Stump D C, Topol E J, Chen A B, Hopkins A, Collen D
Department of Medicine, University of Vermont College of Medicine, Burlington 05405.
Thromb Haemost. 1988 Apr 8;59(2):133-7.
The monitoring of changes in the blood coagulation and fibrinolytic systems during thrombolytic therapy with recombinant tissue-type plasminogen activator (rt-PA) may be complicated by artifacts due to in vitro activation after blood collection and to interference of other agents (e.g., heparin) in the assays. In 106 patients with early acute myocardial infarction, infused with 150 mg of rt-PA (G11044) intravenously over 5 to 8 hours, blood samples were collected into liquid citrate supplemented with the plasmin inhibitor aprotinin (200 KIU/ml plasma) or on a lyophilized mixture of acidified citrate and the synthetic t-PA inhibitor D-Phe-Pro-Arg-CH2Cl (PPACK). A good correlation between precipitable (sulphite) and functional (clotting rate) fibrinogen levels was observed in plasma collected on citrate before therapy (r = 0.76) and in samples collected after 3 hours on either aprotinin (r = 0.87) or PPACK (r = 0.82). Precipitable fibrinogen levels were approximately 10% higher than functional level, in baseline samples collected on citrate alone and approximately 20% higher in 3 hour samples collected on either PPACK or aprotinin. Fibrinogen levels measured with both assays correlated well, but were somewhat higher in samples collected on PPACK than on aprotinin. rt-PA antigen levels assayed in plasma collected in either inhibitor correlated well (r = 0.90) but were 10-20% higher in PPACK containing samples. Addition of heparin up to 9 units/ml to plasma had no effect on the functional fibrinogen assay.(ABSTRACT TRUNCATED AT 250 WORDS)
在使用重组组织型纤溶酶原激活剂（rt-PA）进行溶栓治疗期间，监测血液凝固和纤维蛋白溶解系统的变化可能会因采血后体外激活以及检测中其他药物（如肝素）的干扰而出现假象。在106例早期急性心肌梗死患者中，静脉输注150mg rt-PA（G11044），持续5至8小时，将血样采集到添加纤溶酶抑制剂抑肽酶（200 KIU/ml血浆）的液体枸橼酸盐中，或采集到酸化枸橼酸盐与合成t-PA抑制剂D-苯丙氨酸-脯氨酸-精氨酸-氯甲基酮（PPACK）的冻干混合物上。在治疗前采集的枸橼酸盐血浆中以及在使用抑肽酶（r = 0.87）或PPACK（r = 0.82）采集3小时后的样本中，可沉淀（亚硫酸盐）纤维蛋白原水平与功能性（凝血速率）纤维蛋白原水平之间观察到良好的相关性。在仅采集于枸橼酸盐的基线样本中，可沉淀纤维蛋白原水平比功能性水平高约10%，在采集于PPACK或抑肽酶的3小时样本中高约20%。两种检测方法测得的纤维蛋白原水平相关性良好，但在采集于PPACK的样本中比在采集于抑肽酶的样本中略高。在采集于任何一种抑制剂中的血浆中检测的rt-PA抗原水平相关性良好（r = 0.90），但在含PPACK的样本中高10 - 20%。向血浆中添加高达9单位/ml的肝素对功能性纤维蛋白原检测无影响。（摘要截短于250字）
