Hirschl M M, Wagner A, Gwechenberger M, Herkner H, Müllner M, Woisetschläger C, Laggner A N
Department of Emergency Medicine, University of Vienna, Austria.
Thromb Haemost. 1998 Jan;79(1):140-3.
We examined the effect of intravenous enalaprilat on the course of PAI-1 plasma levels in 23 patients with acute myocardial infarction undergoing thrombolytic therapy. All patients received 100 mg aspirin, 1000 IU/h heparin, thrombolysis with 100 mg rt-PA within 90 min, and betablockers. Eleven out of 23 patients received 5 mg enalaprilat intravenously prior to thrombolysis. Blood samples for determination of PAI-1 plasma levels were collected on admission, 2, 4, 6, 12, and 24 h after thrombolysis. PAI-1 plasma levels in patients receiving enalaprilat were similar to those of the control patients before thrombolysis (5 ng/ml, 95% confidence interval: 2-10 vs. 7 ng/ml, 95% confidence interval: 2-10; p = 0.5). The PAI-1AUC was 9 ng/ml/h (95% confidence interval: 5-10) in the enalaprilat group and 19 ng/ml/h (95% confidence interval: 13-26) in the control group (p = 0.0006). The maximum difference was observed 6 h after thrombolysis (enalaprilat: 13 ng/ml, 95% confidence interval: 5-25, control: 42 ng/ml, 95% confidence interval: 18-55; p = 0.003). Our study clearly demonstrates that application of intravenous enalaprilat prior to thrombolysis attenuates the thrombolysis-related increase of PAI-1. This finding may suggest a possible therapeutic approach to influence the fibrinolytic system in patients with acute myocardial infarction after thrombolysis.
我们研究了静脉注射依那普利拉对23例接受溶栓治疗的急性心肌梗死患者血浆纤溶酶原激活物抑制因子-1（PAI-1）水平变化过程的影响。所有患者均接受100mg阿司匹林、1000IU/h肝素治疗，在90分钟内静脉注射100mg重组组织型纤溶酶原激活剂（rt-PA）进行溶栓，并使用β受体阻滞剂。23例患者中有11例在溶栓前静脉注射5mg依那普利拉。在入院时、溶栓后2、4、6、12和24小时采集血样以测定血浆PAI-1水平。接受依那普利拉治疗的患者在溶栓前的血浆PAI-1水平与对照组相似（5ng/ml，95%置信区间：2-10 vs. 7ng/ml，95%置信区间：2-10；p = 0.5）。依那普利拉组的PAI-1曲线下面积（AUC）为9ng/ml/h（95%置信区间：5-10），对照组为19ng/ml/h（95%置信区间：13-26）（p = 0.0006）。溶栓后6小时观察到最大差异（依那普利拉组：13ng/ml，95%置信区间：5-25，对照组：42ng/ml，95%置信区间：18-55；p = 0.003）。我们的研究清楚地表明，溶栓前静脉注射依那普利拉可减轻溶栓相关的PAI-1升高。这一发现可能提示一种影响急性心肌梗死患者溶栓后纤维蛋白溶解系统的潜在治疗方法。
