Pernambuco J R, Langley P G, Hughes R D, Izumi S, Williams R
Institute of Liver Studies, King's College Hospital, London, UK.
Eur J Gastroenterol Hepatol. 1995 Feb;7(2):155-9.
To evaluate the fibrinolytic system after liver transplantation in patients with fulminant hepatic failure.
Seven patients were studied prior to, and for 4 days after, liver transplantation.
Both activators and inhibitors of the fibrinolytic system were investigated in seven patients with fulminant hepatic failure who underwent liver transplantation.
alpha 2-antiplasmin and C1-inhibitor levels increased rapidly after transplantation (81 and 53% of normal on day 1; 106 and 99% on day 2, respectively). Plasminogen levels remained low throughout the 4-day study period. Plasminogen activator inhibitor-1 was higher than normal before transplantation (21.0 compared with 7.4 U/ml) and increased further on the first day after operation (37.5 U/ml; P < 0.05 versus pre-transplantation). Tissue plasminogen activator levels remained normal (pre-operative, 7.0 IU/ml; Day 4, 0.2 IU/ml). D-dimer remained elevated during the postoperative period showing increased fibrinolytic activity. Thrombin-antithrombin III complex was also elevated during the study period. Antithrombin III was greatly reduced prior to transplantation (13.7% of normal) and plasma levels were less than 50% of normal values during the study.
Measures of fibrinolytic activity are raised after liver transplantation in patients with fulminant hepatic failure. This is probably due to increased fibrin formation caused by a coexisting hypercoagulable state.
评估暴发性肝衰竭患者肝移植后的纤溶系统。
对7例患者在肝移植前及术后4天进行研究。
对7例接受肝移植的暴发性肝衰竭患者的纤溶系统激活剂和抑制剂进行研究。
移植后α2-抗纤溶酶和C1-抑制剂水平迅速升高（第1天分别为正常水平的81%和53%；第2天分别为106%和99%）。在为期4天的研究期间，纤溶酶原水平一直较低。移植前纤溶酶原激活物抑制剂-1高于正常水平（21.0 U/ml，而正常为7.4 U/ml），术后第1天进一步升高（37.5 U/ml；与移植前相比，P<0.05）。组织纤溶酶原激活剂水平保持正常（术前7.0 IU/ml；第4天0.2 IU/ml）。术后D-二聚体持续升高，显示纤溶活性增加。研究期间凝血酶-抗凝血酶III复合物也升高。移植前抗凝血酶III大幅降低（为正常水平的13.7%），研究期间血浆水平低于正常值的50%。
暴发性肝衰竭患者肝移植后纤溶活性指标升高。这可能是由于并存的高凝状态导致纤维蛋白形成增加所致。
