Gaffney P J, Edgell T A, Whitton C M
National Institute for Biological Standards and Control, Potters Bar, UK.
Haemostasis. 1999 Sep;29(1):58-71. doi: 10.1159/000022461.
Prof. Tage Astrup first elaborated the notion that blood fluidity involved a balance between the tendency of blood to clot and for such clots to lyse. It would seem that, at that time, this haemostatic balance involved the notion that forming fibrin orchestrated its own destruction by stimulating fibrinolytic activity. In this review, we have clarified the detail of this balance and developed the thesis that Astrup's far-sighted balance notions involve a variety of control mechanisms. These involve the notion that thrombin, being at first sight a procoagulant, can also, in conjunction with thrombomodulin, act as a stimulus of anticoagulant activity by the generation of activated protein C. The thrombin-activatable fibrinolytic inhibitor (TAFI) is also involved in this balance since the generation of thrombin provokes the neutralisation of fibrinolysis by the TAFI pathway. The kallikrein/factor XII/urokinase pathway is discussed indicating yet another aspect of balance between the generation of coagulation and fibrinolysis. The overall theme of this review, apart from an insight into various aspects of the haemostatic balance, is that blood has a strong tendency to clot when tissue is damaged, and the intact vasculature requires major anticoagulant systems to prevent clots adhering to and stabilising in the vasculature.
Tage Astrup教授首先阐述了这样一种观点，即血液流动性涉及血液凝固倾向与血栓溶解倾向之间的平衡。在那个时候，这种止血平衡似乎涉及到这样一种观念，即形成纤维蛋白通过刺激纤维蛋白溶解活性来精心安排自身的破坏。在这篇综述中，我们阐明了这种平衡的细节，并提出了一个论点，即Astrup具有远见卓识的平衡观念涉及多种控制机制。这些机制包括这样一种观念，即凝血酶乍一看是一种促凝血剂，但它也可以与血栓调节蛋白一起，通过生成活化蛋白C来作为抗凝活性的刺激物。凝血酶可激活的纤维蛋白溶解抑制剂（TAFI）也参与了这种平衡，因为凝血酶的生成会通过TAFI途径引发纤维蛋白溶解的中和。文中讨论了激肽释放酶/因子XII/尿激酶途径，这表明了凝血和纤维蛋白溶解生成之间平衡的另一个方面。这篇综述的总体主题，除了深入了解止血平衡的各个方面之外，还在于当组织受损时血液有很强的凝固倾向，而完整的血管系统需要主要的抗凝系统来防止血栓在血管系统中黏附和稳定。
