Rossetto Valeria, Spiezia Luca, Senzolo Marco, Rodriguez-Castro Krissia Isabel, Gavasso Sabrina, Woodhams Barry, Simioni Paolo
Department of Cardiologic, Thoracic, and Vascular Sciences, 2nd Chair of Internal Medicine, University of Padua Medical School, Via Giustiniani 2, 35100, Padua, Italy.
Intern Emerg Med. 2014 Jun;9(4):397-403. doi: 10.1007/s11739-013-0929-7. Epub 2013 Mar 17.
Hepatic cirrhosis is characterized by complex abnormalities of the fibrinolytic system. Little is known about the possible association between these alterations and thrombosis. The aim of this study was to evaluate the fibrinolytic profile in cirrhotic individuals with and without portal vein thrombosis (PVT). We measured thrombin activatable fibrinolysis inhibitor (TAFI), total amount of activated TAFI (TAFIa/ai), plasminogen activator inhibitor (PAI-1), plasminogen and fibrinogen plasma levels in 66 cirrhotic patients (33 with and 33 without PVT) and in 66 healthy volunteers. TAFI plasma levels (median [range]) were significantly lower in cirrhotic individuals (5.6 μg/ml [1.7-11.7]) than in controls (10.1 μg/ml [6.6-14.2], p < 0.0001), while TAFIa/ai levels were significantly higher in cases (18.3 ng/ml [0.3-35.4]) than in controls (15.9 ng/ml [7.4-41], p = 0.02). Cirrhotic patients with PVT had higher TAFI (6.6 μg/ml [2.9-10.1]), TAFIa/ai (19.2 ng/ml [11.6-35.4]) and PAI-1 (33.1 ng/ml [27.6-56.3]) plasma levels than those without PVT (3.9 μg/ml [1.7-11.7], p = 0.001; 15.6 ng/ml [10.3-33.9], p = 0.037; 15.9 ng/ml [2.5-29.1], p = 0.004. The fibrinolytic profile in cirrhotic individuals with PVT is characterized by higher levels of TAFI, TAFIa/ai and PAI-1 than in those without PVT. These alterations identify a hypofibrinolytic condition that may increase the risk of developing a thrombotic event.
肝硬化的特征是纤维蛋白溶解系统存在复杂异常。关于这些改变与血栓形成之间的可能关联，人们知之甚少。本研究的目的是评估有和没有门静脉血栓形成（PVT）的肝硬化患者的纤维蛋白溶解情况。我们测量了66例肝硬化患者（33例有PVT，33例无PVT）以及66名健康志愿者的凝血酶激活的纤维蛋白溶解抑制剂（TAFI）、活化TAFI的总量（TAFIa/ai）、纤溶酶原激活物抑制剂（PAI - 1）、纤溶酶原和纤维蛋白原的血浆水平。肝硬化患者的TAFI血浆水平（中位数[范围]）显著低于对照组（5.6μg/ml[1.7 - 11.7]），而对照组为（10.1μg/ml[6.6 - 14.2]，p < 0.0001），而病例组的TAFIa/ai水平显著高于对照组（18.3ng/ml[0.3 - 35.4]），对照组为（15.9ng/ml[7.4 - 41]，p = 0.02）。有PVT的肝硬化患者的TAFI（6.6μg/ml[2.9 - 10.1]）、TAFIa/ai（19.2ng/ml[11.6 - 35.4]）和PAI - 1（33.1ng/ml[27.6 - 56.3]）血浆水平高于无PVT的患者（3.9μg/ml[1.7 - 11.7]，p = 0.00；15.6ng/ml[10.3 - 33.9]，p = 0.037；15.9ng/ml[2.5 - 29.1]，p = 0.004）。有PVT的肝硬化患者的纤维蛋白溶解情况的特征是TAFI、TAFIa/ai和PAI - 1水平高于无PVT的患者。这些改变表明存在低纤维蛋白溶解状态，可能会增加发生血栓事件的风险。
