小剂量重组组织纤溶酶原激活剂治疗急性心肌梗死临床研究概况

1990年代中期以来,国内130多家医院入组9378例急性心肌梗死患者,其中用小剂量（50mg）重组组织纤溶酶厚激活剂（rt-PA）治疗6693例,阻塞相关血管开通5318俐,开通率为79.46％;死亡293倒,病死率为4.38％;出血550俐,出血率勾8.22％,其中重度出血7例,颅内出血21例（0.31％）,再次梗塞60例（0.90％）。超过40家医院对rt-PA（50mg）与尿激酶治疗急性心肌梗死疗效进行了比较,共计入组3449倒急性心肌梗死患者,rt-PA治疗1689例,先静脉推注8mg,其余42mg在30或60和90min滴注;尿激酶治疗1760例,150万U位滴注30min。结果显示,阻塞相关冠脉血管开通率分别为79.40％（1341例）和5733％（1009例）,相差非常显著（P〈0.001）。12家医院研究了rt-PA50-9100mg治疗急性心肌梗死的效果,共计入组1054例患者,其中50mg组487例,100mg组567例,阻塞相关血管开通率分别为78.85％和82.36％。另有22家医院入组1017倒病人,行rt-PA50mg30rain给药临味试验,冠脉开通率达80.53％;18家医院行rt-PA50mg 60min给药临床试验,入组942例病人,阻塞相关血管开通率为77.92％;50家医院用rt-PA50mg 90min给药方案治疗急性心肌梗死患者,入组2768例患者,冠脉开通率为77.89％。6家医院对用rt-PA（50mg）与链激酶治疗急性心肌梗死的疗效进行了对比,结果表明相关血管开通率分别为81.4％和65.2％22家医院比较了小剂量rt-PA对急性心肌梗死患者症状发作不同时间的治疗效果,表明症状发作时间越短,用药的溶栓效果越好。刘光对入院前和入院后用小剂量rt-PA溶栓进行了比较研究,证明入院前溶栓比入院后效果好。对冠脉内输注rt-PA（50mg）和2次静脉推注小剂量rt-PA治疗急性心肌梗死的效果也进行了探索。     

急性心肌梗死的静脉溶栓治疗

溶栓是治疗急性心肌梗死最有前途的方法。梗死相关动脉的尽快开通是保护心肌、提高患生存率的关键。本旨在概述已得到认可的溶栓剂和相关的临床试验,包括链激酶、尿激酶、重组组织型纤溶酶原激活剂等。辅助治疗如肝素、水蛭素、血小板糖蛋白Ⅱb／Ⅲa受体拮抗剂也在本综述之列。     

开发中的抗栓剂——水蛭素及其12肽

血栓病是严重危害人类生命与健康的疾病,多年来人们一直在致力于寻找和研制治疗血栓病的有效药物。至今,已有尿激酶、链激酶,组织型纤溶酶原激活剂以及尿激酶原等溶栓药物。与此同时人们也一直在寻找效果更好的抗栓药物。水蛭素就是一种正在开发的抗栓药物。早在1884年就发现了水蛭素,但直到     

尿激酶型纤溶酶原激活剂的研究

尿激酶型纤溶酶原激活剂u-PA(urokinase-type plasminogen activator)属于丝氨酸蛋白酶类,能激活细胞外基质中丰富的纤溶酶原生成纤溶酶,从而催化细胞外基质降解,对纤溶和癌细胞侵染及扩散等一系列生理和病理过程中发生的胞外蛋白水解起重要调节作用。 人u-PA基因位于第10号染色体之上,表达产生一个约54kD的单链糖基化多肽——尿激酶原。尿激酶原经纤溶酶在其158位赖氨酸     

重组纤溶酶原激活剂抑制剂－2基因在HT1080亚克隆中的表达

重组纤溶酶原激活剂抑制剂－２基因在ＨＴ１０８０亚克隆中的表达曹祥荣（南京师范大学生物学系,２１００２４）关键词纤溶酶原激活剂,基因重组,纤溶酶原激活剂抑制剂活性表达目前认为纤溶酶系统是肿瘤细胞浸润和转移蛋白水解过程中重要的酶,纤溶酶能直接水解细胞外间...     

纳豆激酶

纳豆激酶 (ｎａｔｔｏｋｉｎａｓｅ)是一种枯草杆菌蛋白激酶 ,是在纳豆发酵过程中由纳豆枯草杆菌 (Ｂａｃｉｌｌｕｓｓｕｂｔｉｌｉｓ/ｎａｔｔｏ)产生的一种丝氨酸蛋白酶。 1 987年由日本的须见洋行等首先发现[1～ 3] 。研究发现 ,纳豆激酶具有纤溶活性 ,可治疗和预防血栓病 ,它还可激活体内的纤溶酶原 ,从而增加内源性纤溶酶的量与作用[4] 。目前常用的及一些还在开发的治疗心脑血管栓塞疾病的药品 ,如链激酶 (ｓｔｒｅｐ ｔｏｋｉｎａｓｅ ,ＳＫ)、尿激酶 (ｕｒｏｋｉｎａｓｅ ,ＵＫ)、重组组织型纤溶酶原激活剂 (ｒｅｃｏｍｂｉｎａｎｔ…     

纤溶酶原在金黄色葡萄球菌感染中的作用

金黄色葡萄球菌菌体表面有多种纤溶酶原受体,包括次黄嘌呤单核苷酸脱氢酶、核糖核苷酸还原酶、α-烯醇化酶和3-磷酸甘油醛脱氢酶等,它们均可以与纤溶酶原结合。与细菌结合的纤溶酶原可被宿主的纤溶酶原激活剂(组织型纤溶酶原激活剂和尿激酶型纤溶酶原激活剂)或葡萄菌属的纤溶酶原激活剂(葡激酶)激活为纤溶酶。细菌表面的纤溶酶有利于其降解宿主胞外基质,穿越组织屏障,因此哺乳动物的纤溶酶原可能在金黄色葡萄球菌感染宿主过程中起重要作用。     

纳豆激酶溶解血栓机制

根据已有文献报道,综述了关于纳豆激酶溶栓机制的研究进展,将纳豆激酶的溶栓机制归纳为以下四点:直接溶栓作用;刺激血管内皮细胞产生内源tPA;激活体内尿激酶原转变为尿激酶;通过降解和失活纤溶酶原激活剂的抑制剂(PAI1)调控纤溶作用 。     

一种潜在的溶栓药物--纳豆激酶的研究进展

今后20年,我国将步入老龄化社会,血栓病是中老年人的高发病,是对死亡威胁最大的疾病之一,血栓性疾病,尤其是急性心机梗塞严重威胁着人类的生命与健康.目前,溶解血栓是治疗这一类疾病的重要手段,当今用于临床治疗的药物包括链激酶（streptkinase简称SK）、尿激酶（Urokinase,简称UK）、组织血纤溶酶原激活剂（t-PA）、单链尿激酶型血纤溶酶原激活剂（SCUPA）、化学修饰的血纤溶酶-链激酶激活剂复合物（APSAC）等.这些药物均为激活血液中的血纤溶酶原,从而降解纤维蛋白而间接地起作用.在实际应用上,它们都是注射或滴注用药物,有可能引起病人产生全身性内出血,而且在血液中的半衰期很短（3～20 min）,因此在使用这些药物时必须长时间的滴注用药,很不方便,且来源紧缺,造价高.因此,开发新型溶血栓药物成为当前重要研究课题之一.     

重组人纤溶酶原K1-3蛋白的抗肿瘤活性研究

人纤溶酶原K1-3功能区是一个血管生成抑制因子。以人纤溶酶原k1-3基因在大肠杆菌中表达的重组K1-3蛋白进行鸡胚绒毛尿囊膜(chorioallantoicmembrane,CAM)血管生成抑制活性分析和小鼠B16黑色素瘤抑瘤实验,结果证实重组K1-3蛋白具有抑制毛细血管生成和抗肿瘤活性。     

尿激酶原的性质、结构、功能及其药代动力学和临床应用效果

溶栓疗法不仅已被常规地用于急性心肌梗死的治疗,而且也已用于其它血栓病的治疗中,如急性缺血性脑血栓、肺栓塞、急性周围动脉血栓等。尿激酶原是双链尿激酶的单链前体,它主要激活纤维蛋白表面的纤溶蛋白原,所以具有选择性溶栓作用。临床结果表明它是一种安全有效的溶栓药物,与t-PA、链激酶或尿激酶伍用均有协同作用。本文综述它了的特性、结构与功能,以及它的药代动力学和临床的治疗效果。     

The blockage of the high-affinity lysine binding sites of plasminogen by EACA significantly inhibits prourokinase-induced plasminogen activation

Prourokinase-induced plasminogen activation is complex and involves three distinct reactions: (1) plasminogen activation by the intrinsic activity of prourokinase; (2) prourokinase activation by plasmin; (3) plasminogen activation by urokinase. To further understand some of the mechanisms involved, the effects of epsilon-aminocaproic acid (EACA), a lysine analogue, on these reactions were studied. At a low range of concentrations (10-50 microM), EACA significantly inhibited prourokinase-induced (Glu-/Lys-) plasminogen activation, prourokinase activation by Lys-plasmin, and (Glu-/Lys-) plasminogen activation by urokinase. However, no inhibition of plasminogen activation by Ala158-prourokinase (a plasmin-resistant mutant) occurred. Therefore, the overall inhibition of EACA on prourokinase-induced plasminogen activation was mainly due to inhibition of reactions 2 and 3, by blocking the high-affinity lysine binding interaction between plasmin and prourokinase, as well as between plasminogen and urokinase. These findings were consistent with kinetic studies which suggested that binding of kringle 1-4 of plasmin to the N-terminal region of prourokinase significantly promotes prourokinase activation, and that binding of kringle 1-4 of plasminogen to the C-terminal lysine158 of urokinase significantly promotes plasminogen activation. In conclusion, EACA was found to inhibit, rather than promote, prourokinase-induced plasminogen activation due to its blocking of the high-affinity lysine binding sites on plasmin(ogen).     

重组链激酶与尿激酶在急性心肌梗死溶栓治疗中的血管再通率的对比研究

目的：比较国产重组链激酶（r-SK）与尿激酶（uK）在急性心肌梗死（AMI）溶栓中的血管再通率。方法：对68例诊断为AMI并进行溶栓治疗的患者进行临床分组治疗,观察组36例,对照组32例,观察组治疗给予r-SK,对照组治疗给予UK。观察两组患者血管再通率、住院并发症、不良反应以及30d病死率等。结果：观察组患者总血管再通率、小于6h血管再通率以及6-12h血管再通率均明显高于对照组（P〈0．05）,不良反应方面,观察组用药后轻度出血、皮疹、低血压等与对照组比较无差异（P〉0．05）。30d病死率方面,观察组为11．11％,与对照组的15．63％比较无明显差异（P〉0．05）。结论：国产r-SK进行AMI溶栓的血管再通率高,不良反应明显优于UK,30d病死率与UK相似,值得临床应用。     

Early interventions in the management of acute uncomplicated myocardial infarction.

The demonstration that the vast majority of acute transmural myocardial infarctions are caused by an occlusive thrombus in the coronary artery, together with the concept that myocardium can be salvaged for a period of time after the onset of such occlusion, has heralded a new era of management of this disorder. This involves an aggressive interventional approach aimed at restoring coronary artery patency early while decreasing myocardial oxygen demands. Abundant data show that coronary flow can be reestablished using either intravenous chemical thrombolytic agents (tissue-type plasminogen activator and streptokinase), percutaneous transluminal coronary angioplasty, or coronary artery bypass grafting. Conjunctive aspirin or heparin therapy (or both) is effective in maintaining vessel patency once perfusion is restored. Myocardial oxygen demand can be reduced, where feasible, by pharmacotherapy and control of the patient''s associated pain and anxiety. The beta-adrenergic blockers and nitrates are particularly suitable in this regard, and angiotensin-converting enzyme inhibitors favorably affect infarct expansion and ventricular remodeling. With such an approach, infarct size can be reduced, leading to improved left ventricular function--the prime determinant of morbidity and mortality in patients with acute infarction. The in-hospital mortality has fallen from about 30% three decades ago to less than 8% in many coronary care units.     

叶下珠有效部位的溶栓作用及其对PAI-1和tPA活性的影响

采用改良的Charlton和Tomihisa等方法评价叶下珠植物(Phyllanthus urinaria)含corilagin的水溶性有效部位(代号PUW)对电刺激大鼠颈动脉血栓的溶栓作用;应用发色底物方法测定PUW在体内外对血浆tPA、血浆或血小板释放的PAl-1活性的影响。结果显示,5mg／kg的PUW,其再通率为50％,再栓率为60％;10mg／kg PUW的血管再通率为60％,其再栓率为33．3％,低于2万U／kg尿激酶42．9%的再栓率。再通后1h内,血管开放状态表现为,2万U／kg尿激酶组的血管开放状态与5mg／kg PUW组的相似;10mg／kg PUW组,其持续再通率高于2万U／kg的尿激酶组。PUW在体外或静脉注射均明显降低血浆PAI—1活性,同时提高血浆tPA的活性;PUW静注还明显抑制血小板释放的PA1-1活性。本实验结果提示,PUW静脉注射显著提高闭塞颈动脉的再通率,同时降低再通后颈动脉的再栓率;抑制PAI—1活性,同时提高tPA的活性可能是PUW具有较好溶栓作用的分子机制。     

小鼠心梗模型的建立与无创评价

目的建立小鼠的心肌梗死模型,提高动物存活率,并使用心脏超声进行无创心功能评价。方法昆明雄性小鼠20只,气管插管后由左侧第4肋间进胸,结扎冠状动脉左前降支建立小鼠心肌梗死模型,在模型建立的前1 d和术后1 d、1周分别使用心脏超声检测左室收缩末直径、舒张末直径、缩短分数和射血分数,并于术后第8天进行病理检查。结果小鼠心肌梗死模型建立过程中早期死亡率10%（2/20）,术后1周内死亡率15%（3/20）,经过超声评价,造模成功率为75%（15/20）。小鼠心功能明显下降,射血分数由手术前的（92.1±3.45）%下降到术后1周的（49.8±14.20）%,缩短分数由手术前的（61.4±2.85）%下降到（26.1±9.01）%;心室明显扩大,左室收缩末直径由（13.9±1.98）μm扩大到（36.5±7.37）μm,舒张末直径由（35.9±3.12）μm扩大到（48.9±6.05）μm。病理学检查见明显瘢痕形成。结论通过结扎冠状动脉左前降支的方法建立了小鼠心肌梗死模型并可以使用超声心动图评价这一模型。     

Streptokinase--a clinically useful thrombolytic agent

A failure of hemostasis and consequent formation of blood clots in the circulatory system can produce severe outcomes such as stroke and myocardial infraction. Pathological development of blood clots requires clinical intervention with fibrinolytic agents such as urokinase, tissue plasminogen activator and streptokinase. This review deals with streptokinase as a clinically important and cost-effective plasminogen activator. The aspects discussed include: the mode of action; the structure and structure-function relationships; the structural modifications for improving functionality; recombinant streptokinase; microbial production; and recovery of this protein from crude broths.     

蓝莓花色苷预处理对大鼠心肌梗死的保护作用

目的观察蓝莓花色苷（blueberryanthocyanin,BBA）预处理对实验性急性心肌梗死大鼠心肌梗死面积,心肌肌钙蛋白-T（cTn-T）表达,Bax、Bcl-2mRNA表达的影响,探讨其干预心肌梗死的机制。方法40只Wistar大鼠随机分为假手术组,心肌梗死模型组,BBA低、中、高剂量组,药物干预4周,末次给药30min后结扎左冠状动脉前降支建立心梗动物模型。24h后,TTC检测心肌梗死面积;Westernblotting方法检测心肌细胞cTn-T蛋白表达;realtimePCR方法检测Bcl-2mRNA、BaxmRNA表达。结果模型组和假手术组相比,模型组心肌梗死面积显著升高（P〈0．01）,心肌细胞cTn．T蛋白表达下降（P〈0．05）,Bcl-2mRNA表达下降（P〈0．05）,BaxmRNA表达显著升高（P〈0．01）,Bcl-2／Bax比值显著降低（P〈0．01）。BBA干预给药组和模型组相比,中剂量组心肌梗死面积低于模型组（P〈0．05）,低剂量组心肌细胞cTn-T蛋白表达升高（P〈0．05）,中剂量组Bcl-2mRNA表达升高（P〈0．05）,低、中剂量组BaxmRNA表达下降（P〈0．05）,中剂量组Bcl-2／Bax比值升高（P〈0．05）。结论蓝莓花色苷对心肌梗死后心肌细胞具有明确的保护作用,其机制可能与减少心肌梗死面积,上调心肌细胞eTn-T蛋白的表达,上调Bcl-2mRNA表达、下调BaxmRNA表达,抑制心肌梗死后心肌细胞凋亡有关。     

Guidelines for the use of intravenous thrombolytic agents in acute myocardial infarction. Ontario Medical Association Consensus Group on Thrombolytic Therapy.

A consensus group convened under the auspices of the Ontario Medical Association produced guidelines for the use of intravenous thrombolytic agents in acute myocardial infarction. The guidelines, updated to December 1988, include the following points. 1) Any hospital that routinely accepts the responsibility for looking after patients with acute myocardial infarction could offer thrombolytic therapy if monitoring facilities are available and if the staff are experienced in the treatment of cardiac rhythm disturbances. 2) Before treatment, all patients must be carefully screened for factors predisposing to hemorrhagic complications. 3) A physician should be clearly designated as responsible for the care of the patient receiving an infusion and be available in the event of problems. 4) For the two approved agents the usual dosages are as follows: streptokinase, 1.5 million units given over 1 hour; and tissue-type plasminogen activator (tPA), 100 mg over 3 hours, delivered as 60 mg in the first hour (of which 6 to 7 mg should be given as a bolus in the first 1 to 2 minutes) and then an infusion of 20 mg/h over the next 2 hours. 5) Intravenous thrombolytics should be considered for any patient with presumed acute myocardial infarction, as suggested by prolonged chest pain or other appropriate symptoms and typical electrocardiographic changes. Expeditious treatment is critical, since myocardial necrosis occurs within hours. 6) Emergency angiography is indicated for patients with hemodynamic compromise and no apparent response to streptokinase or tPA and in those with recurrent chest pain suggestive of acute myocardial infarction despite an apparent response to intravenous thrombolysis. Angiography before discharge is recommended for patients with postinfarction angina or evidence from noninvasive testing of significant residual ischemic risk. 7) There is insufficient evidence to choose between streptokinase and tPA on the basis of the two most important outcome measures: patient survival and myocardial preservation. More conclusive evidence comparing tPA, streptokinase and another promising agent, acylated plasminogen-streptokinase activator complex, will be available in 1989-90.