Haubelt H, Blome M, Kiessling A H, Isgro F, Bach J, Saggau W, Hellstern P
Institute of Hemostaseology and Transfusion Medicine, Ludwigshafen, Germany.
Vox Sang. 2002 Jan;82(1):9-14. doi: 10.1046/j.1423-0410.2002.00129.x.
Solvent/detergent-treated plasma (SDP) contains markedly lower protein S (PS) and plasmin inhibitor (PI) activity than standard fresh-frozen plasma (FFP). It has also been reported that SDP contains no alpha(1)-antitrypsin. Despite the lack of clinical data, it is suspected that SDP may be less effective than FFP in the treatment of complex coagulopathies. We therefore conducted a prospective trial to study the impact of SDP and FFP on haemostasis and fibrinolysis in complex coagulopathy after open-heart surgery.
Patients received either 600 ml of SDP (n = 36) or 600 ml of FFP (n = 31) at an infusion rate of 30 ml/min. The following parameters were measured before treatment and 60 min after termination of plasma infusion: prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, factor VIII, antithrombin, protein C (PC), free PS and PS activity, prothrombin fragments F1+2 (F1+2), D-dimers (DD), fibrinogen degradation products (FDP), plasmin-plasmin inhibitor complexes (PPI), plasminogen, PI and alpha(1)-antitrypsin.
The rise in fibrinogen, factor VIII, antithrombin, PC, free PS, alpha(1)-antitrypsin and plasminogen, and the decrease in PT and APTT, did not significantly differ between the two study arms. However, PS activity did not increase after SDP infusion but did show a significant elevation after infusion with FFP. PI declined significantly after SDP and remained uninfluenced by FFP. Neither SDP nor FFP had any significant influence on F1+2, DD or FDP. However, a significant decrease in PPI levels caused by both types of plasma indicated a reduction in hyperfibrinolysis. Clinical haemostasis evaluation revealed no significant difference between the two treatment regimens. No adverse reactions were observed.
With the exception of PS and PI, SDP and FFP improved haemostasis and fibrinolysis to a similar degree. The clinical significance of these findings has to be determined in patients with severe acquired PS and PI deficiency requiring plasma transfusions.
与标准新鲜冰冻血浆（FFP）相比，溶剂/去污剂处理血浆（SDP）中的蛋白S（PS）和纤溶酶抑制剂（PI）活性显著降低。也有报道称SDP不含α1抗胰蛋白酶。尽管缺乏临床数据，但怀疑SDP在治疗复杂凝血病方面可能不如FFP有效。因此，我们进行了一项前瞻性试验，以研究SDP和FFP对心脏直视手术后复杂凝血病患者止血和纤溶的影响。
患者以30 ml/min的输注速率接受600 ml SDP（n = 36）或600 ml FFP（n = 31）。在治疗前及血浆输注结束后60分钟测量以下参数：凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原、因子VIII、抗凝血酶、蛋白C（PC）、游离PS和PS活性、凝血酶原片段F1+2（F1+2）、D-二聚体（DD）、纤维蛋白原降解产物（FDP）、纤溶酶-纤溶酶抑制剂复合物（PPI）、纤溶酶原、PI和α1抗胰蛋白酶。
两个研究组之间，纤维蛋白原、因子VIII、抗凝血酶、PC、游离PS、α1抗胰蛋白酶和纤溶酶原的升高，以及PT和APTT的降低，均无显著差异。然而，输注SDP后PS活性未增加，但输注FFP后PS活性显著升高。输注SDP后PI显著下降，而FFP对其无影响。SDP和FFP对F1+2、DD或FDP均无显著影响。然而，两种血浆均导致PPI水平显著降低，表明高纤溶状态有所减轻。临床止血评估显示两种治疗方案之间无显著差异。未观察到不良反应。
除PS和PI外，SDP和FFP在改善止血和纤溶方面程度相似。这些发现的临床意义有待在需要输血的严重获得性PS和PI缺乏患者中确定。
