Phillips M, Dickneite G, Metzner H
Wound Healing, Aventis Behring, King of Prussia, PA 19406-0901, USA.
Cardiovasc Surg. 2003 Aug;11 Suppl 1:13-6. doi: 10.1016/S0967-2109(03)00066-8.
Factor XIII has a well-established role in natural coagulation and clot stabilization. It is often added back to fibrin sealants that are used in a wide range of surgical settings to achieve successful hemostasis, tissue adhesion and wound healing. Factor XIII is the final enzyme to be activated in the blood coagulation cascade. It plays an important role in maintaining the balance between coagulation and fibrinolysis. Factor XIII facilitates the formation of covalent cross-links within the fibrin network, forming a loose mesh after activation by thrombin. It adds significant resilience to fibrin clots, augmenting strength by as much as 5-fold. Both fibrin cross-linking and the factor XIII-catalyzed ligation of the fibrinolysis inhibitor alpha(2)-antiplasmin to the fibrin clot contribute to the increased proteolytic resistance of factor XIII-stabilized clots. Preclinical studies indicate that the inclusion of factor XIII in fibrin sealants used for vascular grafting significantly reduces suture-hole blood loss. This has important implications for the successful control of bleeding in comparable clinical situations. The advantages of factor XIII stabilized clots (increased strength, resistance to proteolysis, promotion of wound healing) suggest that the presence of factor XIII in fibrin sealants may optimize their performance in the clinical setting. The aim of this paper is to review preclinical data that provide evidence for a potentially positive role for factor XIII in fibrin sealants.
凝血因子 XIII 在自然凝血和凝块稳定过程中具有既定作用。它常被添加到用于广泛手术场景的纤维蛋白密封剂中，以实现成功止血、组织粘连和伤口愈合。凝血因子 XIII 是血液凝固级联反应中最后一个被激活的酶。它在维持凝血和纤维蛋白溶解之间的平衡方面发挥着重要作用。凝血因子 XIII 促进纤维蛋白网络内共价交联的形成，在被凝血酶激活后形成一个松散的网状结构。它为纤维蛋白凝块增加了显著的弹性，使强度提高多达 5 倍。纤维蛋白交联以及凝血因子 XIII 催化的纤维蛋白溶解抑制剂α(2)-抗纤溶酶与纤维蛋白凝块的连接，都有助于提高凝血因子 XIII 稳定的凝块对抗蛋白水解的能力。临床前研究表明，在用于血管移植的纤维蛋白密封剂中加入凝血因子 XIII 可显著减少缝合孔失血。这对于在类似临床情况下成功控制出血具有重要意义。凝血因子 XIII 稳定的凝块的优势（增强强度、抗蛋白水解、促进伤口愈合）表明，纤维蛋白密封剂中存在凝血因子 XIII 可能会优化其在临床环境中的性能。本文的目的是回顾临床前数据，这些数据为凝血因子 XIII 在纤维蛋白密封剂中可能发挥的积极作用提供了证据。
