Leschke M, Schoebel F C, Strauer B E
Medizinische Klinik und Poliklinik B - Klinik für Kardiologie, Pneumologie und Angiologie, Heinrich-Heine Universität Düsseldorf, Germany.
Clin Hemorheol Microcirc. 1997 Jan-Feb;17(1):59-66.
Symptomatic end-stage arterial disease in coronary artery or peripheral arterial occlusive disease represents an increasing clinical problem as cardiovascular mortality in these patient groups has declined due to improved secondary prevention. While in peripheral arterial occlusive disease amputation with subsequent life-long physical disability is the major problem, patients with end-stage coronary artery disease and refractory angina pectoris repeatedly report to the emergency ward with the clinical symptoms of unstable coronary syndromes, but myocardial infarction is generally ruled out. For these patients long-term intermittent urokinase therapy has been developed as an alternative treatment modality. Potential mechanisms for clinical effectiveness include improvement of rheological blood properties, thrombolysis of non-occluding arterial thrombi and possibly plaque regression. In coronary artery disease urokinase is applied as an intravenous bolus injection of 500,000 IU urokinase three times a week over a period of 12 weeks. This leads to a marked reduction of fibrinogen by about 35% and of clinical symptoms by around 70% accompanied by a reduction of exercise-induced myocardial ischemia. In observational studies in patients with peripheral arterial occlusive disease injections of 500,000 IU of urokinase were usually given daily for a shorter time period of three to four weeks with a clinical success rate, defined as a cessation or marked reduction of rest pain and/or salvage of a limb, of around 50%. Given the state of critical ischemia in both entities of atherosclerotic disease, long-term intermittent urokinase therapy represents a promising antiischemic approach. In particular in patients with peripheral arterial occlusive disease randomized controlled trials with prolonged treatment periods, which are likely to improve clinical results, are warranted.
在冠状动脉疾病或外周动脉闭塞性疾病中，有症状的终末期动脉疾病已成为一个日益突出的临床问题，因为这些患者群体的心血管死亡率由于二级预防的改善而有所下降。在外周动脉闭塞性疾病中，截肢及随后的终身身体残疾是主要问题，而终末期冠状动脉疾病和难治性心绞痛患者会因不稳定型冠状动脉综合征的临床症状反复前往急诊室就诊，但通常可排除心肌梗死。针对这些患者，已开发出长期间歇性尿激酶疗法作为一种替代治疗方式。临床有效性的潜在机制包括改善血液流变学特性、溶解非闭塞性动脉血栓以及可能的斑块消退。在冠状动脉疾病中，尿激酶以静脉推注的方式给药，每周三次，每次500,000国际单位，持续12周。这会使纤维蛋白原显著降低约35%，临床症状减轻约70%，同时运动诱发的心肌缺血也会减少。在外周动脉闭塞性疾病患者的观察性研究中，通常每天注射500,000国际单位尿激酶，持续三到四周的较短时间，临床成功率（定义为静息痛停止或显著减轻和/或肢体挽救）约为50%。鉴于动脉粥样硬化疾病这两种情况都处于严重缺血状态，长期间歇性尿激酶疗法是一种有前景的抗缺血方法。特别是在外周动脉闭塞性疾病患者中，有必要进行治疗期延长的随机对照试验，这可能会改善临床结果。
