Efficacy of PCI combined with intracoronary thrombolysis in patients with acute ST elevation myocardial infarction
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摘要: 目的 比较经皮冠状动脉介入(PCI)联合冠状动脉(冠脉)内使用不同溶栓药物对急性ST段抬高型心肌梗死(STEMI)患者的疗效。方法 回顾性分析2022年6月-2023年8月因STEMI于广东省第二人民医院进行PCI治疗的88例患者, 按治疗方案分为注射用重组人TNK组织型纤溶酶原激活剂组(rhTNK-tPA组, 25例)、重组人尿激酶原组(rh-proUK组, 33例)和单纯PCI组(对照组, 30例)。比较3组治疗前后血栓分级的变化与心血管不良事件发生率。结果 rhTNK-tPA较rh-proUK具有更好的血栓溶解效果, 且两组均优于对照组。3组住院期间心血管不良事件发生率差异无统计学意义。结论 PCI联合冠脉内溶栓能够更好地减轻患者的血栓负荷, 进而更好地恢复心肌灌注, 且rhTNK-tPA的溶栓效果优于rh-proUK。
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关键词:
- 急性心肌梗死 /
- 重组人TNK组织型纤溶酶原激活剂 /
- 重组人尿激酶原 /
- 血栓分级
Abstract: Objective To compare the efficacy of PCI combined with different thrombolytic agents in patients with acute ST-segment elevation myocardial infarction (STEMI).Methods A retrospective study was conducted on 88 STEMI patients who received PCI in Guangdong Second Provincial General Hospital from June 2022 to August 2023.The patients were divided into recombinant human TNK tissue plasminogen activator for injection group (rhTNK-tPA group, n=25), recombinant human urokinase group (rh-proUK, n=33), and PCI group (control group, n=30) according to treatment strategies.The changes of thrombus grade and the incidence of cardiovascular adverse events in the three groups were compared.Results rhTNK-tPA has better thrombolysis effect than rh-proUK, and both are better than the control group.There was no difference in adverse cardiovascular events during hospitalization among the three groups.Conclusion PCI combined with intracoronary thrombolysis can better reduce the thrombus load and then better restore myocardial perfusion.Moreover, the thrombolytic effect of rhTNK tPA is better than that of rh proUK.-
Key words:
- acute myocardial infarction /
- rhTNK-tPA /
- rh-proUK /
- thrombus grade
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表 1 3组患者的基线资料比较
Table 1. General data
例(%), X±S, M(P25, P75) 项目 rhTNK-tPa组(25例) rh-proUK组(33例) 对照组(30例) F/H/χ2 P 年龄/岁 54.00(46.50，67.50) 53.00(47.50，55.00) 59.00(50.00，66.50) 3.58 0.19 BMI/(kg/cm2) 25.53±3.35 25.63±2.98 23.76±3.79 2.87 0.06 高血压 6(23.10) 25.63±2.98 10(38.50) 0.59 0.75 糖尿病 5(38.50) 1(7.70) 7(53.80) 6.47 0.04 吸烟史 18(30.50) 23(39.00) 18(30.50) 1.06 0.59 S to W/min 161.00
(123.00，268.00)179.00
(112.00，390.00)326.00
(125.00，1510.00)5.46 0.07 红细胞/(×1012/L) 4.69±0.73 5.08±0.50 4.64±0.73 4.24 0.02 血小板(×109/L) 236.36±57.47) 246.88±67.02) 257.53±83.92) 0.61 0.55 血红蛋白/(g/L) 148.00
(138.00，161.50)150.00
(142.50，165.00)142.00
(121.50，152.00)5.88 0.05 总胆固醇/(mmol/L) 5.22±1.17 5.62±0.98 5.18±1.19 1.49 0.23 甘油三酯/(mmol/L) 2.27(1.28，4.04) 1.74(1.45，2.72) 1.47(1.17，2.08) 6.35 0.04 低密度脂蛋白胆固醇/(mmol/L) 3.24±1.27 3.42±0.87 3.32±0.99 0.21 0.82 纤维蛋白原/(g/L) 3.40(2.97，3.63) 3.14(2.57，3.53) 3.84(3.11，5.19) 14.97 < 0.05 D-二聚体/(μg/mL) 0.20(0.13，0.79) 0.21(0.14，0.41) 0.29(0.14，0.51) 0.42 0.82 TIMI危险评分 5.56±2.65 3.79±2.13 5.73±3.03 5.30 < 0.05 超敏肌钙蛋白I峰值/(ng/mL) 50.00(5.90，60.85) 50.00(27.24，71.05) 22.01(13.22，50) 3.29 0.19 血栓分级 4(3.00，4.50) 3(2.00，4.00) 1(1.00，2.00) 35.28 < 0.05 次要心血管事件 17(68.00) 27(81.80) 25(83.30) 2.26 0.33 主要心血管事件 0 0 3(10.00) 4.11 0.06 
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