 5例 ,其中 16例使用SK治疗 (SK组 ) ,14例使用UK溶栓治疗 (UK组 ) ,15例接受常规治疗作为对照组。所有患者于入院即刻及发病后 2 4h、第 7天分别采卧位静脉血 5ml,测定血栓素B2 (TXB2 )、 6 酮 前列腺素Fla (6 -keto -PGFla)、血浆肾素活性 (PRA)、血管紧张素Ⅱ (AngⅡ)的水平。结果 TXB2 在SK组治疗前后及对照组各点均有升高 ,二者比较 ,差异无显著意义 ,UK组治疗后 (即发病后 2 4h、 7thd)较对照组、SK组明显升高 ;6 -keto-PGFla在 3组无变化 ;二者比值TXB2 / 6 -keto -PGFla (T/P)在UK组也明显升高 ;PRA、AngⅡ 在 3组呈升高趋势 ,但差异无显著意义。结论 心梗后及SK、UK溶栓后血小板活性均有增强 ,UK和SK相比 ,前者使血小板活化作用更强。这种作用可能会限制溶栓的效果 ,故溶栓治疗中尤其UK溶栓时更应加强抗血小板治疗 ,包括加大阿司匹林剂量或加用其他更有效的抗血小板制剂。

Objective Acute myocardial infarction(AMI)is an emergency of cardio-vascular system.streptokinase(SK) and urokinase(UK) are widely used in the treatment for AMI.The aim of our research is to compare the effects of SK and UK on platelet and vascular function and plasma renin activity(PRA),angiotensin(Ang Ⅱ)in two groups.Methods 45 patients with AMI were enrolled in this study.14 patients received UK thrombolytic therapy,16 patients received SK.15 cases were treated with conservative therapy.Blood samples were collected from all patients at admission and 24 hours after the onset of symptoms and 7 days later.Thromboxe B 2(TXB 2),6-keto-prostaglandin F la (6-keto-PGF la ),PRA and Ang Ⅱ in the samples were measured by radio immunology assay(RIA).Results The levels of TXB 2 were increased after AMI,SK and UK induced a similar increase in platelet activity which was stronger after UK intravenous thrombolysis.There was no change in 6-keto-PGF la in three groups.The ratio of TXB 2/6-keto-PGF la was elevated.PRA and Ang Ⅱ had no significanty compared with control group.Conclusion Thrombolysis therapy can lead to platelet activation which,at least in part,can be contributed to thrombolytic therapy itself. UK induce a stronger increase than SK.Platelet activation may limit the therapeutic effect of introvenous thrombolysis in AMI.We should enhance antiplatelet therapy while using UK and SK for treatment of AMI. [