阿替普酶与瑞替普酶在动静脉内瘘溶栓治疗中的对比分析  

The comparative analysis of Alteplase and Reteplase for thrombolysis treatment in arteriovenous fistula

作　　者：廖琪 熊艳 蒋秋艳[1] 王凤英[1] 邹贵勉[1] 眭维国[1] LIAO Qi;XIONG Yan;JIANG Qiu-yan;WANG Feng-ying;ZOU Gui-mian;SUI Wei-guo(Nephrology Department,Guilin 181st Hospital,Center of Organ Transplantation and Dialysis of PLA,Guangxi Key Labo-ratory of Metabolic Disease Research,Guilin 541002,China)

机构地区：[1]中国人民解放军第181医院肾脏科、全军器官移植与透析治疗中心、广西代谢性疾病研究重点实验室,桂林541002

出　　处：《中国血液净化》2018年第9期629-632,共4页Chinese Journal of Blood Purification

基　　金：科技创新能力与条件建设20170117-1

摘　　要：目的探讨阿替普酶(alteplase,rt-PA)与瑞替普酶(reteplase,r-PA)应用于动静脉内瘘溶栓的疗效和安全性的对比分析。方法选取2015年1月~2018年2月我院收治的动静脉内瘘血栓形成的透析患者132例,按入院时间先后顺序分组,r-PA治疗组105例,rt-PA治疗组27例。溶栓治疗后观察两组再通率、再通时间、并发症发生率等。结果 2组患者在年龄、危险因素、发病至开始溶栓时间方面差异无统计学意义(P>0.05),rt-PA组溶通22例(81.48%),r-PA组溶通82例(78.10%),两组内瘘再通率差异无统计学意义(22/27比82/105,χ~2=0.147,P=0.701),rt-PA组溶通时间慢于r-PA组[3.75(1.75~4.88)比1.50(1.50~3.23),Z=-2.135,P=0.033]。治疗后两组纤维蛋白原(fibrinogen,FIB)均下降,rPA组较rt-PA组下降更显著[(1.92±0.88)g/L比(2.73±0.88)g/L,t=-5.331,P<0.001],但仍在安全范围。在轻度出血的发生率上rt-PA组低于于r-PA组,但差异无统计学意义(2/27比17/105,χ~2=0.726,P=0.394)。两组均未发生脑出血、消化道出血等重要脏器出血。结论 rt-PA与r-PA在动静脉内瘘溶栓治疗中效果大致相当,具有再通率高、剂量小的优点,rt-PA对凝血功能的影响可能更小,出血的发生率更低。Objective This is a comparative analysis to investigate Alteplase（rt-PA） and Reteplase（rPA） for thrombolysis treatment in arteriovenous fistula（AVF）. Methods A total of 132 patients with the blockage of AVF due to thrombosis and treated in the hospital from January 2015 to February 2018 were recruited in this study. They were assigned into two groups based on the hospitalization day： r-PA group（n=105,treated with r-PA）, and rt-PA group（n=27, treated with rt-PA）. The re-patency rate, re-patency time and adverse events in the two groups were observed after the treatment. Result There were no significant differences in age, risk factors and the time of thrombolysis treatment between the two groups（P〈0.05）. The re-patency rate was 81.48%（22/27 cases） in rt-PA group, and 78.1%（82/105 cases） in r-PA group（χ~2=0.147, P=0.701）.The re-patency time was longer in rt-PA group than in r-PA group [3.75（1.75~4.88） vs. 1.50（1.50~3.23）,Z=-2.135, P=0.033]. Fibrinogen decreased in both groups. The decrease of fibrinogen was within normal range in both groups, but was more in r-PA group than in rt-PA group（1.92±0.88 g/L vs. 2.73±0.88, t=-5.331,P〈0.001]. Patients with minor bleeding were 2/27 in rt-PA group and were 17/105 in r-PA group（χ~2=0.726,P=0.394）. No bleeding in brain, gastrointestinal tract and any other organs were found in both groups. Conclusion r-PA and rt-PA have similar effect on thrombolysis in AVF. rt-PA has less influence on coagulation and bleeding.

关 键 词：阿替普酶 瑞替普酶 动静脉瘘 血栓溶解疗法 透析 

分 类 号：R318.16[医药卫生—生物医学工程]