Department of Emergency Medicine, Hokkaido University Hospital, Sapporo, Japan.
Clin Appl Thromb Hemost. 2020 Jan-Dec;26:1076029620933003. doi: 10.1177/1076029620933003.
The association between severity of fibrinolysis, ascertained by rotational thromboelastometry to diagnose hyperfibrinolysis in patients with out-of-hospital cardiac arrest (OHCA), and conventional fibrinolysis markers (ie, tissue-plasminogen activator [t-PA], plasminogen, α-plasmin inhibitor [α-PI], and plasminogen activator inhibitor [PAI]) with key roles in the fibrinolytic system was investigated. This prospective observational study included 5 healthy volunteers and 35 patients with OHCA from the Hokkaido University Hospital. Blood samples were drawn immediately upon admission to the emergency department. Assessments of the extrinsic pathway using tissue factor activation (EXTEM) and of fibrinolysis by comparison with EXTEM after aprotinin addition (APTEM) were undertaken. Conventional coagulation and fibrinolysis markers were measured in the stored plasma samples. Significant hyperfibrinolysis observed in EXTEM disappeared in APTEM. Patients exhibited significantly higher levels of fibrinogen/fibrin degradation products, plasmin-α-PI complex, and t-PA but lower levels of fibrinogen, plasminogen, and α-PI than healthy controls. The PAI level was unchanged. Fibrinolytic parameters of EXTEM correlated with levels of lactate and conventional fibrinolysis markers, especially t-PA. Increased t-PA activity and decreased plasminogen and α-PI significantly correlated with increased severity of fibrinolysis (hyperfibrinolysis).
研究了通过旋转血栓弹性测定法（ROTEM）确定的纤溶程度（用于诊断院外心脏骤停（OHCA）患者的高纤溶状态）与纤维蛋白溶解系统中起关键作用的常规纤溶标志物（即组织型纤溶酶原激活物（t-PA）、纤溶酶原、α-纤溶酶抑制剂（α-PI）和纤溶酶原激活物抑制剂（PAI））之间的关系。这项前瞻性观察性研究纳入了来自北海道大学医院的 5 名健康志愿者和 35 名 OHCA 患者。在急诊科入院时立即抽取血样。使用组织因子激活（EXTEM）评估外源性途径，并在加入抑肽酶后（APTEM）与 EXTEM 进行比较，以评估纤溶情况。在储存的血浆样本中测量常规凝血和纤溶标志物。EXTEM 中观察到的明显高纤溶状态在 APTEM 中消失。与健康对照组相比，患者的纤维蛋白原/纤维蛋白降解产物、纤溶酶-α-PI 复合物和 t-PA 水平显著升高，而纤维蛋白原、纤溶酶和 α-PI 水平显著降低。PAI 水平不变。EXTEM 的纤溶参数与乳酸水平和常规纤溶标志物相关，尤其是 t-PA。t-PA 活性增加和纤溶酶原及 α-PI 减少与纤溶程度（高纤溶）的增加显著相关。
