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。

Effects of streptokinase and urokinase on fibrinolytic and coagulation activities during intravenous thrombolysis

Aim:To compare the effects of streptokinase(SK) and urokinase(UK)on fibrinolytic and coagulation systems.Method:111 patients with acute myocardial infarction treated with thrombolytic therapy,55 received 1.5 million units of SK intravenously and 56 received a dose of 17 23 thousand units of UK/kg body weight.The plasma activities of plasminogen activator (PA),plasminogen activator inhibiter (PAI),plasminogen (PG),and the levels of fibrinogen,D dimer ,and activated coagulating time (ACT) were measured serially.Results:SK made more significant changes in fibrinolytic and coagulation system,and characterized by higher PA activities,lower PAI activities in 6 12 hours after treatment;longer coagularting time at 2 hours.Lower fibrinogen concentrations persisted 7 days,or more.Clinical data showed a better result in SK group:a slightly higher rate of clinical reperfusion;a lower rate of postinfarction anginas and reinfarctions within 28 days,but the differences were not statistically significant.The incidence of bleeding complication was a little higher in SK than UK and was also not significant.Conclusion:The effects of SK on fibrinolytic and coagulation activities are stronger and longer than that of UK,the differences may be related to the clinical results.