Jan K M, Powers E, Reinhart W, Berke A, Nichols A, Watson R, Reison D, Schwartz A, Chien S
Department of Physiology and Cellular Biophysics, College of Physicians and Surgeons, Columbia University, New York, NY 10032.
Adv Exp Med Biol. 1990;281:409-17. doi: 10.1007/978-1-4615-3806-6_44.
Tissue blood flow is determined by rheological properties of blood as well as by vascular resistance. In acute myocardial infarction patients who participated in the TIMI I trial, we compared the effects of recombinant tissue plasminogen activator (rt-PA) and streptokinase (SK) on blood rheological properties and plasma fibrinogen concentration. Blood viscosity was determined by using a coaxial cylinder viscometer at shear rates, gamma, of 0.01-200 sec-1. Red blood cell (RBC) deformability was studied by filtration through polycarbonate microsieves with pore size of 3 and 5 microns. Therapy with rt-PA resulted in slight decreases but statistically significant in blood viscosity from 5.2 +/- 0.5 to 4.9 +/- 0.4 cP (gamma = 52 sec-1), plasma viscosity from 1.36 +/- 0.09 to 1.32 +/- 0.06 cP, and plasma fibrinogen from 0.26 +/- 0.04 to 0.21 +/- 0.03 g/dl. SK therapy resulted in reductions in blood viscosity from 5.1 +/- 0.5 to 4.6 +/- 0.3 cP, plasma viscosity from 1.26 +/- 0.10 to 1.16 +/- 0.03 cP, and fibrinogen from 0.26 +/- 0.06 to 0.10 +/- 0.05 g/dl. Changes observed with SK were significantly greater than those observed with rt-PA (all p less than 0.05), and the differences persisted at 10 days after thrombolytic therapy. RBC deformability was similar in the two groups. The greater reduction of blood viscosity after SK than rt-PA suggests that, for a given degree of arterial patency, myocardial blood flow may be better maintained with SK than rt-PA in patients with acute myocardial infarction.
组织血流由血液的流变学特性以及血管阻力决定。在参与TIMI I试验的急性心肌梗死患者中，我们比较了重组组织型纤溶酶原激活剂（rt-PA）和链激酶（SK）对血液流变学特性和血浆纤维蛋白原浓度的影响。使用同轴圆筒粘度计在剪切速率γ为0.01 - 200秒⁻¹时测定血液粘度。通过孔径为3和5微米的聚碳酸酯微筛过滤来研究红细胞（RBC）的变形性。rt-PA治疗导致血液粘度从5.2±0.5厘泊轻微降低至4.9±0.4厘泊（γ = 52秒⁻¹），血浆粘度从1.36±0.09厘泊降至1.32±0.06厘泊，血浆纤维蛋白原从0.26±0.04克/分升降至0.21±0.03克/分升，虽降低幅度小但具有统计学意义。SK治疗使血液粘度从5.1±0.5厘泊降至4.6±0.3厘泊，血浆粘度从1.26±0.10厘泊降至1.16±0.03厘泊，纤维蛋白原从0.26±0.06克/分升降至0.10±0.05克/分升。观察到SK引起的变化显著大于rt-PA引起的变化（所有p均小于0.05），且这些差异在溶栓治疗后10天仍持续存在。两组的红细胞变形性相似。SK治疗后血液粘度降低幅度大于rt-PA，这表明在急性心肌梗死患者中，对于给定程度的动脉通畅情况，使用SK比rt-PA可能能更好地维持心肌血流。
