Leschke M, Schoebel F C, Jax T W, Schannwell C M, Marx R, Strauer B E
Klinik für Kardiologie, Pneumologie und Angiologie, Heinrich-Heine-Universität Düsseldorf.
Herz. 1997 Oct;22(5):262-71. doi: 10.1007/BF03044254.
Despite progress in the invasive revascularization procedures and even though conventional antianginal treatment has improved the quality of life in patients with symptomatic coronary artery disease considerably, an increasing number of patients suffers from end-stage coronary artery disease and refractory angina pectoris. For these refractory patients long-term intermittent urokinase therapy was developed as an antithrombotic intervention, which is based on its capacity to enhance thrombolysis and blood rheology, and may possibly lead to plaque regression. The coronary syndrome of refractory angina pectoris is characterized by a mismatch of severe coronary insufficiency and a relatively large amount of viable myocardium as indicated by an only moderately impaired left ventricular function. Prior to initiation of long-term intermittent urokinase therapy all potential measures to improve myocardial perfusion have to be considered in each patient. These supportive measures include rigorous reduction of LDL-cholesterol, which has proven antiischemic properties due to an improved endothelial function of epicardial conductance vessels possibly resulting in an antianginal effect. Apart from the proven antiischemic properties of long-term intermittent urokinase therapy in patients with refractory angina pectoris, objective signs of ischemic myocardial heart failure improve. Follow-up studies demonstrated a significant increase of left ventricular ejection fraction as evaluated with multi-gated blood pool analysis. Furthermore, left ventricular diastolic function normalized after a treatment period of 12 weeks. As the clinical effects last well beyond the actual treatment period and as they are accompanied by a remarkable increase in the quality of life, a complex approach as this one is justified in this highly symptomatic patient group.
尽管侵入性血管重建手术取得了进展，而且传统的抗心绞痛治疗已显著改善了有症状冠状动脉疾病患者的生活质量，但仍有越来越多的患者患有终末期冠状动脉疾病和顽固性心绞痛。对于这些难治性患者，开发了长期间歇性尿激酶治疗作为一种抗血栓干预措施，其依据是尿激酶增强溶栓和血液流变学的能力，并且可能导致斑块消退。顽固性心绞痛的冠状动脉综合征的特征是严重冠状动脉供血不足与相对大量存活心肌不匹配，这表现为左心室功能仅中度受损。在开始长期间歇性尿激酶治疗之前，必须为每位患者考虑所有改善心肌灌注的潜在措施。这些支持性措施包括严格降低低密度脂蛋白胆固醇，由于心外膜传导血管内皮功能改善，低密度脂蛋白胆固醇已被证明具有抗缺血特性，这可能会产生抗心绞痛作用。除了长期间歇性尿激酶治疗对顽固性心绞痛患者已证实的抗缺血特性外，缺血性心肌心力衰竭的客观体征也有所改善。随访研究表明，通过多门控血池分析评估，左心室射血分数显著增加。此外，经过12周的治疗期后，左心室舒张功能恢复正常。由于临床效果在实际治疗期之后仍持续良好，并且伴随着生活质量的显著提高，对于这个症状严重的患者群体，采用这样一种综合方法是合理的。
