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目的：比较急性心肌梗死（ＡＭＩ）患者应用链激酶（ＳＫ）、重组链激酶（ｒＳＫ）、尿激酶（ＵＫ）和重组组织型纤溶酶原激活物（ｒｔＰＡ）溶栓治疗期间凝血与纤溶系统的变化，探讨凝血与纤溶指标的变化同溶栓疗效间的关系。方法：对４３例经溶栓治疗（ＳＫ８例，ｒＳＫ１３例，ＵＫ１６例，ｒｔＰＡ６例）及１４例未经溶栓治疗的ＡＭＩ患者分别于治疗前及治疗后４、１２、２４、４８小时和１周共６次，分别检测凝血酶原时间（ＰＴ）、活化部分凝血活酶时间（ＡＰＴＴ）、纤维蛋白原（ＦＧ）、Ｄ二聚体、纤溶酶原（ＰＬＧ）、α２抗纤溶酶（α２ＡＰ）、组织型纤溶酶原激活物（ｔＰＡ）和组织型纤溶酶原激活物抑制物（ＰＡＩ１）等指标的活性或含量。结果：溶栓组冠脉再通２６例（６０．５％）、应用ＳＫ、ｒＳＫ、ＵＫ、ｒｔＰＡ溶栓治疗后，均会导致ＰＴ、ＡＰＴＴ的明显延长，ｔＰＡ活性、Ｄ二聚体含量的明显增高，ＰＬＧ、α２ＡＰ、ＰＡＩ１活性与ＦＧ含量的明显降低（与溶栓前比较，Ｐ均＜０．０１）。但这种变化为时较短，至溶栓后１２小时，各项指标已出现不同程度的恢复，ｔＰＡ与ＰＡＩ１已回至溶栓前水平。ＳＫ与ｒＳＫ对凝血与纤溶系统的影响略高于ＵＫ，ｒｔＰＡ对ＦＧ含量影响最小。冠?
OBJECTIVE: To compare the coagulation and fibrinolysis during the thrombolytic therapy with streptokinase (SK), recombinant streptokinase (rSK), urokinase (UK) and recombinant tissue plasminogen activator (rtPA) in patients with acute myocardial infarction System changes, to explore changes in coagulation and fibrinolysis with the relationship between thrombolytic efficacy. Methods: Thirty-three patients with thrombolytic therapy (SK8, rSK13, UK16, rtPA6) and 14 patients without thrombolysis were divided into two groups: before treatment and at 4, 12, 24, 48 and 1 Week, total of 6 times, respectively, the detection of prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FG), D dimer, plasminogen (PLG), α2 antiplasmin (Α2AP), tissue-type plasminogen activator (tPA) and tissue-type plasminogen activator inhibitor (PAI1) and other indicators of activity or content. Results: Twenty-six patients (60.5%) underwent thrombolysis and coronary artery recanalization. After thrombolytic therapy with SK, rSK, UK and rtPA, the PT and APTT were significantly prolonged, tPA activity and D dimer content (P <0.01). The activity of PLG, α2AP, PAI1 and the content of FG were significantly decreased (P <0.01 compared with those before thrombolysis). However, this change is relatively short, to 12 hours after thrombolysis, the indicators have been varying degrees of recovery, tPA and PAI1 has returned to the level before thrombolysis. The effect of SK and rSK on coagulation and fibrinolytic system was slightly higher than that of UK, rtPA had the least effect on FG content. crown?