Sinkovic A
Department of Internal Intensive Medicine, Teaching Hospital Maribor, Slovenia.
Clin Cardiol. 2000 Jul;23(7):486-9. doi: 10.1002/clc.4960230723.
The antifibrinolytic effect of plasminogen-activator-inhibitor type 1 (PAI-1) may be responsible for delays in reperfusion and/or reinfarctions after streptokinase (STK) therapy in patients with acute myocardial infarction (AMI).
This study aimed to demonstrate the prognostic role of pretreatment PAI-1 levels for the outcome of STK therapy in patients with AMI, depending on reperfusion and/ or reinfarction.
The mean pretreatment PAI-1 level of 104 patients with AMI, treated with STK, determined by chromogenic method, was 5.8 +/- 8.6 U/ml, range 0.3-66.2 U/ml. Streptokinase therapy was successful when reperfusion was achieved, as assessed noninvasively, without subsequent reinfarction; it failed when reperfusion was delayed and/or reinfarction developed.
Fibrinolysis with STK failed significantly in patients with elevated pretreatment PAI-1 levels (p < 0.05), especially with levels >4.0 U/ml (p< 0.01). The mean pretreatment PAI-1 level was significantly higher in unsuccessfully treated patients. Multivariate statistical testing demonstrated that among pretreatment variables, elevated PAI-1 activity was the most significant independent risk factor of failed fibrinolysis with STK.
Among pretreatment variables, elevated pretreatment PAI-1 activity in patients with AMI was the most significant independent risk factor of failed fibrinolysis with STK, especially at levels > 4.0 U/ml.
1型纤溶酶原激活物抑制剂（PAI-1）的抗纤溶作用可能是急性心肌梗死（AMI）患者接受链激酶（STK）治疗后再灌注延迟和/或再梗死的原因。
本研究旨在证明AMI患者接受STK治疗时，根据再灌注和/或再梗死情况，PAI-1预处理水平对治疗结果的预后作用。
采用发色底物法测定104例接受STK治疗的AMI患者的PAI-1预处理平均水平为5.8±8.6 U/ml，范围为0.3 - 66.2 U/ml。当通过无创评估实现再灌注且无后续再梗死时，链激酶治疗成功；当再灌注延迟和/或发生再梗死时，治疗失败。
预处理PAI-1水平升高的患者，STK溶栓治疗明显失败（p < 0.05），尤其是水平>4.0 U/ml的患者（p < 0.01）。未成功治疗的患者PAI-1预处理平均水平明显更高。多变量统计测试表明，在预处理变量中，PAI-1活性升高是STK溶栓失败最显著的独立危险因素。
在预处理变量中，AMI患者预处理PAI-1活性升高是STK溶栓失败最显著的独立危险因素，尤其是水平>4.0 U/ml时。
