Col J J, Col-De Beys C M, Renkin J P, Lavenne-Pardonge E M, Bachy J L, Moriau M H
Department of Intensive Medicine, St. Luc Hospital, Catholic University of Louvain, Brussels, Belgium.
Am J Cardiol. 1989 May 15;63(17):1185-92. doi: 10.1016/0002-9149(89)90176-8.
The systemic activator activity of 4 streptokinase (SK) regimens (250,000 IU intracoronary, group A; 500,000 IU, group B; 1.5 X 10(6) IU, group C; and 30 U anisoylated plasminogen streptokinase activator complex (APSAC) intravenously, group D) was tested with the fibrin plate technique. One hour after initiation of treatment, the activator activity was highest after APSAC (3.6 +/- 0.9 U), slightly but not significantly less after SK 1.5 X 10(6) IU (3.0 +/- 0.7), and significantly less after SK 500,000 IU (1.6 +/- 0.5) and 250,000 IU (0.6 +/- 0.5), p less than 0.001. After SK, activator activity half-lives were 184 minutes (group B) and 169 minutes (group C), and after APSAC 188 minutes (group D). These were all in agreement with greater than 12 hour duration of changes in other markers of systemic fibrinolysis (euglobulin lysis time) and substrates depletion (fibrinogen, plasminogen, alpha 2 antiplasmin). In extended pilot clinical groups given identical thrombolytic regimens during full anticoagulation with heparin, angiographic coronary patency was found in 83% (35 of 42) after intracoronary SK (group 1), in 73 and 75%, respectively, after 500,000 IU (31 of 43) and 1.5 X 10(6) IU (30 of 40) (group 2 and 3, difference not significant) and 80% (8 of 10) after the 30-U bolus of APSAC (group 4). The overall hemorrhagic risk was 24%, equally distributed among the 4 regimens and mostly (91%) related to catheters. The incidence of bleeding unrelated to vessel puncture was 4%; no deaths occurred. It is concluded that APSAC is the most fibrinolytic regimen but its potential thrombolytic superiority over SK remains to be demonstrated.(ABSTRACT TRUNCATED AT 250 WORDS)
采用纤维蛋白平板技术检测了4种链激酶（SK）治疗方案（冠状动脉内注射250,000 IU，A组；500,000 IU，B组；1.5×10⁶ IU，C组；静脉注射30 U茴香酰化纤溶酶原链激酶激活剂复合物（APSAC），D组）的全身激活剂活性。治疗开始1小时后，APSAC后的激活剂活性最高（3.6±0.9 U），1.5×10⁶ IU的SK后活性略低但无显著差异（3.0±0.7），500,000 IU（1.6±0.5）和250,000 IU（0.6±0.5）的SK后活性显著降低，p<0.001。SK治疗后，激活剂活性半衰期分别为184分钟（B组）和169分钟（C组），APSAC治疗后为188分钟（D组）。这些均与全身纤溶其他标志物（优球蛋白溶解时间）变化及底物消耗（纤维蛋白原、纤溶酶原、α2抗纤溶酶）持续超过12小时一致。在肝素充分抗凝期间给予相同溶栓方案的扩大试点临床组中，冠状动脉内注射SK后（第1组）83%（42例中的35例）血管造影显示冠状动脉通畅，500,000 IU（43例中的31例）和1.5×10⁶ IU（40例中的30例）后分别为73%和75%（第2组和第3组，差异不显著），30 U推注APSAC后为80%（10例中的8例）（第4组）。总体出血风险为24%，在4种治疗方案中分布均匀，且大多（91%）与导管相关。与血管穿刺无关的出血发生率为4%；无死亡发生。结论是APSAC是最具纤溶活性的治疗方案，但其相对于SK的潜在溶栓优势仍有待证实。（摘要截短于250字）
