摘要
目的探讨尿激酶治疗短暂性脑缺血发作(TLA)的临床效果及对凝血和纤溶系统的影响。方法 104例TIA患者分为观察组54例和对照组50例,对照组患者给予常规治疗,观察组患者在常规治疗的基础上加用尿激酶溶栓治疗。于治疗前及治疗后6、24 h检测2组患者凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、纤维蛋白原(FIB)、D-二聚体(DD)、组织型纤溶酶原激活物(tPA)和纤溶酶原激活物抑制剂(PAI)的变化,比较2组患者治疗1周内TIA发作次数、急性脑梗死(ACI)和出血性疾病发生率。结果观察组患者治疗1周内TIA发作次数和ACI发生率均显著少于对照组(P<0.05),但2组患者出血性疾病发生率比较差异无统计学意义(P>0.05)。2组患者治疗前凝血及纤溶系统各项指标比较差异均无统计学意义(P>0.05)。与治疗前比较,溶栓治疗后6 h观察组患者PT、APTT、DD和tPA显著升高(P<0.05),而PAI、FIB显著降低(P<0.05)。与治疗前比较,溶栓治疗后24 h观察组患者PT、APTT、DD和tPA显著升高(P<0.05),而PAI显著降低(P<0.05);但溶栓治疗后24 h观察组患者FIB与治疗前比较差异无统计学意义(P>0.05)。观察组溶栓治疗后24 h患者DD和tPA显著低于治疗后6 h(P<0.05),但PAI和FIB显著高于治疗后6 h(P<0.05)。对照组患者溶栓治疗后6 h PT显著长于治疗前(P<0.05),但其余各项指标比较差异均无统计学意义(P>0.05)。对照组患者溶栓治疗后24 h PT和APTT显著长于治疗前(P<0.05),但其余各项指标比较差异均无统计学意义(P>0.05)。对照组患者溶栓治疗后24 h与溶栓治疗后6 h各项指标比较差异均无统计学意义(P>0.05)。治疗后6 h,2组各项指标比较差异均有统计学意义(P<0.05)。治疗后24 h,观察组患者PT显著长于对照组(P<0.05);但其余各项指标比较差异均无统计学意义(P>0.05)。结论尿激酶溶栓治疗能显著降低TIA患者的凝血活性,提高纤溶活性,减少TIA发作次数,降低ACI发生率。
Objective To explore the clinical effect and influence of urokinase on coagulation and fibrinolytic system in patients with transient ischemic attack（TIA）.Methods A total of 104 patients with TIA were divided into observation group（n = 54） and control group（n =50）,the patients in control group were treated with conventional therapy,based on this,the patients in observation group were treated with urokinase.The prothrombin time（PT）,activated partial thromboplastin time（APTT）,fibrinogen（FIB）,D-dimer（DD）.tissue plasminogen activator（tPA） and plasminogen activator inhibitor（PAI） were detected before treatment and 6,24 hours after treatment.TIA episodes frequency,incidence of acute cerebral infarction（ACI） and hemorrhagic diseases within one week of treatment were compared between the two groups.Results Within one week of treatment,the TIA episodes frequency and ACI incidence in observation group were significantly lower than those in control group（P0.05）,but there was no significant difference in the incidence of hemorrhagic disease between the two groups（P 0.05）.Before treatment,there was no significant difference in the indexes of coagulation and fibrinolytic system between the two groups（P0.05）.In observation group,the PT,APTT,DD and tPA levels after 6 hours thrombolytic therapy were significantly higher than those before treatment（P 0.05）,but the PAI and FIB levels were significantly Iower（P 0.05）.In observation group,the PT,APTT,DD and tPA levels after 24 hours thrombolytic therapy were significantly higher than those before treatment（P 0.05）,but the PAI level was significantly lower（P 0.05）,and there was no significant difference in FIB level between before and after 24 hours thrombolytic therapy（P0.05）.In observation group,the DD and tPA levels after 24 hours thrombolytic therapy were significantly lower than those after 6 hours thrombolytic therapy（P 0.05）,but the PAI and FIB levels after 24 hours thrombolytic therapy were significandy higher than those after 6 hours thrombolytic therapy（P 0.05）.Incontrol group,PT after 6 hours thrombolytic therapy was significantly longer than that before treatment（P 0.05）,PT and APTT after 24 hours thrombolytic therapy were significantly longer than that before treatment（P 0.05）,but there was no significant difference in the other indexes before and after treatment（P 0.05）.There was no significant difference in the indexes between 6 hours and 24 hours thrombolytic therapy in control group（P 0.05）.There were significant differences in the indexes after 6 hours thrombolytic therapy between the two groups（P 0.05）.Twenty-four hours after treatment,PT in observation group was significantly longer than that in control group（P 0.05）,but there was no significant difference in the other indexes between the two groups（P 0.05）.Conclusion Thrombolytic therapy with urokinase can significantly decrease the coagulation activity,increase the fibrinolytic activity,reduce TIA episodes frequency and the ACI incidence in patients with TIA.
出处
《新乡医学院学报》
CAS
2013年第10期829-832,共4页
Journal of Xinxiang Medical University
关键词
短暂性脑缺血发作
尿激酶
凝血功能
纤溶系统
transient ischemic attack
urokinase
coagulation function
fibrinolysis system
