Okumura N, Matsuzawa A, Terasawa F, Sasaki Y, Nakagoshi R, Ishikawa S, Hashikura Y, Matsunami H, Kawasaki S, Makuuchi M
Division of Clinical Chemistry and Medical Technology, School of Allied Medical Sciences, Shinshu University, Matsumoto.
Rinsho Byori. 1995 Aug;43(8):829-35.
We had rare opportunities to examine changes in fibrin degradation products (FDP)-D-dimer (DD), thrombin-antithrombin III complex (TAT), plasmin-alpha 2-plasmin inhibitor complex (PIC) and other coagulation parameters during the clinical courses of living-related partial liver transplantation (LRPLT). In seven out of eight recipients without severe rejection and/or disseminated intravascular coagulation (DIC), FDP-DD values reached their maximum at 5 to 10 days after transplantation, then gradually decreased. On the other hand, TAT values rose to the maximum at anhepatic or reperfusion phase of liver transplantation. These data represent hypercoagulation in consequence of tissue thromboplastin activation after extensive operation. Changes in PIC, tissue-type plasminogen activator, and plasminogen activator inhibitor-1 (PAI-1) in the clinical course of case 1 suggested that fibrinolysis was suppressed by relatively elevated level of PAI-1 around the operation, but thereafter was adversely accelerated by relatively lower levels of PAI-1. In comparison with patients with DIC, TAT was much higher but PIC was significantly lower in recipients of LRPLT. These findings indicated that marked hypercoagulation and mild to moderate hyperfibrinolysis occurred in recipients of LRPLT.
我们有难得的机会在活体亲属供肝部分肝移植（LRPLT）的临床过程中，观察纤维蛋白降解产物（FDP）-D-二聚体（DD）、凝血酶-抗凝血酶III复合物（TAT）、纤溶酶-α2-纤溶酶抑制物复合物（PIC）及其他凝血参数的变化。在8例未发生严重排斥反应和/或弥散性血管内凝血（DIC）的受者中，有7例的FDP-DD值在移植后5至10天达到最高，随后逐渐下降。另一方面，TAT值在肝移植的无肝期或再灌注期升至最高。这些数据表明，广泛手术后组织凝血活酶激活导致了高凝状态。病例1临床过程中PIC、组织型纤溶酶原激活物及纤溶酶原激活物抑制剂-1（PAI-1）的变化提示，手术前后PAI-1水平相对升高抑制了纤溶，但之后PAI-1水平相对降低却对纤溶产生了不利的加速作用。与DIC患者相比，LRPLT受者的TAT水平更高，但PIC水平显著更低。这些发现表明，LRPLT受者发生了明显的高凝状态以及轻至中度的高纤溶状态。
