目的探讨血栓抽吸联合冠状动脉内注射重组人TNK组织型纤溶酶原激活剂对老年ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗术中冠状动脉微循环及心功能的影响。方法回顾性选取2021年1月至2023年10月于天津市第三中心医院就诊的并行急...目的探讨血栓抽吸联合冠状动脉内注射重组人TNK组织型纤溶酶原激活剂对老年ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗术中冠状动脉微循环及心功能的影响。方法回顾性选取2021年1月至2023年10月于天津市第三中心医院就诊的并行急诊经皮冠状动脉介入治疗的老年ST段抬高型心肌梗死患者90例,根据经皮冠状动脉介入治疗术中介入策略不同分为单纯血栓抽吸组(抽吸组)46例和血栓抽吸联合冠状动脉内注射重组人TNK组织型纤溶酶原激活剂组(联合组)44例。比较2组一般临床资料,术后90 min ST段回落指数≥70%比例,术后即刻心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)血流分级,术后TIMI心肌灌注分级,校正的TIMI血流帧数,心脏超声指标以及住院期间主要不良心血管事件及出血事件。结果联合组术后ST段回落≥70%、术后即刻TIMI血流分级3级、术后TIMI心肌灌注分级3级比例显著高于抽吸组,校正的TIMI血流帧数显著低于抽吸组(P<0.05);抽吸组术后1周的左心室射血分数显著低于联合组[(52.5±6.2)%vs(58.3±6.4)%,P<0.05],联合组术后1周左心室舒张末期内径显著低于抽吸组[(44.1±3.9)mm vs(51.9±2.5)mm,P<0.05];联合组住院期间主要不良心血管事件发生率显著低于抽吸组(20.5%vs 37.0%,P<0.05)。结论在应用抽吸导管的基础上配合冠状动脉内注射重组人TNK组织型纤溶酶原激活剂可有效降低老年ST段抬高型心肌梗死患者冠状动脉内血栓负荷,改善心肌微循环灌注,降低住院期间主要不良心血管事件发生率且不增加出血风险。展开更多
The only difference of primary structure between single-chain prourokinase (pro-UK or scu-PA) and two-chain urokinase (UK or tcu-PA) is the cleavage of a single peptide bond (Lys158-Ile159) and transform scu-PA into i...The only difference of primary structure between single-chain prourokinase (pro-UK or scu-PA) and two-chain urokinase (UK or tcu-PA) is the cleavage of a single peptide bond (Lys158-Ile159) and transform scu-PA into its active two-chain form. A 13-peptide (Thr-Leu-Arg-Pro-Arg-Phe-Lys-Ile-Ile-Gly- Gly-Glu-Cys), which spans the cleavage peptide bond, was synthesized and linked to KLH (Keyhole limpet hemocyanin). The Balb/c mice were immunized by the conjugated protein with proper adjuvant. According to the Kohler and Milstein’s methods, a hybridoma cell line G7 secreting monoclonal antibody specific for scu-PA was obtained. The anti-scu-PA McAb, purified from the supernatant of porous microcarrier hybridoma cell culture, was conjugated to CNBr-activated Sepharose 4B to prepare an immuno-affinity chromatography column. The u-PA was purified only by this affinity column from the supernatant of cultivating the u-PA-producing recombinant CHO cell, the u-PA recovery ratio is 90.4%, the purification factor was about 50, with the specific activity of 1.2×10 5IU/mg, the scu-PA ratio in the u-PA product was 96.3%. Compared to immuno-affinity chromatography, the 3-step process for purifying u-PA (cation-exchange co-lumn, gel filtration column and benzamidine affinity column)has a u-PA recovery ratio of about 65%, with a specific activity of 1.0×10 5IU/mg, and an scu-PA ratio of about 90%. These results showed that immuno-affinity chromatography is simple to recover u-PA and effective to separate scu-PA from tcu-PA.展开更多
文摘目的探讨血栓抽吸联合冠状动脉内注射重组人TNK组织型纤溶酶原激活剂对老年ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗术中冠状动脉微循环及心功能的影响。方法回顾性选取2021年1月至2023年10月于天津市第三中心医院就诊的并行急诊经皮冠状动脉介入治疗的老年ST段抬高型心肌梗死患者90例,根据经皮冠状动脉介入治疗术中介入策略不同分为单纯血栓抽吸组(抽吸组)46例和血栓抽吸联合冠状动脉内注射重组人TNK组织型纤溶酶原激活剂组(联合组)44例。比较2组一般临床资料,术后90 min ST段回落指数≥70%比例,术后即刻心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)血流分级,术后TIMI心肌灌注分级,校正的TIMI血流帧数,心脏超声指标以及住院期间主要不良心血管事件及出血事件。结果联合组术后ST段回落≥70%、术后即刻TIMI血流分级3级、术后TIMI心肌灌注分级3级比例显著高于抽吸组,校正的TIMI血流帧数显著低于抽吸组(P<0.05);抽吸组术后1周的左心室射血分数显著低于联合组[(52.5±6.2)%vs(58.3±6.4)%,P<0.05],联合组术后1周左心室舒张末期内径显著低于抽吸组[(44.1±3.9)mm vs(51.9±2.5)mm,P<0.05];联合组住院期间主要不良心血管事件发生率显著低于抽吸组(20.5%vs 37.0%,P<0.05)。结论在应用抽吸导管的基础上配合冠状动脉内注射重组人TNK组织型纤溶酶原激活剂可有效降低老年ST段抬高型心肌梗死患者冠状动脉内血栓负荷,改善心肌微循环灌注,降低住院期间主要不良心血管事件发生率且不增加出血风险。
文摘The only difference of primary structure between single-chain prourokinase (pro-UK or scu-PA) and two-chain urokinase (UK or tcu-PA) is the cleavage of a single peptide bond (Lys158-Ile159) and transform scu-PA into its active two-chain form. A 13-peptide (Thr-Leu-Arg-Pro-Arg-Phe-Lys-Ile-Ile-Gly- Gly-Glu-Cys), which spans the cleavage peptide bond, was synthesized and linked to KLH (Keyhole limpet hemocyanin). The Balb/c mice were immunized by the conjugated protein with proper adjuvant. According to the Kohler and Milstein’s methods, a hybridoma cell line G7 secreting monoclonal antibody specific for scu-PA was obtained. The anti-scu-PA McAb, purified from the supernatant of porous microcarrier hybridoma cell culture, was conjugated to CNBr-activated Sepharose 4B to prepare an immuno-affinity chromatography column. The u-PA was purified only by this affinity column from the supernatant of cultivating the u-PA-producing recombinant CHO cell, the u-PA recovery ratio is 90.4%, the purification factor was about 50, with the specific activity of 1.2×10 5IU/mg, the scu-PA ratio in the u-PA product was 96.3%. Compared to immuno-affinity chromatography, the 3-step process for purifying u-PA (cation-exchange co-lumn, gel filtration column and benzamidine affinity column)has a u-PA recovery ratio of about 65%, with a specific activity of 1.0×10 5IU/mg, and an scu-PA ratio of about 90%. These results showed that immuno-affinity chromatography is simple to recover u-PA and effective to separate scu-PA from tcu-PA.
文摘目的 探究重组组织型纤溶酶原激活剂(Recombinant Tissue Plasminogen Activator,rt-PA)超早期静脉溶栓治疗急性脑梗死的疗效。方法 随机选取2021年1月—2024年1月江苏省邳州市中医院收治的80例急性脑梗死患者为研究对象,以随机数表法分为两组,研究组(40例)实施rt-PA超早期静脉溶栓治疗,对照组(40例)实施常规治疗。比较两组的美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分、Baethel指数、格拉斯哥昏迷评分法(Glasgow Coma Scale,GCS)评分及不良反应发生情况。结果治疗后,研究组的NIHSS评分低于对照组,GCS评分高于对照组,差异有统计学意义(P均<0.05)。治疗24 h和治疗14 d,研究组的Baethel指数高于对照组,差异有统计学意义(P均<0.05)。研究组的不良反应总发生率低于对照组,差异有统计学意义(P<0.05)。结论 使用rt-PA超早期静脉溶栓治疗急性脑梗死能够有效的提高患者的日常生活活动能力和昏迷指数,快速帮助患者溶解血栓,提高治疗的效果,使得患者脑血流快速恢复,减少脑水肿等不良反应的发生。
