不同溶栓剂对急性心肌梗死患者凝血与纤溶系统的影响及其临床意义

ObjectiveTocompare the clinical effects of strepkinase (SK),recombinant strepkinase (rSK),urokinase(UK),recombinant tissuetype plasminogen activator (rtPA) on fibrinolytic and coagulationsystem during the thrombolysis treatment in patients with acute myocardial infarction(AMI).MethodsThe levels of prothrombin time (PT),activated partialthromboplasmin time (APTT),fibrinogen (FG),plasminogen (PLG),α₂antiplasmin (α₂AP),tissueplasminogen activator (tPA),tissue plasminogen activator inhibitor1(PAI1) were measured in43 AMI patients with (SKn=8;rSKn=13;UKn=16;rtPAn=6) and without (n=14) thrombolytictherapy before and at 4,12,24,48 hours,and 1 week after treatment.ResultsAfterthrombolytic treatment 26 cases (60.5％) had coronary artery reperfusion.Followingthrombolytic therapy with SK,rSK,UK,rtPA,plasma PT and APTT were significantlyprolonged;tPA activities and DDimer levels were significantly increased;PAI1,PLG,α₂APactivities and FG levels were significantly decreased (all P<0.01,compare topretreatment values).But those changes were short,and tPA and PAI1 activities returned tothe levels prior to treatment at 12 hours after thrombolytic therapy.The effects of SK andrSK on fibrinolytic and coagulation system were relatively greater than that of UK,andrtPA on FG showed the least effect.In addition,plasma tPA activity in patients withpatency was higher than those without patency pretreatment,but PAI1 activity was on thecontrary (all P<0.05).ConclusionsAfter therapy with SK or rSK,UK orrtPA,the fibrinolytic activity is markedly increased together with reduction incoagulation activity,and changes in coagulation and fibrinolytic activities mightassociate with clinical results with thrombolysis.

The effects of different thrombolytic reagents on coagulation and fibrinolytic system and their clinical significance in patients with acute myocardial infarction