注射用重组人尿激酶原联合氯吡格雷治疗急性ST段抬高型心肌梗死的临床研究

Clinical study of Recombinant Human Prourokinase for injection combined with clopidogrel in treatment of acute ST-segment elevation myocardial infarction

目的观察注射用重组人尿激酶原联合氯吡格雷治疗急性ST段抬高型心肌梗死的临床疗效。方法收集2016年1月—2016年12月商丘市中心医院收治的急性ST段抬高型心肌梗死患者86例,随机分为对照组和治疗组,每组各43例。对照组口服硫酸氢氯吡格雷片,首次给予负荷量300 mg/次,1次/d,然后75 mg/次,1次/d;治疗组在对照组的基础上静脉滴注注射用重组人尿激酶原,50 mg/次,先将20 mg加入生理盐水10 mL,并且3 min内静脉推注完毕,然后30 mg加入生理盐水90 mL,30 min内静脉滴注完毕。两组患者均连续治疗15 d。评价治疗后两组患者临床疗效,同时比较治疗前后两组心电图改善情况和临床症状、炎症和心肌酶学指标水平。结果治疗后,对照组和治疗组的总有效率分别为79.07%、93.02%,两组比较差异具有统计学意义(P<0.05)。治疗后,对照组心电图改善总有效率为76.74%,显著低于治疗组的90.70%,两组比较差异具有统计学意义(P<0.05)。治疗后,两组患者高敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肌酸激酶(CK)和肌酸激酶MB型同工酶(CKMB)指标水平均显著下降,同组比较差异具有统计学意义(P<0.05);且治疗组患者hs-CRP、IL-6、CK和CKMB指标水平显著低于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,治疗组患者胸痛缓解时间明显比对照组更短,两组比较差异具有统计学意义(P<0.05)。结论注射用重组人尿激酶原联合氯吡格雷治疗急性ST段抬高型心肌梗死可迅速改善临床症状,且心电图也得到显著改善,具有一定的临床推广应用价值。

Objective To observe the clinical curative effect of Recombinant Human Prourokinase for injection combined with clopidogrel in treatment of acute ST-segment elevation myocardial infarction. Methods Patients（86 cases） with acute ST-segment elevation myocardial infarction in Shangqiu Central Hospital from January 2016 to December 2016 were randomly divided into control and treatment groups, and each group had 43 cases. Patients in the control group were po administered with Clopidogrel Hydrogen Sulphate Tablets, the first load dose was 300 mg/time, once daily, then 75 mg/time, and once daily. Patients in the treatment group were iv administered with Reocmbinant Human Prourokinase for injection on the basis of the control group, 50 mg/time, firstly, 20 mg added into normal saline 10 mL and intravenous bolus completion within 3 min, then 30 mg added into normal saline 90 mL and intravenous drip completion within 30 min. Patients in two groups were treated for 15 d. After treatment, clinical efficacy was evaluated, and the improvement of ECG and clinical symptoms, and inflammation and myocardial enzymes levels in two groups before and after treatment was compared. Results After treatment, the clinical efficacy in the control and treatment groups were 79.07% and 93.02%, respectively, and there were differences between two groups（P〈0.05）. After treatment, the ECG improved efficiency in the control group was 76.74%, which was significantly lower than 90.70% in the treatment group, and there were differences between two groups（P〈0.05）. After treatment, the hs-CRP, IL-6, CK and CKMB levels in two groups were significantly decreased, and the difference was statistically significant in the same group（P〈0.05）. And the hs-CRP, IL-6, CK and CKMB levels in the treatment group were significantly lower than that in the control group, with significant difference between two groups（P〈0.05）. After treatment, the chest pain relief time in the treatment group was significantly shorter than that in the control group, with significant difference between two groups（P〈0.05）. Conclusion Recombinant Human Prourokinase for injection combined with clopidogrel can quickly improve clinical symptoms in treatment of acute ST-segment elevation myocardial infarction, and ECG was also significantly improved, which has a certain clinical application value.