尿激酶原、瑞替普酶、尿激酶溶栓治疗急性ST段抬高型心肌梗死的疗效比较

Effects of prourokinase, reteplase and urokinase on the patients with acute ST -segment elvation myocardial infarction

目的比较尿激酶原、瑞替普酶及尿激酶溶栓治疗急性sT段抬高型心肌梗死的疗效及安全性。方法对符合条件的急性sT段抬高型心肌梗死患者，采用数字表法将研究对象随机分为三组，尿激酶原组34例、瑞替普酶组42例及尿激酶组32例，分别给予尿激酶原50mg、瑞替普酶36mg及尿激酶150万U进行溶栓治疗，观察罪犯血管开通情况、出血并发症及不良心脏事件发生率。结果溶栓后90min，尿激酶原组TIMI2级以上开通率76．50％，瑞替普酶组83．30％，尿激酶组53．10％，尿激酶原组与瑞替普酶组具有相似的罪犯血管再通率，差异无统计学意义，尿激酶原组与瑞替普酶组均显著高于尿激酶组（x2=8．27，P=0．004），而出血并发症及不良事件发生率尿激酶原组17．65％、瑞替普酶组28．57％，尿激酶组42．19％，尿激酶原组较瑞替普酶组及尿激酶组低（x2=6．36，P=0．012）。结论尿激酶原与瑞替普酶均具有高效的罪犯血管再通率，尿激酶原出血并发症及主要不良心脏事件发生率更低。

Objective To compare the efficacy and safety of prourokinase, reteplase and urokinase on the patients with acute ST - segment elvation myocardial infarction. Methods According to random number table, the eligible patients with acute ST - segment elvation myocardial infarction were randomly divided into prourokinase group （50mg,n =34） ,retepiase group （36mg,n =42） and urokinase group （1 500 000IU,n =32）. The patency of infarct related coronary artery was estimated by coronary angiography at 90min after administration of thrombolytic agents. The adverse reaction was also observed including bleeding and the major adverse cardiac events（MACEs）. Results The patency of culprit vessel in the prourokinase group was 76.50% （≥ TIMI 2 flow）, which in the reteplase group was 83.30% （ ≥TIMI 2 flow）, and which in the urokinase group was 53.10% （ ≥TIMI 2 flow） ,respctively. Both of prourokinase group and reteplase group were higher in the patency than theurokinase group（ X2 = 8.27 ,P =0.004）. The MACEs and bleeding adverse reaction（ prourokinase group 17.65%, reteplase group 28.57%, urokinase group 42.19% ） showed that security of prourokinase group was securer than reteplase group and urokinase group （ X2 = 6. 36,P =0. 012）. Conclusion Both of prourokinase and reteplase are effective for the patients with acute myocardial infarction with ST - segment elvation, and prourokinase is safer.