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目的 对比观察注射用重组人尿激酶原(Pro- UK)对全身纤溶系统的影响。方法 将114 例符合溶栓标准的急性心肌梗死患者随机给予不同剂量的Pro UK或尿激酶(UK)进行溶栓。其中Pro -UK 30 mg及40 mg组26 例,50 mg组29例,60 mg组28例;UK组31例。观察溶栓前和溶栓开始后2、24、48 h血浆纤溶酶原(PLG)、D 二聚体(D D)、组织型纤溶酶原激活物(t PA)、纤溶酶原激活物抑制物(PAI)、纤维蛋白原(Fib)的变化以及出血并发症,并于溶栓开始后90 min进行冠状动脉造影,比较Pro UK和UK组溶栓后的血管开通率。结果 各用药组溶栓开始后2 h的PLG及PAI活性较溶栓前显著降低(P<0.01),而D D和t PA活性较溶栓前显著升高(P<0.01);UK组溶栓开始后2 h Fib较溶栓前显著降低(P<0.01),而Pro UK各剂量组Fib降低不明显;以上所有变化在溶栓开始后24 h基本恢复;溶栓开始后2 h Pro UK各剂量组的Fib明显高于UK组(P<0.01),其他时间点各用药组之间的所有观测指标均无显著差异;各用药组之间梗死相关血管开通率和出血并发症均无显著差异;溶栓开始后2 h梗死相关血管开通组的PAI显著低于未开通组(P<0.01),其他指标无显著差异。结论 UK溶栓后对全身纤溶系统激活较明显,与UK比较Pro -UK对全身纤溶系统无明显激活作用。
Objective To compare the effects of injectable recombinant human pro-urokinase (Pro-UK) on systemic fibrinolytic system. Methods One hundred and fourteen patients with acute myocardial infarction who met thrombolysis criteria were randomized to receive different doses of Pro UK or urokinase (UK) for thrombolysis. Among them, Pro-UK 30 mg and 40 mg group 26 cases, 50 mg group 29 cases, 60 mg group 28 cases; UK group 31 cases. Plasma plasminogen (PLG), D dimer (DD), tissue plasminogen activator (t PA), plasminogen activator (PAI), fibrinogen (Fib) and bleeding complication. Coronary angiography was performed at 90 min after the start of thrombolysis. The rate of vessel opening after thrombolysis in Pro UK and UK groups was compared. Results The activities of PLG and PAI at 2 h after initiation of thrombolysis in each drug group were significantly lower than those before thrombolysis (P <0.01), while the activities of DD and t PA were significantly higher than those before thrombolysis (P <0.01) Fib levels were significantly lower at 2 h after initiation of thrombolytic therapy (P <0.01), while Fib levels were not significantly reduced at each dose of Pro UK; all of these changes were restored almost 24 h after initiation of thrombolysis; Pro UK The Fib level in the dose group was significantly higher than that in the UK group (P <0.01). There was no significant difference between the two groups at all time points. There was no significant difference in infarct-related vessel opening rate and bleeding complications PAI in infarct-related vascular access group 2 h after thrombolysis was significantly lower than that in non-open group (P <0.01), and no significant difference was observed in other indexes. Conclusion The activation of systemic fibrinolytic system after UK thrombolytic therapy is more obvious. Compared with UK, Pro-UK has no obvious activation on systemic fibrinolysis system.