Seitz R, Egbring R, Radtke K P, Wolf M, Fuchs G, Fischer J, Lerch L, Karges H E
Int J Tissue React. 1985;7(4):321-8.
In inflammation, particularly in septicaemia, complex coagulation disorders may lead to a dangerous haemorrhagic diathesis. The conventional concept for this syndrome called DIC implicates the occurrence of active thrombin in the circulation, which may be followed by hyperfibrinolysis due to plasmin formation. In this study data are presented suggesting an important role for a third proteolytic system, granulocytic elastase. The complexes of plasmin and elastase with their specific inhibitors, alpha 2-antiplasmin-plasmin (alpha 2AP-PI) and alpha 1-antitrypsin-elastase (alpha 1AT-ELP) were determined immunologically. The alpha 1AT-ELP appears mainly in gram-negative septicaemia, particularly in meningococcal disease. The estimation of alpha 2AP-PI and alpha 1AT-ELP, together with a method for the detection of the antithrombin III--thrombin complex which remains to be established, is a suitable tool for for the differential diagnosis of the consumption of coagulation proteins. The assumption that at least three proteolytic systems participate in the development of the haemorrhagic diathesis during inflammation leads to the concept of a broad, comprehensive substitution therapy with e.g. concentrates of AT III, PPSB, or fresh frozen plasma. The aim of this treatment is to replace not only the consumed procoagulatory factors, but also the lacking inhibitors in order to control this "abnormal proteolysis syndrome".
在炎症反应中，尤其是在败血症时，复杂的凝血功能障碍可能会导致危险的出血素质。对于这种称为弥散性血管内凝血（DIC）的综合征，传统概念认为循环中会出现活性凝血酶，随后由于纤溶酶的形成可能会发生高纤溶状态。在本研究中，所呈现的数据表明第三种蛋白水解系统——粒细胞弹性蛋白酶发挥了重要作用。通过免疫学方法测定了纤溶酶和弹性蛋白酶与其特异性抑制剂α2 -抗纤溶酶 - 纤溶酶（α2AP - PI）和α1 -抗胰蛋白酶 - 弹性蛋白酶（α1AT - ELP）的复合物。α1AT - ELP主要出现在革兰氏阴性败血症中，尤其是在脑膜炎球菌病中。α2AP - PI和α1AT - ELP的测定，以及一种有待建立的抗凝血酶III - 凝血酶复合物检测方法，是用于鉴别诊断凝血蛋白消耗情况的合适工具。认为至少三种蛋白水解系统参与炎症期间出血素质的发展这一假设，引出了采用例如抗凝血酶III浓缩物、凝血酶原复合物或新鲜冰冻血浆进行广泛、全面替代治疗的概念。这种治疗的目的不仅是补充消耗的促凝血因子，还包括补充缺乏的抑制剂，以控制这种“异常蛋白水解综合征”。
