Marini C, Di Ricco G, Rossi G, Rindi M, Palla R, Giuntini C
Pulmonary Unit, University of Pisa, Italy.
Respiration. 1988;54(3):162-73. doi: 10.1159/000195517.
Dissolution of pulmonary emboli with heparin and urokinase is ascribed, respectively, to anticoagulation and fibrinolysis. Since truly independent assessment of these effects in man is lacking, we administered each drug alone. Fibrinogen and plasminogen plasma levels and the resolution of pulmonary emboli were measured in three randomized groups of 10 patients each: groups A and C infused with small repeated doses of urokinase and a large single dose of urokinase, respectively, and group B who received heparin. After 6 h of treatment, fibrinogen fell in all the groups, while, after 12 h, remained equally reduced in groups A and B and declined further in group C. Plasminogen behaved similarly. Up to 60 h, statistical analysis showed that these effects were related to timing and amounts of urokinase and heparin infusion. These observations suggest that heparin may induce a lytic state. As to signs of pulmonary emboli resolution, no differences between groups were found in lung perfusion and gas exchange recovery at any time (from 1 day to 1 year) and in pulmonary artery pressure reduction at 1 week. The greater angiographic and scintigraphic recovery observed with urokinase, versus heparin alone, after 1 day of treatment in the Urokinase Pulmonary Embolism Trial may be ascribed to a synergistic effect with urokinase of heparin administered during the diagnostic work-out. The indications of heparin and urokinase should be evaluated in the light of these results.
肝素和尿激酶对肺栓塞的溶解作用分别归因于抗凝和纤维蛋白溶解。由于缺乏对人体这些作用的真正独立评估，我们分别单独使用每种药物。在三个随机分组的每组10名患者中测量纤维蛋白原和纤溶酶原血浆水平以及肺栓塞的消退情况：A组和C组分别输注小剂量重复使用的尿激酶和大剂量单次使用的尿激酶，B组接受肝素治疗。治疗6小时后，所有组的纤维蛋白原均下降，而12小时后，A组和B组的纤维蛋白原仍同等程度降低，C组进一步下降。纤溶酶原表现类似。直至60小时，统计分析表明这些作用与尿激酶和肝素输注的时间及剂量有关。这些观察结果提示肝素可能诱导一种溶解状态。至于肺栓塞消退的迹象，在任何时间（从1天至1年）的肺灌注和气体交换恢复以及1周时的肺动脉压降低方面，各组之间均未发现差异。在尿激酶肺栓塞试验中，治疗1天后，与单独使用肝素相比，尿激酶观察到的更大程度的血管造影和闪烁扫描恢复可能归因于在诊断检查期间给予的肝素与尿激酶的协同作用。应根据这些结果评估肝素和尿激酶的适应证。
