应用reteplase治疗兔视网膜动脉阻塞  

Experimental study on the treatment of retinal artery occlusion with reteplase in rabbits

作　　者：张瑞帆[1,2] 翁欢[1] 李秋华[1] 

机构地区：[1]复旦大学附属华山医院眼科,上海200040 [2]四川省人民医院眼科,成都610072

出　　处：《中国眼耳鼻喉科杂志》2009年第5期279-282,I0001,共5页Chinese Journal of Ophthalmology and Otorhinolaryngology

基　　金：上海市经济委员会高新技术产业科技开发项目(沪创新J-59-3)

摘　　要：目的观察组织型纤溶酶原激活物突变体(reteplase,r-PA)和重组组织型纤溶酶原激活物(re-combinant tissue-type plasm inogen activator,rt-PA)治疗兔视网膜动脉阻塞(retinal artery occlusion,RAO)的效果,评价这两种药物的有效性和安全性。方法将45只RAO模型新西兰白兔分为3组,每组15例,分别给予r-PA溶液(0.3MU/kg)、rt-PA溶液(1.7mg/kg)和注射用水。4h时,直接眼底镜、眼底照相检查双眼,荧光素血管造影(fundus fluorescence angiography,FFA)检查实验眼。各组于给药后1、2、3、4h检查凝血及纤溶功能;4h行头颅磁共振成像,并行实验眼组织学检查。结果r-PA组动脉完全再通率为86.67%(13/15),rt-PA组为66.67%(5/15);r-PA组和rt-PA组与对照组(0/15)比较差异有统计学意义(P<0.05),r-PA组与rt-PA组比较差异无统计学意义(P>0.05)。r-PA组和rt-PA组血浆凝血酶时间、纤维蛋白原和D-二聚体较对照组有不同程度改变,r-PA组对凝血酶时间、纤维蛋白原的影响较rt-PA组小(P<0.05)。实验兔均无颅内出血和玻璃体积血。光学显微镜下两组均未见视网膜动脉管腔中有明显血栓形成,管壁未见明显坏死或变薄。结论r-PA和rt-PA对RAO模型均有较好的治疗效果,两者之间疗效无明显差别;r-PA对凝血和纤溶系统的影响比rt-PA小。Objective To observe the therapeutic effect of reteplase, a recombinant plasminogen activator （r-PA）, and recombinant plasminogen activator （rt-PA）on retinal artery occlusion（RAO） and to compare the efficiency and safety of the two drugs. Methods Forty-five New Zealand albino rabbits were divided into 3 groups of 15 in each in- jected with r-PA （0.3 MU/kg） ,rt-PA （1.7 mg/kg） and injection water respectively. Four hours after drug administration, all eyes of the rabbits were examined by direct ophthalmoscope and fundus microscope. The experimental eyes were further examined by fundus fluorescence angiography （FFA）. Plasma thromboplastin, activated partial thromboplastin time,thrombin time（TT） ,fibrinogen（Fbg） and D-dimer was detected at 1 h, 2 h, 3 h, 4 h post-treatment respectively in all animals. All rabbits were examined by magnetic resonance imaging 4 hours after drug administration. All the experimental eyes were enucleated and the retina was observed under light microscopy. Results There were 86.67% arteries reperfused entirely in the r-PA group and 66.67% in the rt-PA group, all significantly increased compared with the control group （ P 〈 0.05 ）. But no significant difference was observed between the r-PA group and the rt-PA group. The values of TT, Fbg and D-dimer of the r-PA group were all significantly different from those of the control group （ P 〈 0.05 ）, so was the rt-PA group. Compared with the rt-PA group, the r-PA had less influence on TT and Fbg （P 〈 0.05 ）. There was no hemorrhage in brain or vitreous in all rabbits. Neither thrombi, necrosis or thinning of tubal wall was found under light microscope in all experimental eyes of the r-PA group and the rt-PA group. Conclusions Both r-PA and rt-PA had therapeutic effect on RAO in rabbits, with no obvious difference between them. But r-PA had less influence on the cruor and fibrinolysis system than rt-PA.

关 键 词：光化学 视网膜动脉阻塞 组织型纤溶酶原激活物 

分 类 号：R774.1[医药卫生—眼科] R-332[医药卫生—临床医学]