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目的 比较阿替普酶(rt-PA)与尿激酶(UK)经导管溶栓(CDT)治疗亚急性髂-股静脉血栓形成(DVT)的安全性和临床疗效.方法 收集2013年6月至2017年6月南京医科大学附属南京医院,采用rt-PA或UK持续性CDT治疗或单纯抗凝治疗单侧亚急性髂-股DVT患者116例,其中采用rt-PA-CDT治疗43例(rt-PA-CDT组)、UK-CDT治疗39例(UK-CDT组),与单纯抗凝治疗34例(抗凝组)进行对比.对3组患者基线资料、CDT溶栓持续时间、灌注rt-PA或UK总量、血栓溶解率和临床疗效等方面进行回顾性对比分析.CDT平均时间的比较采用独立样本t检验(符合正态分布),3组间计量资料比较采用单因素方差分析,计数资料采用χ2检验.结果3组患者一般临床特征差异无统计学意义(P>0.05).溶栓持续时间、灌注溶栓药物总量、血栓溶解率(≥50%)在rt-PA-CDT组分别为(5.8± 1.3)d,(49.7±16.1)mg,86.0%;UK-CDT组分别为(6.3±1.5)d,(440±99)万U,66.7%,两组溶栓药物灌注时间差异无统计学意义(t=-1.868,P>0.05),rt-PA-CDT组血栓溶解率(≥50%)高于UK-CDT组(χ2=4.315,P<0.05).rt-PA-CDT组获得Ⅲ级血栓溶解率时间(4.7±0.9)d明显短于UK-CDT组(6.0±1.2)d,差异有统计学意义(t=-2.343,P<0.05).rt-PA-CDT组和UK-CDT组出院时临床疗效有效率分别为88.4%(38/43)和76.9%(30/39),较单纯抗凝组的26.5%(9/34)明显升高(P<0.05),但在rt-PA-CDT组与UK-CDT组间临床有效率差异无统计学意义(χ2=1.893,P>0.05).3组均未见严重并发症事件发生,小出血发生率分别为16.3%(7/43)、17.9%(7/39)和8.8%(3/34),差异均无统计学意义(χ2=1.396,P>0.05).结论 CDT使用rt-PA或UK溶栓治疗亚急性期DVT较单纯抗凝具较高临床疗效,rt-PA在血栓溶解率(≥50%)方面明显优于UK.

Objective To compare the safety and clinical efficacy of recombinant human tissue plasminogen activator (rt-PA) and urokinase(UK)in catheter-directed thrombolysis(CDT)for the treatment of subacute iliofemoral deep venous thrombosis(DVT). Methods From June 2013 to June 2017, a total of 116 subacute DVT patients underwent consistent CDT with either rt-PA or urokinase, or simple anticoagulation treatment in this study.The patients were divided into three groups for comparison:rt-PA-CDT group(n=43), UK-CDT group(n=39)and anticoagulation group(n=34). The baseline data, thrombolysis duration, rt-PA or UK dosages, thrombolytic rate and clinical efficacy rate were compared among the three groups. Independent t-test(accorded to normal distribution)was used to analyze the thrombolysis duration.The quantitative data were analyzed with analysis of varianc and the qualitative data were compared by the chi-square test. Results There was no significant difference in general clinical features among the three groups(P>0.05). The thrombolysis duration, total dosages and thrombolytic rate (≥50)were(5.8±1.3)d,(49.7±16.1)mg,86.0% for rt-PA-CDT group,and(6.3±1.5)d,(440±99)×104 U, 66.7% for UK-CDT group.The difference of thrombolysis duration was not statistically significant between the rt-PA-CDT group and UK-CDT group(t=-1.868, P>0.05). The thrombolysis rate of rt-PA-CDT group was significantly higher than that of UK-CDT group(χ2=4.315, P<0.05). The time of obtaining grade Ⅲthrombosis rate was shorter for rt-PA-CDT group(4.7±0.9)d compared with UK-CDT group(6.0±1.2 d) (t=-2.343,P<0.05).The clinical efficacy rates of the rt-PA-CDT group[88.4%(38/43)]and UK-CDT group [76.9%(30/39)]were significantly higher than that of anticoagulation group[26.5%(9/34)](P<0.05).There was no statistical difference between the rt-PA-CDT group and UK-CDT group(χ2=1.893, P>0.05). No severe complications were found in all groups. The incidence rates of mild complication of the rt-PA-CDT group, UK-CDT group and anticoagulation group were 16.3%(7/43), 17.9%(7/39)and 8.8%(3/34), respectively, and there were no significant differences among the three groups(χ2=1.396, P>0.05). Conclusion The clinical efficacy of CDT using rt-PA and UK for subacute DVT is better than simple anticoagulation treatment.Thrombolytic rate of rt-PA is superior to UK.