Department of Cardiology, College of Medicine, Istanbul, Turkey.
Artif Organs. 2014 Jan;38(1):28-33. doi: 10.1111/aor.12182. Epub 2013 Nov 14.
In the brain, the components of the fibrinolytic system, tissue plasminogen activator (tPA) and its endogenous inhibitor plasminogen activator inhibitor-1 (PAI-1), regulate various neurophysiological and pathological responses. Fibrinolytic balance depends on PAI-1 and tPA concentrations. The objective of this study is to compare the effects of pulsatile and nonpulsatile perfusion on fibrinolytic balance in children undergoing pediatric cardiopulmonary bypass (CPB). Plasma PAI-1 antigen and tPA antigen were measured in 40 children (n = 20 pulsatile and n = 20 nonpulsatile group). Plasma samples (1.5 mL) were collected (i) prior to incision, (ii) 1 h after CPB, and (iii) 24 h after CPB. PAI-1 and tPA levels were measured at each time point. PAI-1 and tPA levels were significantly increased at 1 h after CPB, followed by a decrease at 24 h. Nonpulsatile but not pulsatile CPB lowered PAI-1 : tPA ratio significantly at 24 h (median PAI-1 : tPA ratio 4.63 ± 0.83:1.98 ± 0.48, P = 0.03, for the nonpulsatile group and 4.50 ± 0.92:3.56 ± 1.28, P = 0.2, for the pulsatile group). These results suggest that pulsatile flow maintains endogenous fibrinolytic balance after pediatric cardiopulmonary bypass. Further studies are needed to define the clinical significance of these differences.
在大脑中，纤维蛋白溶解系统的组成部分，组织纤溶酶原激活物（tPA）及其内源性抑制剂纤溶酶原激活物抑制剂-1（PAI-1），调节着各种神经生理和病理反应。纤维蛋白溶解平衡取决于 PAI-1 和 tPA 浓度。本研究的目的是比较搏动和非搏动灌注对小儿体外循环（CPB）后纤维蛋白溶解平衡的影响。测量了 40 名儿童（n=20 名搏动组和 n=20 名非搏动组）的血浆 PAI-1 抗原和 tPA 抗原。在每个时间点采集（i）切开前、（ii）CPB 后 1 小时和（iii）CPB 后 24 小时的血浆样本（1.5mL）。在每个时间点测量 PAI-1 和 tPA 水平。CPB 后 1 小时 PAI-1 和 tPA 水平显著升高，随后 24 小时下降。非搏动性但非搏动性 CPB 可使 PAI-1:tPA 比值在 24 小时显著降低（中位数 PAI-1:tPA 比值 4.63±0.83:1.98±0.48，P=0.03，非搏动组和 4.50±0.92:3.56±1.28，P=0.2，搏动组）。这些结果表明，搏动性血流在小儿体外循环后维持内源性纤维蛋白溶解平衡。需要进一步研究来确定这些差异的临床意义。
