Agren Anna, Wiman Björn, Schulman Sam
Department of Hematology, Coagulation Unit, Karolinska University Hospital, Stockholm, Sweden.
Blood Coagul Fibrinolysis. 2007 Oct;18(7):657-60. doi: 10.1097/MBC.0b013e3282dded21.
Low activity of plasminogen activator inhibitor type 1 (PAI-1) has been associated with bleeding complications in surgery. We earlier reported a higher prevalence of low PAI-1 activity among patients with bleeding tendency as compared with normal control individuals. The present study evaluated whether low PAI-1 activity actually is associated with markers of increased fibrinolytic activity in plasma from patients with a history of bleeding. PAI-1 activity, plasmin-antiplasmin complex (PAP) and D-dimer were analyzed in plasma samples from 424 consecutive patients referred to the Coagulation Unit for investigation of bleeding symptoms. The median PAI-1 activity was 4.0 U/ml [interquartile range (IQR), 1-10 U/ml], the median PAP level was 1.59 mg/l (IQR, 1.40-1.91 mg/l) and the median D-dimer level was 71 microg/l (IQR, 46-111 microg/l). The median PAP concentration for patients with PAI-1 less than 1.0 U/ml was 1.73 mg/l (IQR, 1.53-2.30 mg/l), and that for PAI-1 of at least 1.0 U/ml was 1.54 mg/l (IQR, 1.36-1.83 mg/l) (P < 0.0001). There was also a significant difference between the PAP levels in patients with normal PAI-1 (1-15 U/ml) versus elevated PAI-1 (> 15 U/ml) (P = 0.024). The level of D-dimer did not correlate with PAI-1 activity. In conclusion, the activation of plasminogen measured as PAP was higher in patients with bleeding symptoms in combination with PAI-1 activity less than 1.0 U/ml than in those with PAI-1 activity of at least 1.0 U/ml. The coagulation activity under normal conditions, as measured by D-dimer, did not differ between the two patient subsets. The results support our previous definition of low PAI-1 as activity below 1.0 U/ml.
纤溶酶原激活物抑制剂1型（PAI-1）活性降低与手术中的出血并发症相关。我们之前报道，与正常对照个体相比，有出血倾向的患者中PAI-1活性降低的患病率更高。本研究评估了PAI-1活性降低是否实际上与有出血史患者血浆中纤溶活性增加的标志物相关。对424例因出血症状转诊至凝血科进行检查的连续患者的血浆样本分析了PAI-1活性、纤溶酶 - 抗纤溶酶复合物（PAP）和D - 二聚体。PAI-1活性中位数为4.0 U/ml [四分位间距（IQR），1 - 10 U/ml]，PAP水平中位数为1.59 mg/l（IQR，1.40 - 1.91 mg/l），D - 二聚体水平中位数为71 μg/l（IQR，46 - 111 μg/l）。PAI-1低于1.0 U/ml的患者PAP浓度中位数为1.73 mg/l（IQR，1.53 - 2.30 mg/l），PAI-1至少为1.0 U/ml的患者PAP浓度中位数为1.54 mg/l（IQR，1.36 - 1.83 mg/l）（P < 0.0001）。PAI-1正常（1 - 15 U/ml）与PAI-1升高（> 15 U/ml）的患者之间PAP水平也存在显著差异（P = 0.024）。D - 二聚体水平与PAI-1活性不相关。总之，以PAP衡量的纤溶酶原激活在PAI-1活性低于1.0 U/ml的出血症状患者中高于PAI-1活性至少为1.0 U/ml的患者。通过D - 二聚体测量的正常条件下的凝血活性在两组患者中无差异。结果支持我们之前将PAI-1活性低于1.0 U/ml定义为低PAI-1的定义。
