小剂量尿激酶治疗不稳定性心绞痛对凝血、纤溶活性和血小板聚集的影响  

Low Dose Urokinase in the Treatment of Unstable Angina: Effects on Coagulation, Fibrinolytic Activity and Platelet Aggregation

作　　者：关婷[1] 陈纪林[1] 赵秀文[2] 张峻[1] 陈在嘉[1] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院冠心病研究室,北京市100037 [2]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院分子生物学实验室,北京市100037

出　　处：《中国循环杂志》2001年第3期176-179,共4页Chinese Circulation Journal

摘　　要：目的：在小剂量尿激酶溶栓治疗不稳定性心绞痛中，探索溶栓前充分抗凝和抗血小板与否对血浆纤维蛋白肽Ａ（ＦＰＡ）、凝血烷Ｂ２（ＴＸＢ２）、组织纤溶酶原激活物（ｔ－ＰＡ）和纤溶酶原激活剂的抑制物（ＰＡＩ－１）活性的影响。 方法：选择 １周内加重的不稳定性心绞痛患者 １６例，随机分为试验组（ ｎ＝ ８）和对照组（ ｎ＝８）。试验组先予乙酰水杨酸水溶片（巴米尔）０．３ｇ口服及依诺肝素钠（克赛）３０ｍｇ静脉注射＋１ｍｇ／ｋｇ皮下注射，１小时后再予尿激酶５０万ＩＵ静脉滴注６０分。对照组入院即予尿激酶５０万ＩＵ静脉滴注６０分，溶栓前不给予低分子肝素，仅给予肠溶阿司匹林 ５０ ｍｇ口服。两组分别于溶栓前及溶栓开始后 ２、 ４、 １２、 ２４小时各采静脉血检测 ＦＰＡ、ＴＸＢ２浓度和 ｔ－ＰＡ、 ＰＡＩ－１活性。 结果：①试验组溶栓前后ＦＰＡ浓度无显著差异；两组间比较ＦＰＡ浓度在治疗前无差异，溶栓后２小时在对照组出现ＦＰＡ浓度反弹性增高，有非常显著差异（Ｐ＜０．０１），同期相比试验组浓度明显低于对照组，有显著差异（Ｐ＜０．０５）。②试验组溶栓后４小时ＴＸＢ２浓度明显下降；对照组溶栓前后ＴＸＢ２浓度无显著差异。两组间比较，溶栓后２～１２小时试验组?Objective: To examine the changes of plasma levels of fibrinopeptide A (FPA)and thromboxane B2 (TXB2)and the activities of tissue plasminogen activator (t-PA)and plasminogen activator inhibitor type 1 (PA1-1 ) during the treatment of unstable angina with two different methods of low dose urokinase. Methods: Sixteen patients with unstable angina were randomly divided into two groups. In the experimental group, as- pirin 300 mg and low molecular weight heparin (30 mg iv + 1 mg/kg IH) were administered and urokinase (500,000IU, ivgtt within 60 minutes)were administered an hour later. In the control group, only aspirin 50 mg were given. The plasma concentrations of FPA and TXB2 and activities of t-PA and PAI-1 were measured before and 2, 4, 12, 24 hrs after treatment. Results: No difference was found in FPA concentration of the experimental group during the treatment. FPA concentra- tion in the control group was increased significantly 2 hrs after urokinase infusion (p<0 .01 )and was higher than that in the experimental group (p<0.05). TXB2 concentration in experimental group was remarkably decreased 2-12 hrs after urokinase infusion compared with the control group (p< 0.05). Activity of PAI-1 was decreased and that of t-PA increased 2 for after thrombolytic therapy in both groups (p< 0 .001 ). Conclusion: Low dose urokinase could remarkably increase the fibrinolytic activity but the could activate the thrombin during the treatment of unstable angina. The effective antithrombin therapy before low dose urokinase administration could inhibit the activating of thrombin.

关 键 词：不稳定型心绞痛 尿激酶 凝血酶 血小板聚集 纤溶酶原激活剂 治疗 

分 类 号：R541.4[医药卫生—心血管疾病]