AMI患者尿激酶与组织型纤溶酶原激活剂治疗结果的对比

比较31例尿激酶(UK)及14例组织型纤溶酶原激活剂(t-PA)静脉溶栓辅以阿斯匹林及肝素治疗急性心肌梗塞(AMI)的疗效.t-PA组与UK组相比较:血管再通率分别为78.6%与58.1%(P>0.05);脑、消化道及呼吸道出血并发症在t-PA组稍多,而UK组以局部皮肤出血较多.血管再通组心力衰竭、严重性心律失常、室壁瘤及梗塞后心绞痛的发生率较低,但两组间均无显著性差异;再通组病人心脏破裂的发生明显低于未再通组(0与17.6%P<0.05).本研究提示静脉t-PA溶栓治疗血管再通率高于静脉UK,有条件者可以首选t-PA.溶栓再通可以减少心力衰竭、室壁瘤、心梗后再缺血的发生,特别是心脏破裂的发生,从而改善病人的预后.     

链激酶,尿激酶静脉溶栓对凝血和纤溶系统的影响

尿激酶（ＵＫ）和链激酶（ＳＫ）同属第一代溶栓剂，二者均无“纤维蛋白选择性”，本研究目的在于比较ＳＫ和ＵＫ对凝血和纤溶系统的影响及其与临床的关系。静脉溶栓治疗急性心肌梗塞１１１例，其中５５例使用ＳＫ（１５０万单位／例），５６例使用ＵＫ（１．７－２．３万单位／ｋｇ体重，平均１５３．２５万单位／例），于溶栓前、溶栓后２、６、１２、２４小时、第３天、第７天分别测定血浆纤溶酶原激活物（ＰＡ）、纤溶酶原激活物抑制物（ＰＡＩ）、及纤溶酶原（ＰＬＧ）活性，并测定纤维蛋白原（ＦＧ）浓度、激活的试管法凝血时间（ＡＣＴ）。结果显示：ＳＫ引起的凝血和纤溶系统变化均比ＵＫ明显，特征为：在溶栓后２～６小时有较高的ＰＡ活性和较低的ＰＡＩ活性；溶栓后２小时较长的凝血时间；较低的纤维蛋白原浓度从２小时持续到第７天，上述差异均有极显著意义。本文结果提示ＳＫ对凝血和纤溶系统的影响比ＵＫ强烈而持久，二者在血液学特征上的差异与临床疗效及使用抗凝剂等问题可能有一定的关系。     

Thrombolytic therapy in acute myocardial infarction following prolonged cardiopulmonary resuscitation.

Thrombolytic therapy was administered to a 49-year-old woman with an acute anterior wall myocardial infarction after having prolonged cardiopulmonary resuscitation for 13 minutes. On admission, there was no clinical or radiographic evidence of gross trauma. There was no significant morbidity and the patient recovered to a completely functional status. The literature of thrombolytic therapy after cardiopulmonary resuscitation is reviewed. In the absence of gross trauma from cardiopulmonary resuscitation, thrombolytic therapy in acute myocardial infarction should not necessarily be excluded because of the duration of resuscitation. Further experience with such patients will shed additional light on efficacy and safety.     

Thrombolytic therapy for acute ischaemic stroke: successful implementation in an Australian tertiary hospital

The use of tissue-type plasminogen activator (t-PA) in ischaemic stroke outside of experienced stroke centres remains controversial. The aim of this study was to present the initial experience with t-PA in patients with ischaemic stroke at an institution with no prior experience in i.v. stroke thrombolysis and to compare results to published reports. Prospective audit of 888 patients with consecutive stroke and transient ischaemic attack admitted to a 426-bed tertiary referral hospital from March 2003 to October 2005. Main outcome measures were treatment rate, exclusion criteria, protocol violations, intracerebral haemorrhage, disability (modified Rankin scale) and mortality at 3 months. Over the study period, 72 patients received t-PA (11% of ischaemic strokes). The main reason for exclusion was presentation beyond 3 h of onset (44%); if all eligible patients had arrived within 3 h, treatment rate was estimated at 32.5%. Protocol violations occurred in 15 (21%) patients. There were seven (10%) asymptomatic intracerebral haemorrhage and one (1%) non-fatal symptomatic intracerebral haemorrhage. At 3 months, 37% had achieved excellent recovery (modified Rankin scale 0-1) and seven (10%) had died. The delivery and outcomes associated with the use of t-PA were comparable to the results of the National Institute of Neurological Disorders and Stroke trial and meta-analysis of open-labelled studies. With appropriate infrastructure and protocols, previously inexperienced tertiary referral centres can replicate the experience and outcome measures reported by clinical trials of t-PA in patients with stroke.     

An Experimental Study on the Flexibility of Prevention against Thrombosis Following Mechanical Valve Replacement by tPA Gene Transduction

Objectives Use a gene suture immersed recombinant tissue-type plasminogen activator （r-tPA）expression plasmid to transduce myocardia to prevent the thrombosis after mechanical tricuspid valve replacement in pigs. Methods A r-tPA gene plasmid was constructed and conjugated to a novel cationic phosphonolipid and a r-tPA gene suture was made. Eighteen pigs were selected and divided into two groups at randomization. There were 9 pigs in the experimental group and 9 in the control group, all the 18 pigs＇ tricuspids were replaced with mechanical valves. The gene threads were sutured into the right ventricular walls near mechanical valves and an ultrasound was used on the surfaces of the right ventricular walls for the gene transfer in the experimental group. Coagulative function, D-dimer level of the blood and the thrombosis on the surfaces of the valves were observed. Results r-tPA gene plasmid was successfully constructed and r-tPA protein was expressed in the ventricular cells around the gene sutures. D-dimer reached its peak level （ 1.67 ±0. 79） μg · mL^-1 in 1 week after operation in two groups, but it decreased to preoperation level thereafter in control group and kept on the high level and reincreased to a new high level （ 1.89 ± 0.79 ） μg · mL^-1 until the end of the experiment in experimental group. The thromboses around the valves were found in all the control group （100%） but only 1 （ 11.11% ） case in experimental group. There were no changes in prothrombin time pre and post operation in two groups. Conclusions Using gene suture immersed r-tPA expression plasmid to transduce myocardia might be a best substitution for life long anti-coagulation therapy for the patients, who underwent operation.     

Thrombolysis in ischaemic stroke — how far from a clinical breakthrough ?

Abstract. Thromboembolic occlusions of the cerebral arteries often recanalize spontaneously, and patients with early recanalization have a better outcome than patients who do not recanalize. Clinical as well as experimental data support the concept of a time window within which brain tissue will profit from restoration of blood flow. In occlusion of middle cerebral artery, internal carotid artery, as well as vertebrobasilar arteries, open studies of intra-arterial administration of thrombolytic agents have demonstrated recanalization within hours in 40–100% of patients in small series. In intravenous drug administration, recanalization rate was obtained in 34–59% of patients. Favourable outcome was associated with recanalization. Intracerebral bleeding complications with clinical deterioration occurred in about 10% of patients. Three randomized controlled trials comprising 156 patients with acute ischaemic stroke have reported favourable outcome in treated patients, with no difference of intracerebral haemorrhagic complications between treated and controls. Results of ongoing randomized placebo controlled trials are expected in 1995 to disclose whether a clinical breakthrough is achieved or whether haemorrhagic complications will outweigh a beneficial effect of thrombolytic therapy in acute cerebral ischaemia.     

解毒活血中药对急性冠脉综合征患者PCI术后CD40-L及tPA的影响

目的检测解毒活血中药对急性冠脉综合征(ACS)患者冠脉介入术(PCI)术后白细胞分化抗原40及其配体(CD40-L)及组织型纤溶酶原激活剂(tPA)的影响,探讨解毒活血中药治疗急性冠脉综合征不稳定斑块的机制。方法采用经皮Seldinger穿刺法或经桡动脉穿刺法选择性冠脉造影术。检测PCI术前及PCI术后用药30d后采用酶联免疫吸附法(ELISA)分别测定CD40-L、tPA水平。结果治疗组治疗后CD40-L及tPA水平下降更明显(P<0.05)。结论解毒活血中药能降低ACS患者PCI术后CD40-L及tPA水平,抑制PCI术后炎症。     

国人小剂量与快速常规剂量rt-PA治疗急性心肌梗死的疗效与安全性比较

目的：评价重组组织型纤溶酶原激活剂(rt—PA)快速给药对国人急性心肌梗死(AMl)溶栓治疗的疗效及安全性，并与小剂量rt—PA的疗效进行对比。方法：快速常规剂量组(R组)75例AMI病人在阿司匹林和肝素治疗后接受20mg rt—PA一次弹丸注射，随后80mg半小时内快速滴入，尽快行急诊冠状动脉造影响术。小剂量治疗组(S组)32例AMI病人在阿斯匹林和肝家治疗基础上接受8mg rt—PA一次弹丸注射，继之42mg在90分钟内滴入，并进行冠状动脉造影。以用药后冠状动脉造影显示梗死相关动脉(1RA)TIMI血流分级作为主要终点评价疗效。结果：107例冠状动脉造影的冠状动脉血流通畅率(TIMt和I级)：R组显高于S组(88％、75％，P＜0．01)，达到了IMl3级血流R组亦高于S组(62％、47％，P＜0．01)，左室射血分数：R组明显高于S组(P＝0．05)，出血发生率：两组差异无显性。结论：快速常规剂量rt—PA对国人AMI病人是有效和安全的。其冠状动脉再通率明显高于小剂量rt—PA治疗。     

肺血栓栓塞症溶栓患者临床表现和疗效分析

目的分析96例肺血栓栓塞症(PTE)溶栓患者的临床特点,探讨该溶栓方案的有效性和安全性。方法分析96例接受溶栓的PTE患者的临床表现、实验室检查和影像学资料。Ⅰ组(62例)病程在2周内;Ⅱ组(26例)病程超过1个月,症状加重2周;Ⅲ组(8例)病程超过2周(最长呼吸困难史5个月),但影像学判断血栓较新鲜。采用尿激酶(75万~150万U)或重组组织型纤溶酶原激活剂(50~100mg)溶栓。综合判断溶栓疗效和安全性。结果74%PTE患者伴有下肢静脉疾患,96%有呼吸困难症状。溶栓后,呼吸频率、心率显著改善(P<0.001)。溶栓总有效率Ⅰ组97%;Ⅱ组73%(与Ⅰ组比较,P=0.001);Ⅲ组100%。结论下肢静脉病是PTE主要诱因,对于不能解释的劳力性呼吸困难、晕厥应高度怀疑PTE。     

Use of Thrombolytic Therapy for Acute Myocardial Infarction: Effects of Gender and Age on Treatment Rates

Background: Although there have been efforts to increase the utilization of thrombolytic therapy, there are still many patients who might benefit from this treatment who do not receive it. Women and the elderly have been particularly undertreated, despite evidence that their survival can be improved with thrombolysis. This study was undertaken to determine the relative rates of treatment of women vs. men and the elderly vs. younger subjects and to examine factors that might explain differences in treatment frequency. Methods and Results: This is a retrospective study of patients who presented to the Emergency Departments of four local hospitals in 1993 and 1994 with evidence for acute ST-elevation myocardial infarction. Demographic data, past medical history, information on co-morbid illnesses, and times to hospital arrival, first electrocardiogram, physician notification, and thrombolytic therapy were recorded as was survival to hospital discharge. Data for patients who did or did not receive thrombolytic therapy were compared. Men were treated more frequently in both tertiary and community hospitals. Women were older, but within each age bracket, men were treated more often. The time of arrival was similar for men and women, but men who arrived within 6 hours or 6–12 hours after pain onset were treated at a higher rate than women. For patients without contraindications, treatment was not affected by gender or age. However, treatment rates decreased with increased prevalence of exclusionary factors, and since both women and the elderly tended to have more such factors, elderly women were treated at a markedly lower rate. The single clinical factor that increased thrombolytic usage in women compared to men was a history of prior myocardial infarction. Conclusion: Despite convincing evidence that thrombolytic therapy is beneficial in women and the elderly, these groups have been relatively neglected unless attention is called to clinical risk, for example, by history of prior myocardial infarction.     

尿激酶和巴曲酶治疗早期急性脑梗死的疗效和安全性研究

目的比较尿激酶和巴曲酶治疗超早期脑梗死的效果和安全性。方法比较150万单剂量尿激酶和不同剂量及给药时间的巴曲酶治疗发病6 h内脑梗死的效果。以治疗后3个月和6个月死亡率、改良Rankin评分(mRS)和巴塞尔指数(BI)作为主要终结指标,以美国国家卫生研究所卒中评分(NIHSS)变化作为次要终结指标,收录患者74例。分为A组(尿激酶组)26例,B组(巴曲酶常规剂量组)25例,C组(巴曲酶加大剂量及延长疗程组)23例。结果尿激酶和巴曲酶均可以改善部分患者神经功能评分,2h内尿激酶平均改善NIHSS较快,但是有波动,而巴曲酶效果较平缓而稳定。3个月时A、B、C各组的BI 95~100分患者占的比例分别是26.9%,33.3%,28.6%;mRS 0~2分患者分别为42.3%,41.7%,42.9%;6个月BI 95~100分患者占的比例分别是50.0%,58.3%,47.6%;mRS 0~2分患者分别为57.7%,66.7%,57.1%。差异均无显著性意义。结论缺血性脑卒中6 h内给予尿激酶或者巴曲酶对3个月和6个月后终结指标影响没有显著差异。     

Clinical experience with intracoronary tissue plasminogen activator: Results of a multicenter registry

Clinical experience with the use of intracoronary tissue plasminogen activator (t-PA) is limited. We therefore undertook this study to document current clinical usage of intracoronary t-PA during a 2-yr period in a multicenter registry. Intracoronary t-PA was utilized on 206 occasions in 198 patients (154 men and 44 women; mean age, 59 ± 12 yr). The mean dose of intracoronary t-PA was 31 ± 15 mg. Indications for use included acute myocardial infarction (MI) (n = 83), preexisting thrombus with (n = 49) or without (n = 41) percutaneous transluminal coronary angioplasty (PTCA), unstable angina (n = 14), abrupt vessel closure (n = 11), and post-PTCA “clean-up” (n = 8). The Thombolysis in Myocardial Infarction (TIMI Phase I) criteria were used to assess perfusion and degree of thrombus formation. Overall, the mean TIMI flow grade increased from 1.2 ± 1.1 before treatment to 2.3 ± 1.0 after treatment (P<0.0001); the mean TIMI thrombus grade decreased from 3.2 ± 1.0 before treatment to 1.6 ± 1.4 after treatment (P<0.0001). Complications included bleeding (9.2%), MI (17.6%), need for coronary artery bypass grafting (CABG) (9.2%), need for repeat PTCA/atherectomy/stents (4.9%), and ventricular fibrillation (1.7%, all associated with opening totally occluded vessels). There were 14 subsequent in-hospital deaths: 13 of the patients who died had originally presented with MI; the other had experienced abrupt vessel closure during a PTCA procedure. Intracoronary t-PA appears to be effective in improving distal flow and decreasing thrombus burden; however, intracoronary delivery of t-PA has associated risks. Further prospective evaluations of intracoronary t-PA will be necessary to determine the optimal clinical situations for its use, as well as the appropriate dose regimen.     

Hypofibrinolysis in patients with hypercoagulability: The roles of urokinase and of plasminogen activator inhibitor

The prevalence of abnormalities of fibrinolysis in patients with venous thromboembolism is as yet unknown. Defined abnormalities include congenital dysfunction and deficiency of plasminogen, and probably impaired plasminogen activation secondary to elevated levels of plasminogen activator inhibitor type 1 (PAI-1) or to impaired release of tissue plasminogen activator (tPA). In this preliminary study, we analyzed plasma samples from 21 patients for whom an investigation for possible thrombophilia was requested. Twenty of the patients had venous thromboembolism, and one had arterial thrombosis at an early age. Two patients had deficiency of protein C or protein S, but no other recognized biochemical disturbances related to thrombophilia were identified. Patient samples and plasma from 25 normal controls were assayed for tPA activity, PAI-1 activity, and urokinase (uPA) activity and antigen. tPA activity and antigen were not significantly different in patients than in controls. PAI-1 activity was significantly greater in patients (P < 0.0001). uPA activity was not different in the two groups. However, uPA antigen was significantly reduced in patients compared to controls (P = 0.001). These data suggest that hypofibrinolysis leading to a risk of thrombosis may be caused not only by elevated PAI-1 activity but also by reduced total uPA concentration. © 1993 Wiley-Liss, Inc.     

瑞替普酶和重组组织型纤溶酶原激活剂治疗急性心肌梗死的临床研究

目的对比观察瑞替普酶与重组组织型纤溶酶原激活剂(rt-PA)用于急性心肌梗死(AMI)静脉溶栓治疗的效果及安全性。方法将122例发病12h内的AMI患者随机分为两组,瑞替普酶组60例,瑞替普酶20mU间隔30min分2次静脉推注;rt-PA组62例,rt-PA8mg静脉推注,42mg,90min内静脉滴注。观察两组溶栓再通率、急性期病死率、心肌梗死并发症和不良事件发生率。结果溶栓后30、60、90和120min瑞替普酶组临床判断再通率均高于rt-PA组,两组60和90min2个时间段比较,差异有显著性意义(P<0.01,P<0.05)。90min瑞替普酶组48例行冠状动脉造影,42例显示梗死相关血管再通为87.5%,rt-PA组42例行冠状动脉造影,29例显示梗死相关血管再通为69.05%(P<0.01);35天瑞替普酶组死亡2例(3.33%),rt-PA组死亡3例(4.84%);两组均无脑出血病史;不良事件发生率瑞替普酶组为23.3%,rt-PA组为25.6%。结论瑞替普酶静脉溶栓治疗AMI比较安全,较rt-PA能更早地使梗死相关血管开通,并有较高的血管开通率及较低的急性期病死率。     

New strategies in the development of thrombolytic agents

Summary Recombinant DNA technology has allowed large-scale production of the physiological, fibrin-specific, plasminogen activators tissue-type plasminogen activator (t-PA) and single-chain urokinase-type plasminogen activator (scu-PA). The results of clinical trials with these agents, mainly for the treatment of acute myocardial infarction, have revealed a limited fibrin specificity at the large therapeutic doses required for efficient thrombolysis. Mutants and variants of t-PA and scu-PA have given important information on structure-function relationships in these proteins and have resulted in rt-PA variants with significantly prolonged half-lives in vivo. Construction of chimaeric plasminogen activators containing various portions of t-PA and scu-PA has produced functionally active enzymes, however with a lower fibrin-affinity than wild-type t-PA. The promise of antibody targeting and the use of synergistic combinations of thrombolytic agents remains to be further investigated. We anticipate that eventually these research lines will yield artificial plasminogen activators with improved efficacy, risk/benefit and cost/benefit ratios.     

尿激酶热敏脂质体的体内溶栓实验

目的观察以二棕榈酸磷脂酰胆碱和尿激酶(UK)为原料制备的UK热敏脂质体对兔颈总动脉血栓的溶栓效果。方法采用反相蒸发法制备UK热敏脂质体并测定其包封率;新西兰大白兔24只随机分为对照组(输PBS液)、15万U/kg UK组、5万U/kg UK热敏脂质体组、7.5万U/kg UK热敏脂质体组,每组6只;FeCl3包裹兔颈总动脉,建立血栓模型;颈动脉压降至最低点时,分别给4组输入不同药物,记录血压动态变化;最后取各组血栓段血管和心、肝、脾、肺、肾做病理学检查。结果所制备的UK热敏脂质体包封率为65%,脂质体呈圆形或椭圆形,直径为0.08-0.36μm;7.5万U/kg UK热敏脂质体组与15万U/kg UK组比较溶栓效果相似,但前者UK用量仅为后者的1/2,且各脏器均未见出血。结论UK热敏脂质体在溶栓治疗中有良好的靶向性,且出血副作用小。如能进一步优化,可为临床的溶栓治疗提供一条新途径。     

uPA及V-ATPase在肝细胞癌中的表达及意义

目的研究尿激酶型纤溶酶原激活物（uPA）和ATP动力型质子泵（V-ATPase）在肝癌细胞株的表达,及抑制V-ATPase与癌细胞抑制和凋亡的关系。方法用RT-PCR和Western blot检测稳定转染真核表达质粒pCMV-uPA-HA的HCC97L细胞及转染空载体pCMV-HA的HCC97L细胞中uPA和V-ATPase mRNA和蛋白的表达;在转染uPA的HCC97L细胞培养基中加入不同浓度的Bafilomycin A1,用流式细胞仪和CCK-8分别检测癌细胞凋亡及受抑制情况。结果将uPA转染入低转移潜能肝癌细胞株HCC97L后,uPA mRNA和蛋白表达强于转染空载体的HCC97L,V-ATPase mRNA和蛋白表达随着转染uPA而增强。在细胞培养基中加入Bafilomycin A1后细胞生长增殖受到抑制、凋亡增加,且抑制率和凋亡率均随Bafilomycin A1浓度的加大而增加。结论 V-ATPase mRNA和蛋白表达随癌细胞转移能力的提高而增强;Bafilomycin A1抑制V-ATPase,干扰癌细胞内H＋泵出,从而抑制癌细胞生长增殖、促进癌细胞凋亡。     

缺血性脑血管病患者血脂、凝血及纤溶指标的变化

目的　观察缺血性脑血管病 (ICVD)患者血脂、凝血及纤溶指标的变化。方法　对缺血性脑血管病 113例 [包括脑梗死 (CI)急性期 2 5例 ,恢复期 30例 ;短暂性脑缺血发作 (TIA) 5 8例 ]和正常对照组 77名进行血脂、血浆组织型纤溶酶原激活物 (t PA)、纤溶酶原激活物抑制物 (PAI)和D 二聚体浓度进行测定。结果　CI组甘油三酯 (TG)、总胆固醇 (TC)、载脂蛋白B10 0 (ApoB10 0 )、氧化型低密度脂蛋白 (ox LDL)水平显著高于对照组 ;CI急性期、恢复期和TIA组PAI高于对照组 ,而t PA活性均低于对照组 ;TIA伴有梗死灶者血浆D 二聚体和PAI含量明显高于无梗死灶者 ,t PA含量低于无梗死灶者。结论　ICVD患者不仅存在血脂代谢紊乱 ,且体内凝血活性增强 ,纤溶功能下降。     

Bolus Administration of Saruplase in Europe (BASE), a Pilot Study in Patients with Acute Myocardial Infarction

To study the safety and efficacy of the thrombolytic agent saruplase as a bolus, the angiographic and clinical outcomes of three bolus regimens were investigated in a pilot study conducted in 192 patients with an acute myocardial infarction and were compared with the standard regimen. Fifty-two patients received a double bolus of 40 mg and 40 mg after 30 minutes, 51 patients a bolus of 80 mg, and 36 patients a bolus of 60 mg. Fifty-three patients received the standard regimen (a bolus of 20 mg and 60 mg IV infusion over 1 hour). At 60 minutes TIMI 2 and 3 flow were, respectively, 9.6% and 61.5% with the 40/40-mg bolus, 15.7% and 51.0% with the 80-mg bolus, 16.7% and 30.6% with the 60-mg bolus, and 7.5% and 54.7% with the standard 20/60-mg infusion. At 90 minutes TIMI 2 and 3 flow improved to 9.6% and 73.1%, 15.7% and 56.9%, 13.9% and 36.1%, and 5.7% and 71.7%, respectively. The primary endpoint, persistent patency (TIMI 2 + 3) at 24–45 hours, was seen in 69.2%, 64.7%, 44.4%, and 67.9% of patients who had no rescue PTCA, respectively. Inclusion in the 60-mg bolus group was prematurely stopped because of their low patency rates. The 40/40-mg bolus group had the highest mortality rate (13.5%), whereas the 60-mg bolus group had no deaths. Other adverse event rates were similar in the four groups. This clinical outcome is highly influenced by rescue PTCA of patients with insufficient TIMI flow. This pilot study indicates that in patients with an acute myocardial infarction, a double bolus of 40/40 mg resulted in the highest patency but also had the highest complication rate. The 80-mg single bolus is an attractive alternative for further evaluation because of its acceptable patency and event profile, and its easy form of administration.     

尿激酶与组织型纤溶酶原激活剂静脉溶栓治疗急性心肌梗塞的对比研究

为比较尿激酶（UK）及组织型纤溶酶原激活剂（t-PA）静脉溶栓辅以阿司匹林及肝素对急性心肌梗塞的效果及其副作用。对急性心肌梗塞患者发病6h内者，42例给予静脉UK15例静脉内t-PA溶栓辅以静脉肝素及阿司匹林治疗。结果表明，t-PA组、UK组临床血管再通率分别为86．7％与57．1％（P＜0．05），前者消化道与呼吸道出血并发症为13．3％，而后者为0（P＜0．05）。本研究提示静脉t-PA溶栓血管再通率显著高于静脉UK，但出血合并症的发生t-PA组显著高于UK组。