Yamasawa F, Hasegawa N, Asano K, Sayama K, Fujita H, Urano T, Aoki T, Ishizaka A, Kanazawa M, Kawashiro T
Department of Internal Medicine, School of Medicine, Keio University.
Kokyu To Junkan. 1992 Jul;40(7):685-90.
The key enzyme for fibrinolysis is plasmin, which is converted from plasminogen by plasminogen activator. Activated plasmin lyses fibrinogen and fibrin to make fibrin degradation products(FDPs) and plasmin is inactivated immediately by alpha 2 plasmin inhibitor. As FDP.D dimer is derived solely from insoluble fibrin, FDP.D dimer is thought of as an index for clot lysis. We measured plasmin-alpha 2 plasmin inhibitor complex(PIC) and FDP.D dimer plasma levels in 3 patients with acute pulmonary thromboembolism treated with recombinant tissue plasminogen activator(tPA). Fifteen million units of tPA(TD-2061) were infused in one hour on the first, second and third hospital days. PIC and FDP.D dimer before tPA infusion showed slightly elevated values as compared to normal ranges. They increased markedly after tPA infusion. These findings suggest that the fibrinolytic system is slightly activated in the acute phase of pulmonary thromboembolism and also strongly activated by tPA infusion. Increased FDP D dimer suggests that fibrin clots are dissolved by activated plasmin. Improvement of arterial oxygen tension was observed after tPA infusion. As sustained higher FDP.D dimer means the existence of fibrin clots, heparin treatment should be continued for prevention of clot formation as long as FDP.D dimer shows higher value. In conclusion, PIC and FDP.D dimer are useful indices not only to detect the activated state of the fibrinolytic system but also to know clot lysis in tPA treatment.
纤维蛋白溶解的关键酶是纤溶酶，它由纤溶酶原激活物将纤溶酶原转化而来。活化的纤溶酶溶解纤维蛋白原和纤维蛋白，产生纤维蛋白降解产物（FDPs），而纤溶酶会立即被α2纤溶酶抑制剂灭活。由于FDP.D二聚体仅来源于不溶性纤维蛋白，因此FDP.D二聚体被视为血栓溶解的指标。我们测定了3例接受重组组织型纤溶酶原激活剂（tPA）治疗的急性肺血栓栓塞患者的纤溶酶-α2纤溶酶抑制剂复合物（PIC）和FDP.D二聚体血浆水平。在住院的第一、第二和第三天，1500万单位的tPA（TD - 2061）在1小时内输注完毕。tPA输注前的PIC和FDP.D二聚体与正常范围相比略有升高。tPA输注后它们显著升高。这些发现表明，在肺血栓栓塞的急性期纤维蛋白溶解系统略有激活，并且tPA输注可使其强烈激活。FDP D二聚体升高表明纤维蛋白凝块被活化的纤溶酶溶解。tPA输注后观察到动脉血氧张力有所改善。由于持续较高的FDP.D二聚体意味着存在纤维蛋白凝块，只要FDP.D二聚体值较高，就应继续进行肝素治疗以预防血栓形成。总之，PIC和FDP.D二聚体不仅是检测纤维蛋白溶解系统激活状态的有用指标，而且对于了解tPA治疗中的血栓溶解情况也很有用。
