Department of Emergency Medicine, Hokkaido University Hospital, N14W5, Kita-ku, Sapporo, 060-8648, Japan.
Sci Rep. 2021 Oct 13;11(1):20283. doi: 10.1038/s41598-021-99426-2.
In severe trauma, excessive fibrinolytic activation is associated with an increase in the transfusion volume and mortality rate. However, in the first several hours after a blunt trauma, changes in fibrinolytic activation, suppression, and activation-suppression balance have not yet been elucidated, which the present study aimed to clarify. Anesthetized 9-week-old male Wistar S/T rats experienced severe blunt trauma while being placed inside the Noble-Collip drum. Rats were randomly divided into four groups of seven. The no-trauma group was not exposed to any trauma; the remaining groups were analysed 0, 60, and 180 min after trauma. Immediately following trauma, total tissue-plasminogen activator (tPA) levels significantly increased in the plasma, and the balance of active tPA and active plasminogen activator inhibitor-1 (PAI-1) significantly tipped toward fibrinolytic activation. After trauma, both tPA and PAI-1 levels increased gradually in various organs and active and total PAI-1 levels increased exponentially in the plasma. Total plasma tPA levels 60 min after trauma returned quickly to levels comparable to those in the no-trauma group. In conclusion, fibrinolytic activation was observed only immediately following trauma. Therefore, immediately after trauma, the fibrinolytic system was activated; however, its activation was quickly and intensely suppressed.
在严重创伤中，过度的纤维蛋白溶解激活与输血量和死亡率的增加有关。然而，在钝性创伤后的最初几个小时内，纤维蛋白溶解激活、抑制和激活-抑制平衡的变化尚未阐明，本研究旨在阐明这一点。麻醉 9 周龄雄性 Wistar S/T 大鼠在 Noble-Collip 鼓内经历严重的钝性创伤。大鼠随机分为四组，每组 7 只。无创伤组不暴露于任何创伤；其余组在创伤后 0、60 和 180 分钟进行分析。创伤后，血浆中总组织型纤溶酶原激活物（tPA）水平显著升高，活性 tPA 和活性纤溶酶原激活物抑制剂-1（PAI-1）的平衡明显向纤维蛋白溶解激活倾斜。创伤后，tPA 和 PAI-1 水平在各种器官中逐渐增加，血浆中活性和总 PAI-1 水平呈指数增加。创伤后 60 分钟时，总血浆 tPA 水平迅速恢复到与无创伤组相当的水平。总之，仅在创伤后立即观察到纤维蛋白溶解激活。因此，创伤后立即激活了纤维蛋白溶解系统；然而，其激活很快且强烈地受到抑制。
