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目的:观察一种新的含有tPA和scuPA的纤溶酶原激活剂-人组织型纤溶酶原激活剂(HTU-PA)对急性心肌梗死的溶栓效果。方法:用HTU-PA对21例急性心肌梗死患者进行溶栓治疗,并与国产尿激酶(46例)和链激酶(54例)比较。溶栓90分钟后行冠状动脉造影(CAG),同时动态检测包括PT、APTT、纤维蛋白原、纤溶酶原、FDP、D二聚体、a_2-抗纤溶酶原、PAP、F1+2、PAI、tPA等血液学指标至溶栓后24小时。结果:HTU-PA组临床血管再通率为95％,CAG显示达TIMI3级血流者占76.2％。因溶栓失败或不良反应而引起的5周病死率、轻度出血和严重出血并发症3组间差异不显著。与链激酶组和尿激酶组相比,tPA水平增高显著(P<0.01),血浆浓度高峰持续时间约6小时,PAI明显增高(10～20倍),PT、APTT、纤维蛋白原的变化无显著差异(P>0.05)。TAT的变化与临床再通同步。结论:HTU-PA具有比第一代溶栓剂更长的半寿期和更强的血栓溶解力,但由于纤维蛋白原水平降幅较大,故仍需注意出血的危险性。
AIM: To observe the thrombolytic effect of a new tissue plasminogen activator (tPA) containing tPA and scuPA on human acute myocardial infarction (AMI). Methods: Twenty-one patients with acute myocardial infarction were treated with HTU-PA. Thrombolytic therapy was compared with that of domestic urokinase (46 cases) and streptokinase (54 cases). Coronary angiography (CAG) was performed 90 minutes after thrombolytic therapy, and simultaneous dynamic measurements included PT, APTT, fibrinogen, plasminogen, FDP, D dimer, a_2- antiplasmin, PAP, , PAI, tPA and other hematological indicators to 24 hours after thrombolysis. Results: The rate of clinical recanalization was 95% in HTU-PA group and 76.2% in CAG group. The 5-week mortality rate, mild bleeding and severe bleeding complications caused by failed thrombolysis or adverse reactions were not significantly different among the three groups. Compared with streptokinase group and urokinase group, tPA level increased significantly (P <0.01), plasma concentration peak duration of about 6 hours, PAI increased significantly (10 ~ 20 times), PT, APTT, fibrinogen changes Significant difference (P> 0.05). TAT changes and clinical re-synchronization. CONCLUSIONS: HTU-PA has a longer half-life and stronger thrombolytic activity than the first generation of thrombolytic agents. However, due to the large decrease in fibrinogen levels, the risk of bleeding should be noted.