小剂量长疗程尿激酶治疗不稳定性心绞痛的临床研究

Study of Prolonged Low-Dose Urokinase Therapy in Patients With Unstable Angina

目的 :探讨应用小剂量长疗程尿激酶治疗不稳定性心绞痛的疗效。方法 :将符合入选标准的 2 2 8例不稳定性心绞痛病人分为观察组 118例 ,在常规治疗的基础上 ,加尿激酶 2 0万～ 3 0万IU /d静脉滴注 ,对照组 110例 ,仅采用常规治疗方法 ,疗程均为 10天。分别于治疗第 5天和第 10天统计心绞痛缓解程度、出血并发症以及心脏事件 [急性心肌梗死 (AMI)或死亡 ]等的发生率。结果 :治疗第 5天 ,心绞痛缓解显效率观察组明显高于对照组 (79 6%对 68 2 % ,P <0 0 5 ) ,加拿大心脏病学会(CCS)分级观察组明显低于对照组 (P <0 0 5 ) ,而轻度粘膜出血、急性心肌梗死 (AMI)及死亡事件的发生率两组间差异无显著性 ;治疗第 10天 ,两组间心绞痛缓解显效率及CCS分级仍然存在差异 (P均 <0 0 5 ) ,而轻度粘膜出血、AMI及死亡事件的发生率两组间差异仍无显著性意义 ;两组均未发生脑出血事件。结论 :在常规抗心绞痛、抗血小板、抗凝血酶治疗的基础上 ,联合小剂量长疗程尿激酶的综合方案治疗不稳定性心绞痛 ,其心绞痛缓解有效率高于常规方案 ,而出血、AMI等并发症并无明显增加 ,尤其对不能或不愿接受介入治疗的病人值得应用。

Objective:To evaluate the effectiveness of prolonged low-dose urokinase therapy in patients with unstable angina (UA).Methods:UA patients were randomly divided into study group ( n =118) and control group ( n =110).Patients in the control group received a routine treatment,while patients in the study group received urokinase with a dose of 200,000-300,000 IU per day besides the routine treatment.The clinical remission rate of angina symptoms and the incidence of bleeding complications and cardiac events were evaluated on the 5th day and the 10th day of treatment,respectively.Results:The 5-day remission rate in the study group was higher than that in the control group (79.6% vs 68.2%,p <0.05).With regard to the CCS classification score,significant difference was shown between two groups (2.3±0.5 vs 2.6±0.6,p <0.05).No significant differences were found in bleeding complications ( p >0.05),acute myocardial infarction ( p >0.05) and cardiac death ( p >0.05).By the end of treatment,there still existed significant differences in the angina remission rate (90.7% vs 80.9%,p <0.05) and in the CCS classification score(2.1±0.5 vs 2.4±0.7,p <0.05),but still no significant differences were found in bleeding complications ( p >0.05),acute myocardial infarction ( p >0.05) and cardiac death ( p >0.05).Conclusions:The prolonged low-dose urokinase therapy combined with routine treatment achieves a satisfactory effect with a low complication incidence.It may be highly recommended to UA patients,especially to those who are reluctant to interventional therapy.