Aoki S, Mieno T, Kuratomi Y, Kitamura S, Kajii E, Sumiya M
Department of Pulmonary Medicine, Jichi Medical School, Tochigi, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1990 Apr;28(4):617-22.
A 22-year-old man was admitted because of hemosputum and progressive dyspnea with 3 attacks of chest pain and dyspnea over the previous 4 months. Chest roentgenography showed pulmonary infarction of the left lower lobe, and the diagnosis was confirmed by pulmonary perfusion and inhalation scintigraphy and pulmonary arteriography. Thrombolytic therapy was performed, but no significant effect could be obtained and anticoagulant therapy was performed continuously. No deep-vein thrombosis could be seen. He was considered to have autoimmune hemolytic anemia with lupus anticoagulant on the basis of auto-antibody data. Lupus anticoagulant is an antibody to phospholipid, and it is suggested that a decrease in the production of prostanoid in the endothelium causes thrombosis. In this case, as the patient showed a low level of 6-keto-PGF1 alpha in the blood, it is suggested that one of the etiological factors of pulmonary thromboembolism is a disorder of prostacyclin production in the endothelium, causing thrombosis by lupus anticoagulant.
一名22岁男性因咯血痰和进行性呼吸困难入院，在过去4个月中有3次胸痛和呼吸困难发作。胸部X线检查显示左下叶肺梗死，经肺灌注和吸入闪烁扫描及肺动脉造影确诊。进行了溶栓治疗，但未取得明显效果，遂持续进行抗凝治疗。未发现深静脉血栓形成。根据自身抗体数据，考虑其患有伴有狼疮抗凝物的自身免疫性溶血性贫血。狼疮抗凝物是一种针对磷脂的抗体，提示内皮细胞中前列腺素生成减少会导致血栓形成。在该病例中，由于患者血液中6-酮-前列腺素F1α水平较低，提示肺血栓栓塞的病因之一是内皮细胞前列环素生成紊乱，由狼疮抗凝物导致血栓形成。
