Maekawa H, Yoshikawa Y, Toda G, Oka H
First Department of Internal Medicine, Faculty of Medicine, University of Tokyo.
Nihon Shokakibyo Gakkai Zasshi. 1990 Jan;87(1):62-8.
Previous studies have demonstrated that plasma tissue plasminogen activator (t-PA) level was elevated in patients with liver disease. In this study, t-PA antigen levels were investigated in patients with acute hepatitis (AH; N = 12), chronic hepatitis (CH; N = 8), compensated liver cirrhosis (CLC; N = 40), decompensated liver cirrhosis (DLC; N = 23) and hepatocellular carcinoma (HCC; N = 35). The increased t-PA levels (higher than 14 ng/ml) were found in 33% (4/12) of AH on the early hospital days, 25% (2/8) of CH, 45% (18/40) of CLC and 91% (21/23) of DLC, and 60% (21/35) of Hcc cases. In patient with LC, the correlations between t-PA levels and serum total bilirubin (T.Bill) and hepatic synthetic functions were investigated. The results were that the t-PA levels correlated positively with T. Bil and negatively with liver synthetic functions such as albumin, protein C and choline-esterase, indicating that t-PA increased almost in proportion to the deterioration of hepatic function. Serial determination of t-PA in patients with HCC treated by transcatheter arterial embolization (TAE) revealed that TAE failed to normalize the t-PA levels. In one case of HCC complicated with disseminated intravascular coagulation (DIC), t-PA showed a marked increase at acute phase of DIC and subsequent decrease after the successful treatment for DIC by gabexate mesilate (FOY) infusion. These results suggest that increased t-PA in liver disease is due mainly to deterioration of hepatic function, and that secondary fibrinolytic state, such as DIC, is also a contributing factor.
以往研究表明，肝病患者血浆组织型纤溶酶原激活物（t-PA）水平升高。在本研究中，对急性肝炎（AH；n = 12）、慢性肝炎（CH；n = 8）、代偿期肝硬化（CLC；n = 40）、失代偿期肝硬化（DLC；n = 23）和肝细胞癌（HCC；n = 35）患者的t-PA抗原水平进行了调查。在住院早期，33%（4/12）的AH患者、25%（2/8）的CH患者、45%（18/40）的CLC患者、91%（21/23）的DLC患者以及60%（21/35）的HCC患者的t-PA水平升高（高于14 ng/ml）。在肝硬化患者中，研究了t-PA水平与血清总胆红素（T.Bill）和肝脏合成功能之间的相关性。结果显示，t-PA水平与T.Bil呈正相关，与白蛋白、蛋白C和胆碱酯酶等肝脏合成功能呈负相关，表明t-PA几乎与肝功能恶化成比例增加。对经肝动脉化疗栓塞术（TAE）治疗的HCC患者进行t-PA的连续测定发现，TAE未能使t-PA水平恢复正常。在1例合并弥散性血管内凝血（DIC）的HCC患者中，t-PA在DIC急性期显著升高，在通过输注甲磺酸加贝酯（FOY）成功治疗DIC后随后下降。这些结果表明，肝病中t-PA升高主要是由于肝功能恶化，并且继发性纤溶状态，如DIC，也是一个促成因素。
