Gando Satoshi, Kameue Takashi, Sawamura Atsushi, Hayakawa Mineji, Hoshino Hirokatsu, Kubota Nobuhiko
Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, N17 W5, Sapporo 060, Japan.
Thromb Res. 2007;120(1):87-93. doi: 10.1016/j.thromres.2006.07.009. Epub 2006 Oct 4.
We conducted this prospective study in order to investigate the hypotheses that an alternative pathway for fibrinolysis is activated in patients who have undergone cardiopulmonary bypass (CPB) surgery and major abdominal surgery and that the levels of fibrin degradation products digested by polymorphonuclear neutrophil elastase (elastase-XDP) and the D-dimer increase in the patients' plasma.
We studied a total of 77 patients who were scheduled to undergo either CPB surgery (36 patients) or major abdominal surgery (41 patients) and then measured the elastase-XDP and D-dimer levels at several time points both during and after the surgeries. The CPB surgery was divided into surgery for aortic dissection (AD) and cardiac surgery. The major abdominal surgery consists of hepatic resection and esophagectomy.
The elastase-XDP and D-dimer levels significantly increased in the patients who underwent both CPB surgery and major abdominal surgery. The elastase-XDP levels in AD surgery showed highest values at the end of the CPB, while the levels in the other surgeries reached their peak on the day after the surgery. Statistical difference was seen in the levels of elastase-XDP among the three subgroups undergoing a hepatic resection. While we found significant correlations between the levels of elastase-XDP and D-dimer in patients undergoing CPB surgery and a subsegmentectomy of a cirrhotic liver, the correlation coefficients were markedly low in comparison to those of the other surgeries.
Our findings demonstrated that the elastase-mediated pathway of fibrinolysis is activated to varying degrees depending on the surgery performed. Variations in the correlation coefficients between the levels of elastase-XDP and D-dimer may suggest that elastase-mediated fibrinolysis play a different role from the physiological fibrinolysis mediated by plasmin.
我们开展这项前瞻性研究，旨在探究以下假设：在接受体外循环（CPB）手术和腹部大手术的患者中，纤溶的替代途径被激活，且患者血浆中多形核中性粒细胞弹性蛋白酶消化的纤维蛋白降解产物（弹性蛋白酶-XDP）水平和D-二聚体水平升高。
我们共研究了77例计划接受CPB手术（36例患者）或腹部大手术（41例患者）的患者，然后在手术期间和术后的几个时间点测量弹性蛋白酶-XDP和D-二聚体水平。CPB手术分为主动脉夹层（AD）手术和心脏手术。腹部大手术包括肝切除术和食管切除术。
接受CPB手术和腹部大手术的患者中，弹性蛋白酶-XDP和D-二聚体水平显著升高。AD手术中弹性蛋白酶-XDP水平在CPB结束时最高，而其他手术中的水平在术后第一天达到峰值。在接受肝切除术的三个亚组中，弹性蛋白酶-XDP水平存在统计学差异。虽然我们发现接受CPB手术和肝硬化肝脏亚段切除术的患者中弹性蛋白酶-XDP水平与D-二聚体水平之间存在显著相关性，但与其他手术相比，相关系数明显较低。
我们的研究结果表明，弹性蛋白酶介导的纤溶途径根据所进行的手术不同而有不同程度的激活。弹性蛋白酶-XDP水平与D-二聚体水平之间相关系数的差异可能表明，弹性蛋白酶介导的纤溶与纤溶酶介导的生理纤溶发挥不同的作用。
