Vaziri N D, Winer R L, Gonzales E V, Eltorai I M
Department of Medicine, University of California, Irvine Medical Center.
J Am Paraplegia Soc. 1993 Jul;16(3):149-52. doi: 10.1080/01952307.1993.11735892.
Earlier studies have revealed a variety of coagulation abnormalities in patients with long-standing spinal cord injury (SCI) and end-stage renal disease (ESRD). The present study was undertaken to examine the fibrinolytic and protease inhibitory systems in this population. Twelve spinal cord injured men with ESRD were studied. All patients had chronic active urinary tract infections, pressure ulcers and were practically bed-bound. The results were compared with those obtained in a group of 32 normal volunteers. Plasma plasminogen and unstimulated tissue-type plasminogen activator (t-PA) concentrations in the SCI-ESRD group were comparable with those found in the control group. No significant difference was found in plasma plasminogen activator inhibitor (PAI) activity in the two groups. In contrast, plasma alpha 2-antiplasmin antigen concentration and antiplasmin activity were significantly reduced in the study population. In addition, plasma alpha 1-antitrypsin activity and antigen concentration were significantly increased while the alpha 2-macroglobulin activity-to-antigen concentration ratio was significantly reduced in the SCI-ESRD group. Although the mechanism of the observed reduction in alpha 2-antiplasmin and total antiplasmin activity is uncertain, its presence could enhance fibrinolysis in this otherwise thrombosis-prone population. Likewise, elevated alpha 1-antitrypsin could attenuate tissue damage by leukocyte-derived proteases in the face of persistent suppurative infections. The reduced alpha 2-macroglobulin activity-to-antigen concentration ratio was thought to reflect the presence of alpha 2-macroglobulin complexes with various proteases generated by the activation of leukocytes, coagulation, fibrinolytic and other proteolytic systems.
早期研究已揭示，长期脊髓损伤（SCI）和终末期肾病（ESRD）患者存在多种凝血异常。本研究旨在检测该人群的纤溶和蛋白酶抑制系统。对12名患有ESRD的脊髓损伤男性进行了研究。所有患者均有慢性活动性尿路感染、压疮，且几乎长期卧床。将结果与32名正常志愿者组成的对照组进行比较。SCI-ESRD组的血浆纤溶酶原和未刺激的组织型纤溶酶原激活物（t-PA）浓度与对照组相当。两组的血浆纤溶酶原激活物抑制剂（PAI）活性无显著差异。相比之下，研究人群的血浆α2-抗纤溶酶抗原浓度和抗纤溶酶活性显著降低。此外，SCI-ESRD组的血浆α1-抗胰蛋白酶活性和抗原浓度显著升高，而α2-巨球蛋白活性与抗原浓度之比显著降低。虽然观察到的α2-抗纤溶酶和总抗纤溶酶活性降低的机制尚不确定，但其存在可能会增强这个原本易发生血栓形成人群的纤溶作用。同样，在持续化脓性感染的情况下，升高的α1-抗胰蛋白酶可减轻白细胞衍生蛋白酶对组织的损伤。α2-巨球蛋白活性与抗原浓度之比降低被认为反映了α2-巨球蛋白与白细胞、凝血、纤溶和其他蛋白水解系统激活产生的各种蛋白酶形成的复合物的存在。
