Kant K S, Pollak V E, Dosekun A, Glas-Greenwalt P, Weiss M A, Glueck H I
J Lab Clin Med. 1985 Jan;105(1):77-88.
Recent evidence demonstrates that coagulation plays a role in mediating glomerular damage in patients with systemic lupus erythematosus and diffuse proliferative glomerulonephritis. Because of its beneficial effect in experimental glomerulonephritis, we treated patients with systemic lupus erythematosus and diffuse proliferative glomerulonephritis with ancrod, a drug known to lower fibrinogen levels and thought to activate fibrinolysis. Our patients had unusually severe renal disease; renal function was deteriorating in many. Before ancrod, vascular plasminogen activator levels were low, and levels of an inhibitor of plasminogen activation were elevated. Some patients had elevated plasmin inhibitor levels. Results were considered in two groups. In 13 patients characterized as fibrinolysis responders, the low vascular plasminogen activator and increased plasminogen activation inhibitor levels normalized. After ancrod, striking resolution of microvascular thrombosis occurred, which was associated with some improvement in renal function and blood pressure control. In five patients characterized as fibrinolysis nonresponders and who also had an elevated plasmin inhibitor (alpha 2-antiplasmin) level, normalization of fibrinolysis did not occur. There was little change in microvascular thrombosis, renal function, or blood pressure control in the fibrinolysis nonresponders. These preliminary observations demonstrate a disorder of fibrinolysis in patients with systemic lupus erythematosus with microvascular thrombi in the kidney. Ancrod therapy reverses this disorder rapidly in patients with a normal level of plasmin inhibitor and may lead to repair of glomerular damage.
最近的证据表明，凝血在系统性红斑狼疮和弥漫性增殖性肾小球肾炎患者的肾小球损伤介导过程中发挥作用。鉴于其在实验性肾小球肾炎中的有益作用，我们用安克洛德治疗系统性红斑狼疮和弥漫性增殖性肾小球肾炎患者，安克洛德是一种已知可降低纤维蛋白原水平并被认为能激活纤溶的药物。我们的患者患有异常严重的肾脏疾病；许多患者的肾功能正在恶化。在使用安克洛德之前，血管纤溶酶原激活物水平较低，而纤溶酶原激活抑制剂水平升高。一些患者的纤溶酶抑制剂水平也升高。结果分为两组。在13名被判定为纤溶反应者的患者中，低水平的血管纤溶酶原激活物和升高的纤溶酶原激活抑制剂水平恢复正常。使用安克洛德后，微血管血栓形成显著消退，这与肾功能和血压控制的一些改善相关。在5名被判定为纤溶无反应者且其纤溶酶抑制剂（α2-抗纤溶酶）水平也升高的患者中，纤溶并未恢复正常。纤溶无反应者的微血管血栓形成、肾功能或血压控制几乎没有变化。这些初步观察结果表明，患有肾脏微血管血栓的系统性红斑狼疮患者存在纤溶障碍。安克洛德治疗可使纤溶酶抑制剂水平正常的患者迅速逆转这种障碍，并可能导致肾小球损伤的修复。
