Pendlebury W W, Iole E D, Tracy R P, Dill B A
Department of Pathology, University of Vermont, Burlington 05405.
Ann Neurol. 1991 Feb;29(2):210-3. doi: 10.1002/ana.410290216.
Tissue plasminogen activator (t-PA) has been approved as thrombolytic therapy for the treatment of acute myocardial infarction, but this agent can cause serious bleeding complications including intracerebral hemorrhages. Mechanisms underlying the development of these hemorrhages have not been clarified. We report a patient who developed two intracerebral hemorrhages shortly after receiving t-PA for the treatment of an acute myocardial infarction, and who was found to have cerebral amyloid angiopathy at autopsy. Staining of cortical sections with Congo red and an antibody directed against beta amyloid protein (A4 peptide) disclosed specific involvement of most of the subarachnoid and superficial cortical vessels in the region of the two hemorrhages. Based on the findings in this patient and in 6 additional patients reported recently, it is likely that cerebral amyloid angiopathy plays a pathogenic role in some intracerebral hemorrhages associated with the administration of t-PA. The cautious use of t-PA with heparin in patients who are elderly or demented may be advisable.
组织型纤溶酶原激活剂（t-PA）已被批准作为急性心肌梗死溶栓治疗的药物，但该药物可引起包括脑出血在内的严重出血并发症。这些出血发生的机制尚未阐明。我们报告了1例在接受t-PA治疗急性心肌梗死后不久发生两次脑出血的患者，尸检发现其患有脑淀粉样血管病。用刚果红和抗β淀粉样蛋白（A4肽）抗体对皮质切片进行染色，发现两次出血区域的大多数蛛网膜下和浅表皮质血管有特异性受累。基于该患者及最近报道的另外6例患者的研究结果，脑淀粉样血管病可能在一些与t-PA给药相关的脑出血中起致病作用。对于老年或痴呆患者，谨慎联合使用t-PA和肝素可能是可取的。
