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目的 急性心肌梗死 (AMI)是心血管急症这一 ,链激酶 (SK)、尿激酶 (UK)同属第一代溶栓剂 ,在我国AMI临床治疗中应用广泛。本研究的目的在于比较SK与UK静脉溶栓对血小板、内皮细胞功能、肾素活性的影响及其临床意义。方法 选择符合 1979年WHO诊断标准的AMI患者 4 5例 ,其中 16例使用SK治疗 (SK组 ) ,14例使用UK溶栓治疗 (UK组 ) ,15例接受常规治疗作为对照组。所有患者于入院即刻及发病后 2 4h、第 7天分别采卧位静脉血 5ml,测定血栓素B2 (TXB2 )、 6 酮 前列腺素Fla (6 -keto -PGFla)、血浆肾素活性 (PRA)、血管紧张素Ⅱ (AngⅡ)的水平。结果 TXB2 在SK组治疗前后及对照组各点均有升高 ,二者比较 ,差异无显著意义 ,UK组治疗后 (即发病后 2 4h、 7thd)较对照组、SK组明显升高 ;6 -keto-PGFla在 3组无变化 ;二者比值TXB2 / 6 -keto -PGFla (T/P)在UK组也明显升高 ;PRA、AngⅡ 在 3组呈升高趋势 ,但差异无显著意义。结论 心梗后及SK、UK溶栓后血小板活性均有增强 ,UK和SK相比 ,前者使血小板活化作用更强。这种作用可能会限制溶栓的效果 ,故溶栓治疗中尤其UK溶栓时更应加强抗血小板治疗 ,包括加大阿司匹林剂量或加用其他更有效的抗血小板制剂。
Purpose Acute myocardial infarction (AMI) is a cardiovascular emergency. Streptokinase (SK) and urokinase (UK) belong to the first generation of thrombolytic agents and are widely used in the clinical treatment of AMI in China. The aim of this study was to compare the effects of intravenous thrombolysis with UK and UK on platelet, endothelial cell function and renin activity and their clinical significance. Methods Forty-five AMI patients were selected according to the 1979 WHO diagnostic criteria. Sixteen patients were treated with SK (SK), 14 received UK thrombolytic therapy (UK), and 15 received routine therapy as control. All patients received 5 ml of venous blood immediately after admission and at 24 h and 7 d after onset, and measured TXB2, 6-keto-PGFla and PRA, , Angiotensin Ⅱ (Ang Ⅱ) levels. Results The level of TXB2 in SK group was significantly higher than that in control group and SK group after treatment (ie, at 24 hours and 7th day after onset), but there was no significant difference between the two groups. -keto-PGFla did not change in the three groups; the ratio of TXB2 / 6 -keto-PGFla (T / P) was also significantly increased in the UK group; PRA, AngⅡ in the three groups showed an upward trend, but the difference was not significant. Conclusions After thrombolysis, the platelet activity in both MI and MI increased after myocardial infarction. Compared with SK, the former has stronger platelet activation. This effect may limit the effect of thrombolysis, thrombolytic therapy, especially in UK when thrombolytic therapy should be more antiplatelet therapy, including increased aspirin dose or with other more effective antiplatelet agents.