Collen D, Bounameaux H, De Cock F, Lijnen H R, Verstraete M
Circulation. 1986 Mar;73(3):511-7. doi: 10.1161/01.cir.73.3.511.
Coagulation and fibrinolysis were studied in patients with acute myocardial infarction during intravenous infusion of recombinant human tissue-type plasminogen activator (rt-PA) (0.75 mg/kg over 90 min, n = 101), streptokinase (1,500,000 IU over 60 min, n = 61), or placebo (n = 40). In the rt-PA group, the plasma level of rt-PA antigen was 1.2 +/- 0.6 micrograms/ml (mean +/- SD) and the euglobulin fibrinolytic activity (EFA) was 910 +/- 735 IU t-PA/ml. In the streptokinase group, the EFA was equivalent to 430 +/- 435 IU t-PA/ml. At the end of the infusion, the plasma fibrinogen level measured with a coagulation rate assay was decreased to 57 +/- 33% of the preinfusion value in the rt-PA group, to 7 +/- 10% in the streptokinase group, and remained unchanged in the placebo group. Fibrinogen-fibrin degradation products increased to 0.75 +/- 0.54 mg/ml in the streptokinase group but to only 0.10 +/- 0.13 mg/ml in the rt-PA group. The plasma levels of alpha 2-antiplasmin, plasminogen, and factor V decreased to between 30% and 45% in the rt-PA group but significantly more in the streptokinase group (to between 15% and 25%). Thus rt-PA induced much less systemic fibrinolytic activation than streptokinase. In the patients who received rt-PA, a weak correlation (r = .21, n = 89, .1 greater than p greater than .05) was found between the extent of fibrinogen breakdown at 90 min and the plasma rt-PA concentration.(ABSTRACT TRUNCATED AT 250 WORDS)
在急性心肌梗死患者静脉输注重组人组织型纤溶酶原激活剂（rt-PA）（90分钟内输注0.75mg/kg，n = 101）、链激酶（60分钟内输注1,500,000IU，n = 61）或安慰剂（n = 40）期间，对凝血和纤溶进行了研究。在rt-PA组中，rt-PA抗原的血浆水平为1.2±0.6μg/ml（均值±标准差），优球蛋白纤溶活性（EFA）为910±735IU t-PA/ml。在链激酶组中，EFA相当于430±435IU t-PA/ml。输注结束时，用凝血速率测定法测得的血浆纤维蛋白原水平在rt-PA组降至输注前值的57±33%，在链激酶组降至7±10%，而在安慰剂组保持不变。纤维蛋白原-纤维蛋白降解产物在链激酶组增加至0.75±0.54mg/ml，但在rt-PA组仅增加至0.10±0.13mg/ml。rt-PA组中α2-抗纤溶酶、纤溶酶原和因子V的血浆水平降至30%至45%之间，但在链激酶组中下降幅度更大（降至15%至25%之间）。因此，rt-PA诱导的全身纤溶激活比链激酶少得多。在接受rt-PA的患者中，发现90分钟时纤维蛋白原分解程度与血浆rt-PA浓度之间存在弱相关性（r = 0.21，n = 89，0.1＞p＞0.05）。
