阿替普酶与瑞替普酶在动静脉内瘘溶栓治疗中的对比分析
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摘要
目的探讨阿替普酶(alteplase,rt-PA)与瑞替普酶(reteplase,r-PA)应用于动静脉内瘘溶栓的疗效和安全性的对比分析。方法选取2015年1月~2018年2月我院收治的动静脉内瘘血栓形成的透析患者132例,按入院时间先后顺序分组,r-PA治疗组105例,rt-PA治疗组27例。溶栓治疗后观察两组再通率、再通时间、并发症发生率等。结果 2组患者在年龄、危险因素、发病至开始溶栓时间方面差异无统计学意义(P>0.05),rt-PA组溶通22例(81.48%),r-PA组溶通82例(78.10%),两组内瘘再通率差异无统计学意义(22/27比82/105,χ~2=0.147,P=0.701),rt-PA组溶通时间慢于r-PA组[3.75(1.75~4.88)比1.50(1.50~3.23),Z=-2.135,P=0.033]。治疗后两组纤维蛋白原(fibrinogen,FIB)均下降,rPA组较rt-PA组下降更显著[(1.92±0.88)g/L比(2.73±0.88)g/L,t=-5.331,P<0.001],但仍在安全范围。在轻度出血的发生率上rt-PA组低于于r-PA组,但差异无统计学意义(2/27比17/105,χ~2=0.726,P=0.394)。两组均未发生脑出血、消化道出血等重要脏器出血。结论 rt-PA与r-PA在动静脉内瘘溶栓治疗中效果大致相当,具有再通率高、剂量小的优点,rt-PA对凝血功能的影响可能更小,出血的发生率更低。
Objective This is a comparative analysis to investigate Alteplase(rt-PA) and Reteplase(rPA) for thrombolysis treatment in arteriovenous fistula(AVF). Methods A total of 132 patients with the blockage of AVF due to thrombosis and treated in the hospital from January 2015 to February 2018 were recruited in this study. They were assigned into two groups based on the hospitalization day: r-PA group(n=105,treated with r-PA), and rt-PA group(n=27, treated with rt-PA). The re-patency rate, re-patency time and adverse events in the two groups were observed after the treatment. Result There were no significant differences in age, risk factors and the time of thrombolysis treatment between the two groups(P>0.05). The re-patency rate was 81.48%(22/27 cases) in rt-PA group, and 78.1%(82/105 cases) in r-PA group(χ~2=0.147, P=0.701).The re-patency time was longer in rt-PA group than in r-PA group [3.75(1.75~4.88) vs. 1.50(1.50~3.23),Z=-2.135, P=0.033]. Fibrinogen decreased in both groups. The decrease of fibrinogen was within normal range in both groups, but was more in r-PA group than in rt-PA group(1.92±0.88 g/L vs. 2.73±0.88, t=-5.331,P<0.001]. Patients with minor bleeding were 2/27 in rt-PA group and were 17/105 in r-PA group(χ~2=0.726,P=0.394). No bleeding in brain, gastrointestinal tract and any other organs were found in both groups. Conclusion r-PA and rt-PA have similar effect on thrombolysis in AVF. rt-PA has less influence on coagulation and bleeding.
Objective This is a comparative analysis to investigate Alteplase(rt-PA) and Reteplase(rPA) for thrombolysis treatment in arteriovenous fistula(AVF). Methods A total of 132 patients with the blockage of AVF due to thrombosis and treated in the hospital from January 2015 to February 2018 were recruited in this study. They were assigned into two groups based on the hospitalization day: r-PA group(n=105,treated with r-PA), and rt-PA group(n=27, treated with rt-PA). The re-patency rate, re-patency time and adverse events in the two groups were observed after the treatment. Result There were no significant differences in age, risk factors and the time of thrombolysis treatment between the two groups(P>0.05). The re-patency rate was 81.48%(22/27 cases) in rt-PA group, and 78.1%(82/105 cases) in r-PA group(χ~2=0.147, P=0.701).The re-patency time was longer in rt-PA group than in r-PA group [3.75(1.75~4.88) vs. 1.50(1.50~3.23),Z=-2.135, P=0.033]. Fibrinogen decreased in both groups. The decrease of fibrinogen was within normal range in both groups, but was more in r-PA group than in rt-PA group(1.92±0.88 g/L vs. 2.73±0.88, t=-5.331,P<0.001]. Patients with minor bleeding were 2/27 in rt-PA group and were 17/105 in r-PA group(χ~2=0.726,P=0.394). No bleeding in brain, gastrointestinal tract and any other organs were found in both groups. Conclusion r-PA and rt-PA have similar effect on thrombolysis in AVF. rt-PA has less influence on coagulation and bleeding.
引文
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[2]廖琪,黄江燕,董力,等.瑞替普酶局部溶栓治疗尿毒症患者动静脉内瘘血栓观察[J].解放军医药杂志, 2015(8):6-8.
[3]蒋秋艳,廖琪,郑艺花,等.局部使用瑞替普酶与尿激酶治疗尿毒症患者内瘘血栓效果比较[J].国际移植与血液净化杂志, 2016, 14(5):28-30.
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[8]姜燕,谢毅,钱媛,等. Fogarty球囊导管在动静脉内瘘取栓中的应用[J].重庆医学, 2015(36):5123-5125.
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[10]戎殳,李惠民,叶朝阳,等. CO2血管造影在血液透析血管通路功能评价中的初步应用[J].中国中西医结合肾病杂志,2005, 6(9):520-522.
[11]田野,张陈匀,吴曼,等.瑞替普酶在急性心肌梗死患者溶栓治疗中的疗效与安全性[J].中国老年学, 2015(9):2535-2536.
[12] Orgeron GM, Pollard JL, Pourmalek P, et al. CatheterDirected Low-Dose Tissue Plasminogen Activator for Treatment of Right Atrial Thrombus Caused by a Central Venous Catheter[J]. Pharmacotherapy, 2015, 35(10):153-158.
[13]第七届全国血栓与止血学术会议制定的几项诊断参考标准[J].中华血液学杂志, 2000, 21(3):165-168.
[14]张幼林,崔颖,蔡力进,等.阿替普酶对静脉溶栓患者24h内凝血系统的影响[J].山西医药杂志, 2015(14):1591-1594.
[15]邓可,吴晓球. rPA治疗急性期脑梗死的临床研究[J].卒中与神经疾病, 2014, 21(2):101-103.
[2]廖琪,黄江燕,董力,等.瑞替普酶局部溶栓治疗尿毒症患者动静脉内瘘血栓观察[J].解放军医药杂志, 2015(8):6-8.
[3]蒋秋艳,廖琪,郑艺花,等.局部使用瑞替普酶与尿激酶治疗尿毒症患者内瘘血栓效果比较[J].国际移植与血液净化杂志, 2016, 14(5):28-30.
[4]张桂艳,孙璇玉.局部尿激酶溶栓治疗动静脉内瘘血栓[J].中国现代药物应用, 2012, 06(16):86-87.
[5] Feldman HI, Held PJ, Hutchinson JT, et al. Hemodialysis vascular access morbidity in the United States[J]. Kidney Int, 1993, 43(5):1091-6.
[6]张智敏,程圣英,张五星,等.维持性血液透析患者内瘘情况分析[J].中国血液净化, 2007, 6(6):312-313.
[7]杜春玲.维持性血液透析患者动静脉内瘘失功的原因分析及护理[J].实用医学杂志, 2010, 26(10):1832-1834.
[8]姜燕,谢毅,钱媛,等. Fogarty球囊导管在动静脉内瘘取栓中的应用[J].重庆医学, 2015(36):5123-5125.
[9] Vascular Access Work Group. Clinical practice guidelines for vascular access[J]. Am J Kidney Dis, 2006,48(1):248-273.
[10]戎殳,李惠民,叶朝阳,等. CO2血管造影在血液透析血管通路功能评价中的初步应用[J].中国中西医结合肾病杂志,2005, 6(9):520-522.
[11]田野,张陈匀,吴曼,等.瑞替普酶在急性心肌梗死患者溶栓治疗中的疗效与安全性[J].中国老年学, 2015(9):2535-2536.
[12] Orgeron GM, Pollard JL, Pourmalek P, et al. CatheterDirected Low-Dose Tissue Plasminogen Activator for Treatment of Right Atrial Thrombus Caused by a Central Venous Catheter[J]. Pharmacotherapy, 2015, 35(10):153-158.
[13]第七届全国血栓与止血学术会议制定的几项诊断参考标准[J].中华血液学杂志, 2000, 21(3):165-168.
[14]张幼林,崔颖,蔡力进,等.阿替普酶对静脉溶栓患者24h内凝血系统的影响[J].山西医药杂志, 2015(14):1591-1594.
[15]邓可,吴晓球. rPA治疗急性期脑梗死的临床研究[J].卒中与神经疾病, 2014, 21(2):101-103.