Bell William R
Division Hematology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Rev Cardiovasc Med. 2002;3 Suppl 2:S34-44.
Various thrombolytic agents have been studied as activators of the plasminogen-plasmin system for thrombolysis of thrombus formation. They include streptokinase, urokinase, tissue plasminogen activators, single-chain urokinase plasminogen activator, and anisoylated or acylated plasminogen-streptokinase activator complex (APSAC), only some of which are commercially available. All thrombolytic agents, including APSAC (not commercially available), recombinant tissue plasminogen activator, and prourokinase, generate great quantities of degradation products of fibrinogen or fibrin. All of the second-generation thrombolytic agents induce systemic activation of the entire fibrinolytic system, and none are capable of specifically activating the fibrinolytic system at the site of thrombus formation. The most systemically active agent known at the present time is APSAC. Trials show that bleeding occurs as frequently with the second-generation agents as with the older agents, and further studies may even find that the newer agents are associated with more bleeding than urokinase and streptokinase have been. With knowledge of the properties of the various thrombolytic agents available today, the physician can intelligently select the optimal agent for a given patient problem.
各种溶栓剂已被作为纤溶酶原-纤溶酶系统的激活剂进行研究，用于血栓形成的溶栓治疗。它们包括链激酶、尿激酶、组织纤溶酶原激活剂、单链尿激酶型纤溶酶原激活剂以及茴香酰化或酰化纤溶酶原-链激酶激活剂复合物（APSAC），其中只有一些是可商购的。所有溶栓剂，包括APSAC（不可商购）、重组组织纤溶酶原激活剂和尿激酶原，都会产生大量纤维蛋白原或纤维蛋白的降解产物。所有第二代溶栓剂都会诱导整个纤溶系统的全身激活，且没有一种能够在血栓形成部位特异性激活纤溶系统。目前已知全身活性最高的药物是APSAC。试验表明，第二代药物引起出血的频率与旧药物相同，进一步的研究甚至可能发现，与尿激酶和链激酶相比，新型药物与更多的出血相关。了解当今可用的各种溶栓剂的特性后，医生可以明智地为特定患者问题选择最佳药物。
