Juhan-Vague I, Aillaud M F, Valadier J, Alessi M C, Serradimigni A
Ann Med Interne (Paris). 1986;137(6):471-4.
Quantitative abnormalities of fibrinolytic system factors (tissue plasminogen activator (t-PA), plasminogen activator inhibitor (PA-inhibitor) are often found in the patients exhibiting an idiopathic thromboembolic pathology. Exploration of fibrinolytic system is performed by taking blood samples prior and after stimulation (after venous occlusion or DDAVP injection). Patients can be "good responders" (that is presenting with an increase of fibrinolytic activity after stimulation) or "bad responders". Among these latter (that is 30 p. 100 of cases), there are two groups: patients exhibiting an increase of PA inhibitor level, this concealing fibrinolytic role of t-PA released by stimulation (20 p. 100 of cases), patients failing to present any t-PA release through endothelial cells stimulation (10 p. 100 of cases). Furthermore, an hypofibrinolysis was demonstrated a long time ago, in certain thrombogenic conditions (post-operative period, obesity, elderly patients). Hypofibrinolysis was recently demonstrated, according to such conditions, as liable to an increase in the PA inhibitor levels. As pathogenic role of hypofibrinolysis is then demonstrated, therapeutic studies reducing the PA inhibitor level or increasing the t-PA rate produced and released by endothelial cells are to be developed.
在表现为特发性血栓栓塞性病变的患者中，常发现纤溶系统因子（组织型纤溶酶原激活物（t-PA）、纤溶酶原激活物抑制剂（PA抑制剂））的定量异常。通过在刺激前后（静脉阻塞或注射去氨加压素后）采集血样来探究纤溶系统。患者可分为“良好反应者”（即刺激后纤溶活性增加）或“不良反应者”。在后者（即30%的病例）中，有两组：PA抑制剂水平升高的患者，这掩盖了刺激释放的t-PA的纤溶作用（20%的病例），未能通过内皮细胞刺激释放任何t-PA的患者（10%的病例）。此外，很久以前就在某些血栓形成状态（术后、肥胖、老年患者）中证实了纤溶功能减退。最近根据这些情况证实，纤溶功能减退易导致PA抑制剂水平升高。由于纤溶功能减退的致病作用已得到证实，因此应开展降低PA抑制剂水平或提高内皮细胞产生和释放的t-PA速率的治疗研究。
