Hoffmann J J
Department of Clinical Laboratories, Catharina Hospital, Eindhoven, The Netherlands.
Eur Heart J. 1990 Aug;11 Suppl F:29-35. doi: 10.1093/eurheartj/11.suppl_f.29.
The mechanisms by which thrombolytic drugs accomplish their impressive clinical effects in the treatment of acute myocardial infarction are as yet incompletely appreciated. Factors other than lysis of thrombi and restoration of blood flow most likely play a role, and blood viscosity and platelet function probably are important factors. Blood viscosity is inversely related to oxygen supply to myocardial tissue and therefore a decrease in viscosity might contribute to preservation of myocardial function. Since fibrinogen is a major determinant of blood viscosity and this protein is largely degraded by some thrombolytic drugs, it is conceivable that a systemic fibrinogenolytic state is of additional benefit for the patient. Fibrinogen and other plasma proteins which change during thrombolytic therapy are also essential for adequate platelet function. Besides, thrombolytic drugs can directly affect platelet activity. Although the exact effects are still unknown, it is certain that changes in platelet function induced by thrombolytic drugs are important for the clinical efficacy and probably for the side-effects of thrombolytic therapy.
溶栓药物在治疗急性心肌梗死时产生显著临床效果的机制尚未完全明确。除了血栓溶解和血流恢复之外，其他因素很可能也发挥了作用，血液黏度和血小板功能可能是重要因素。血液黏度与心肌组织的氧气供应呈负相关，因此黏度降低可能有助于心肌功能的维持。由于纤维蛋白原是血液黏度的主要决定因素，并且这种蛋白质在某些溶栓药物作用下会大量降解，可以想象全身性纤维蛋白原溶解状态对患者还有额外益处。溶栓治疗期间发生变化的纤维蛋白原和其他血浆蛋白对于血小板的正常功能也至关重要。此外，溶栓药物可直接影响血小板活性。虽然确切作用尚不清楚，但可以肯定的是，溶栓药物引起的血小板功能变化对于溶栓治疗的临床疗效以及可能的副作用都很重要。
