Takahashi H, Tatewaki W, Wada K, Hanano M, Shibata A
First Department of Internal Medicine, Niigata University School of Medicine, Japan.
Am J Hematol. 1990 Feb;33(2):90-5. doi: 10.1002/ajh.2830330204.
In order to assess the thrombin and plasmin generation in vivo in disseminated intravascular coagulation (DIC), plasma levels of thrombin-antithrombin III (ATIII) complex (TAT) and plasmin-alpha 2-antiplasmin (a2AP) complex (PAP) were measured together with standard coagulation and fibrinolytic parameters in 80 patients with DIC. Both TAT and PAP were markedly elevated in patients with DIC. When plotted by the underlying disease categories, differences in the magnitude of the elevations of these complexes were recognized among groups. Patients with acute promyelocytic leukemia (APL) had the highest PAP, the lowest TAT/PAP ratio, low a2AP, and low fibrinogen, indicating that the most excessive fibrinolysis can occur in APL. Similar profiles, although less marked, were observed in patients with other leukemias and vascular diseases. Patients with sepsis showed the highest TAT/PAP ratio and the lowest PAP with no decrease in a2AP or fibrinogen, demonstrating a relatively impaired fibrinolysis. Patients with cancer had a relatively high TAT and high TAT/PAP ratio. In addition, both TAT and PAP were markedly elevated in patients with shock. From these, it was suggested that, although laboratory manifestations in DIC are extremely variable from patient to patient, underlying disorders are, at least in part, responsible for the observed variations. Recognition of this variable activation of coagulation and fibrinolysis would be helpful for the proper management of patients with DIC.
为了评估弥散性血管内凝血（DIC）患者体内的凝血酶和纤溶酶生成情况，我们检测了80例DIC患者血浆中凝血酶 - 抗凝血酶III（ATIII）复合物（TAT）和纤溶酶 - α2 - 抗纤溶酶（a2AP）复合物（PAP）的水平，并同时检测了标准凝血和纤溶参数。DIC患者的TAT和PAP均显著升高。根据潜在疾病类别进行绘制时，发现这些复合物升高幅度在不同组之间存在差异。急性早幼粒细胞白血病（APL）患者的PAP最高，TAT/PAP比值最低，a2AP低，纤维蛋白原低，表明APL中可发生最过度的纤溶。在其他白血病和血管疾病患者中观察到类似的情况，尽管不太明显。脓毒症患者的TAT/PAP比值最高，PAP最低，a2AP或纤维蛋白原无降低，表明纤溶相对受损。癌症患者的TAT相对较高，TAT/PAP比值较高。此外，休克患者的TAT和PAP均显著升高。由此表明，尽管DIC患者的实验室表现个体差异极大，但潜在疾病至少在一定程度上导致了观察到的差异。认识到凝血和纤溶的这种可变激活情况将有助于对DIC患者进行恰当的管理。
