Seitz R, Wolf M, Egbring R, Radtke K P, Liesenfeld A, Pittner P, Havemann K
Eur J Haematol. 1987 Mar;38(3):231-40. doi: 10.1111/j.1600-0609.1987.tb01169.x.
The prognosis of septicaemia depends on the occurrence of complications such as shock and coagulation defects. The damage to haemostasis is usually explained by the action of the main coagulation and fibrinolysis enzymes, thrombin and plasmin. This paper presents data concerning the role of a third protease, granulocytic elastase. 82 patients who had been admitted to our hospital with suspected septicaemia were examined. Septicaemia was proven in 22 patients by the growth of microorganisms in blood cultures, and was clinically diagnosed in 9 patients. The plasma levels of neutrophil elastase-like protease complexed to a1antitrypsin (a1AT-ELP) were measured by zone immunoelectrophoresis assay (ZIA). The a1AT-ELP values were significantly increased in the 31 septic as compared to the 51 non-septic patients. In patients with complicated septicaemia, negative correlations of a1AT-ELP with factor XIII and the coagulation inhibitor antithrombin III were demonstrable. Among the patients with septic complications, the 3 who survived exhibited a dramatic decrease of a1AT-ELP, whereas in the other 16 patients who died the levels remained elevated. It might be of therapeutic significance that in 9 patients receiving fresh plasma and AT III-concentrate substitution for DIC the a1AT-ELP levels dropped, whereas they remained high in the other septicaemia patients. There were no correlations between a1AT-ELP and the a2antiplasmin-plasmin complexes (a2AP-P1), but strong correlations with signs of coagulation. The data suggest an interaction of coagulation and elastase release, probably involving the Hageman factor.
败血症的预后取决于诸如休克和凝血缺陷等并发症的发生情况。止血功能受损通常被解释为主要凝血酶和纤溶酶（凝血酶和纤溶酶）的作用。本文介绍了有关第三种蛋白酶——粒细胞弹性蛋白酶作用的数据。对82例因疑似败血症入院的患者进行了检查。通过血培养中微生物的生长在22例患者中证实了败血症，在9例患者中临床诊断为败血症。通过区带免疫电泳分析（ZIA）测量与α1抗胰蛋白酶（α1AT-ELP）复合的中性粒细胞弹性蛋白酶样蛋白酶的血浆水平。与51例非败血症患者相比，31例败血症患者的α1AT-ELP值显著升高。在伴有并发症的败血症患者中，α1AT-ELP与因子ⅩⅢ和凝血抑制剂抗凝血酶Ⅲ呈负相关。在有败血症并发症的患者中，存活的3例患者α1AT-ELP显著下降，而在其他16例死亡患者中该水平仍升高。9例接受新鲜血浆和抗凝血酶Ⅲ浓缩物替代治疗弥散性血管内凝血的患者，其α1AT-ELP水平下降，而其他败血症患者的该水平仍较高，这可能具有治疗意义。α1AT-ELP与α2抗纤溶酶-纤溶酶复合物（α2AP-P1）之间无相关性，但与凝血迹象密切相关。数据表明凝血与弹性蛋白酶释放之间存在相互作用，可能涉及哈格曼因子。
