Ward E, Buckley O, Collins A, Browne R F, Torreggiani W C
Department of Radiology, Adelaide and Meath Hospitals incorporating the National Children's Hospital, Tallaght, Dublin 24, Ireland.
Eur Radiol. 2009 Mar;19(3):670-8. doi: 10.1007/s00330-008-1198-0. Epub 2008 Oct 17.
Thrombin is a naturally occurring coagulation protein that converts soluble fibrinogen into insoluble fibrin and plays a vital role in the coagulation cascade and in turn haemostasis. Thrombin also promotes platelet activation. In the last few years, there has been a rapid increase in the use of thrombin by radiologists in a variety of clinical circumstances. It is best known for its use in the treatment of pseudoaneurysms following angiography. However, there are now a variety of cases in the literature describing the treatment of traumatic, inflammatory and infected aneurysms with thrombin in a variety of locations within the human body. There have even been recent reports describing the use of thrombin in conventional aneurysms as well as ruptured aneurysms. Its use has also been described in the treatment of endoleaks (type II) following aneurysm repair. In nearly all of these cases, treatment with thrombin requires imaging guidance. Recently, thrombin has also been used as a topical treatment post-percutaneous intervention to reduce or stop bleeding. Most radiologists have only a limited knowledge of the pharmacodynamics of thrombin, its wide range of utilisation and its limitations. Apart from a few case reports and case series, there is little in the radiological literature encompassing the wide range of applications that thrombin may have in the radiology department. In this review article, we comprehensively describe the role and pathophysiology of thrombin, describing with examples many of its potential uses. Techniques of usage as well as pitfalls and limitations are also described.
凝血酶是一种天然存在的凝血蛋白，可将可溶性纤维蛋白原转化为不溶性纤维蛋白，在凝血级联反应进而在止血过程中发挥至关重要的作用。凝血酶还可促进血小板活化。在过去几年中，放射科医生在各种临床情况下对凝血酶的使用迅速增加。它最广为人知的用途是在血管造影术后治疗假性动脉瘤。然而，现在文献中有各种病例描述了在人体不同部位使用凝血酶治疗创伤性、炎性和感染性动脉瘤。甚至最近有报道描述了在真性动脉瘤以及破裂动脉瘤中使用凝血酶。其在动脉瘤修复术后治疗内漏（II型）中的应用也有描述。在几乎所有这些病例中，凝血酶治疗都需要影像引导。最近，凝血酶还被用作经皮介入术后的局部治疗以减少或止血。大多数放射科医生对凝血酶的药效学、其广泛的用途及其局限性了解有限。除了一些病例报告和病例系列外，放射学文献中几乎没有涵盖凝血酶在放射科可能具有的广泛应用。在这篇综述文章中，我们全面描述了凝血酶的作用和病理生理学，并举例说明了其许多潜在用途。还描述了使用技术以及陷阱和局限性。
