重组人尿激酶原(普佑克)治疗急性ST段抬高型心肌梗死52例探讨

Recombinant Human Prourokinase(Pu Youke) in Treatment of Acute STSegment Elevation Myocardial Infarction:an Observation of 52 Cases

目的探讨重组人尿激酶原治疗急性ST段抬高型心肌梗死的疗效及安全性。方法选择急性ST段抬高型心肌梗死患者52例,根据随机数字表法将患者分为尿激酶原组和同瑞替普酶组,每组各26例。同瑞替普酶组给予同瑞替普酶治疗,重组尿激酶原组采用重组尿激酶原治疗。比较两组给药后不同时间点的纤溶酶、纤溶酶原、纤维蛋白原水平变化、冠状动脉再开通情况及心脏事件、出血程度情况。结果两组纤溶酶在给药0 h、24 h、48 h差异无统计学意义(P>0.05),但给药2 h时,重组尿激酶原组纤溶酶明显高于同瑞替普酶组(P<0.05);两组纤溶酶原、纤维蛋白原在给药0 h、48 h差异无统计学意义(P>0.05),但给药2 h、24 h时,重组尿激酶原组纤溶酶原、纤维蛋白原明显高于同瑞替普酶组(P<0.05)。重组尿激酶原组的心脏事件发生率明显低于同瑞替普酶组,出血程度明显轻于同瑞替普酶组(P<0.05)。重组尿激酶原组的再通率和完全再通率明显高于同瑞替普酶组(P<0.05)。结论重组尿激酶原对急性ST段抬高型心肌梗死患者的凝血和纤溶系统影响较小,确保了溶栓效果,提高了再通和完全再通率,减少了心脏事件的发生风险及减轻再出血程度,故具有较好的临床适用性。

Objective To investigate the efficacy and safety of recombinant human urokinase in the treatment of acute ST-segment elevation myocardial infarction.Methods 52 patients with acute ST-segment elevation myocardial infarction were selected and randomly divided into prourokinase group and reteplase group with 26 patients in each group.Patients in the reteplase group were given reteplase treatment,while recombinant prourokinase group received recombinant urokinase therapy.Of the two groups,plasmin,plasminogen,fibrinogen levels,coronary artery patency and cardiac events,the degree of bleeding situation at different time points after administration were compared.Results The administration of plasmin in 0 h,24 h,48 h had no significant difference（P〈0.05）,but when administered 2 h,plasmin of the recombinant prourokinase was significantly higher than that of the reteplase groups（P〈0.05）;Plasminogen,and fibrinogen 0 h and 48 h after administration of the two groups showed no significant difference between the two groups（P〈0.05）,Plasminogen and fibrinogen 2 h and 24 h after administration of the recombinant prourokinase group was significantly higher than that of the reteplase group（P〈0.05）.Cardiac event rate and bleeding of the recombinant urokinase was significantly lower than that of the reteplase group（P〈0.05）.Recanalization rate and complete recanalization rate of the recombinant urokinase was significantly lower than that of the reteplase group（P〈0.05）.Conclusion For patients with acute STsegment elevation myocardial infarction,recombinant prourokinase,with lower effect on coagulation and fibrinolysis system,can ensure the thrombolytic effects,improve rate of recanalization and complete recanalization,and reduce the risk of cardiac events and extent of rebleeding,so it has a better clinical applicability.