Sobel B E
Jpn Circ J. 1987 Jan;51(1):1-4. doi: 10.1253/jcj.51.1.
Although coronary thrombolysis with fibrinolytic agents leads to restoration of patency of coronary arteries demonstratable angiographically, elucidation of the efficacy of the approach requires evaluation of its effect on the heart. Clot-selective fibrinolytic agents such as tissue-type plasminogen activator (t-PA) offer particular promise as therapeutic agents because they induce clot lysis without marked activation of the fibrinolytic system in the circulating blood and hence without marked fibrinogenolysis and predisposition to bleeding. Results of several large scale clinical trials demonstrate recanalization in approximately 75% of patients. Detection of recanalization may be achievable by analysis of plasma creatine kinase isoforms as a function of time, and in the research environment, with the use of positron emission tomography. This modality demonstrates restoration of regional perfusion and intermediary myocardial metabolism and provides an approach for calibration of conventional and more widely applicable diagnostic procedures such as scintigraphy.
尽管使用纤溶药物进行冠状动脉溶栓可使冠状动脉造影显示血管再通，但要阐明该方法的疗效，需要评估其对心脏的影响。组织型纤溶酶原激活剂（t-PA）等凝块选择性纤溶药物作为治疗药物具有特殊前景，因为它们可诱导凝块溶解，而不会显著激活循环血液中的纤溶系统，因此不会显著引起纤维蛋白原溶解和出血倾向。几项大规模临床试验的结果表明，约75%的患者实现了再通。通过分析血浆肌酸激酶同工酶随时间的变化，以及在研究环境中使用正电子发射断层扫描，可能实现对再通的检测。这种方法可显示局部灌注和心肌中间代谢的恢复，并为校准诸如闪烁扫描等传统且更广泛应用的诊断程序提供了一种方法。
