Helft G, Lecompte T, Le Feuvre C, Metzger J P, Vacheron A, Samama M M
Clinique cardiologique, hôpital Necker, Paris.
Arch Mal Coeur Vaiss. 1997 Jul;90(7):975-80.
The use of thrombolytics has significantly improved the management of patients with acute myocardial infarction but available molecules remains imperfect: restoration of normal coronary patency in about half the cases, risks of reocclusion, risk of bleeding. Streptokinase (SK), which is the least expensive agent, has disadvantages as do the other thrombolytics. SK, an immunogenic bacterial protein, has another feature: administration of SK leads to an immunitory response with the production of specific anti-streptokinase antibodies. These anti-streptokinase antibodies may interfere with the future administration of a compound containing SK either by inducing an allergic response or by neutralising the SK and making it ineffective. Moreover, anti-streptokinase antibodies, the result of previous streptococcal infections, are present in the circulation. Although the prevalence of anti-streptokinase antibodies in the general population, especially coronary patients at risk of myocardial infarction, is not well known and their potentially harmful effects are even less well known. In particular, the platelet aggregant effect in vitro of these antibodies in the presence of SK was not taken into account in the trials studying the influence of anti-streptokinase antibodies in the results of thrombolysis by SK. The anti-lytic effect of anti-streptokinase antibodies is well documented. For this reason, it is not recommended to readminister SK in patients who have previously been thrombolysed with a product containing SK.
溶栓药物的使用显著改善了急性心肌梗死患者的治疗，但现有的药物仍存在不足：约半数病例中冠状动脉血流恢复正常，存在再闭塞风险和出血风险。链激酶（SK）是最便宜的药物，与其他溶栓药物一样存在缺点。SK是一种具有免疫原性的细菌蛋白，还有另一个特点：使用SK会引发免疫反应，产生特异性抗链激酶抗体。这些抗链激酶抗体可能会干扰未来含有SK的化合物的使用，要么引发过敏反应，要么中和SK使其失效。此外，先前链球菌感染产生的抗链激酶抗体存在于循环系统中。虽然普通人群中，尤其是有心肌梗死风险的冠心病患者中抗链激酶抗体的患病率尚不清楚，其潜在有害影响更是鲜为人知。特别是，在研究抗链激酶抗体对SK溶栓结果影响的试验中，未考虑这些抗体在SK存在时的体外血小板聚集作用。抗链激酶抗体的抗溶解作用已有充分记录。因此，不建议对先前已用含SK产品进行溶栓治疗的患者再次使用SK。
