Chakrabarty S, Fluck D S, Flores N A, Sheridan D J
Academic Cardiology Unit, St. Mary's Hospital Medical School, London, U.K.
Eur Heart J. 1994 May;15(5):699-704. doi: 10.1093/oxfordjournals.eurheartj.a060570.
Despite variable efficacy in achieving recanalization, different thrombolytic agents demonstrate similar abilities to reduce mortality following myocardial infarction. We investigated whether factors other than the ability to achieve coronary artery recanalization are important in mediating the beneficial effects associated with thrombolytic therapy during acute myocardial infarction using anaesthetized rabbits. Coronary artery occlusion was produced using either a single ligature (which was released to initiate reperfusion) or by placing two ligatures 5 mm apart to allow the formation of an intraluminal thrombus. In this case, ligature removal followed by thrombolysis was required for recanalization to occur. Experiments were performed in the presence and absence of streptokinase. Streptokinase was most effective in reducing myocardial necrosis when associated with thrombolytic recanalization (total left ventricular infarct size was reduced from 37 +/- 7% to 13 +/- 1%, P < 0.01). However, streptokinase also reduced infarct size in the absence of reperfusion (45 +/- 4% vs 35 +/- 2%, P < 0.05), although further work is needed to clarify the mechanisms.
尽管在实现血管再通方面疗效各异，但不同的溶栓药物在降低心肌梗死后死亡率方面显示出相似的能力。我们使用麻醉的兔子，研究了在急性心肌梗死期间，除实现冠状动脉再通的能力之外，其他因素在介导与溶栓治疗相关的有益作用方面是否重要。冠状动脉闭塞通过以下两种方式产生：一种是使用单个结扎线（松开结扎线以启动再灌注），另一种是放置相距5毫米的两个结扎线以形成腔内血栓。在这种情况下，需要去除结扎线并随后进行溶栓才能实现再通。实验在有和没有链激酶的情况下进行。当与溶栓再通相关时，链激酶在减少心肌坏死方面最有效（左心室梗死总面积从37±7%降至13±1%，P<0.01）。然而，在没有再灌注的情况下，链激酶也能减小梗死面积（45±4%对35±2%，P<0.05），尽管需要进一步研究来阐明其机制。
