冠脉内注射尿激酶原与抽吸技术治疗急性ST段抬高型心肌梗死疗效与安全性的对比研究

A comparative study of the efficacy and safety of intracoronary injection of prourokinase and aspiration technique in the treatment of acute ST-segment elevation myocardial infarction

目的对比研究冠状动脉(冠脉)内注射尿激酶原与抽吸导管技术治疗高负荷血栓的急性ST段抬高型心肌梗死(STEMI)的疗效与安全性。方法95例急性ST段抬高型心肌梗死患者作为研究对象,按照治疗方法的不同分为注射用重组尿激酶原(rhPro-UK)组(44例)和血栓抽吸组(51例)。两组患者均实行急诊经皮冠脉介入治疗(PCI),分别在冠脉内注射尿激酶原与抽吸导管技术。比较两组患者术后1、12、24周的左心室射血分数(LVEF)及左心室舒张末期内径(LVED),术后90minST段回落率、心脏再发梗死率、术后1个月及12个月死亡率以及术后不良心血管事件(MACE)发生率。结果注射用重组尿激酶原组患者术后1、12、24周的LVEF分别为(53.23±5.98)、(55.47±5.88)、(56.14±3.56)%,均明显高于血栓抽吸组的(47.78±6.13)、(51.31±6.93)、(52.22±3.37)%,LVED分别为(47.78±6.13)、(49.31±6.93)、(49.14±3.56)mm,均明显小于血栓抽吸组的(53.23±5.98)、(52.47±5.88)、(51.22±3.37)mm,差异均有统计学意义(P<0.05)。注射用重组尿激酶原组患者的心脏再发梗死率、术后1个月及12个月死亡率分别为4.55%、4.55%、6.82%,均明显低于血栓抽吸组的17.65%、17.65%、21.57%,术后90minST段回落率为93.18%,明显高于血栓抽吸组的78.43%,差异均有统计学意义(P<0.05)。经PCI术后,所有患者均无大出血事件发生,注射用重组尿激酶原组患者术后MACE发生率9.09%略高于血栓抽吸组的3.92%,但比较差异无统计学意义(P>0.05)。结论与抽吸导管技术相比,冠脉内注射尿激酶原的治疗方法能更高效、安全地帮助患者减轻血栓负荷,恢复心肌供血,降低患者死亡率及心脏再发梗死率。

Objective To compare the efficacy and safety of intracoronary injection of prourokinase and aspiration technique in the treatment of acute ST-segment elevation myocardial infarction (STEMI) with high-load thrombosis. Methods A total of 95 acute ST-segment elevation myocardial infarction patients as study subjects were divided by different treatment methods into recombinant human prourokinase (rhPro- UK) for injection group (44 cases) and thrombus aspiration group (51 cases). Emergency percutaneous coronary intervention (PCI) was performed in both groups. Urokinase and aspiration catheter were injected into the coronary artery respectively. Comparison were made on left ventricular ejection fraction (LVEF) and left ventricular enddiastolic diameter (LVED) at 1, 12 and 24 weeks after operation, ST segment fall-back rate at 90 minutes after operation, cardiac recurrent infarction rate, mortality at 1 and 12 months after operation, and incidence of main adverse cardiovascular events (MACE) after operation between the two groups. Recombinant human prourokinase for injection group had obviously higher LVEF at 1, 12 and 24 weeks respectively as (53.23±5.98),(55.47±5.88) and (56.14±3.56)% than (47.78±6.13),(51.31±6.93) and (52.22±3.37)% in thrombus aspiration group, and obviously lower LVED respectively as (47.78±6.13),(49.31±6.93) and (49.14±3.56) mm in recombinant human prourokinase for injection group. Their difference was statistically significant (P<0.05). Recombinant human prourokinase for injection group had obviously lower cardiac recurrent infarction rate, mortality at 1 and 12 months after operation respectively as 4.55%, 4.55% and 6.82% than 17.65%, 17.65% and 21.57% in thrombus aspiration group, and obviously higher ST segment fall-back rate at 90 minutes after operation as 93.18% than 78.43% in thrombus aspiration group. Their difference was statistically significant (P<0.05). After PCI, no massive hemorrhage occurred in all patients. Recombinant human prourokinase for injection group had a little higher incidence of MACE after operation as 9.09% than 3.92% in thrombus aspiration group, but the difference was not statistically significant (P>0.05). Conclusion Compared with aspiration catheter technique, intracoronary injection of prourokinase can help patients reduce thrombus load, restore myocardial blood supply, and reduce mortality and recurrence of myocardial infarction more efficiently and safely.