Kobayashi M, Wada H, Wakita Y, Shimura M, Nakase T, Hiyoyama K, Nagaya S, Minami N, Nakano T, Shiku H
2nd Department of Internal Medicine, Mie University School of Medicine, Mie Ken, Japan.
Thromb Haemost. 1995 Jan;73(1):10-4.
We measured plasma levels of tissue factor (TF) and tissue factor pathway inhibitor (TFPI) in patients with thrombotic thrombocytopenic purpura (TTP) and disseminated intravascular coagulation (DIC) to examine the relationship between TFPI and vascular endothelial cell injury. TF antigen was detected in the plasma of healthy volunteers, and the levels were significantly increased in the patients with DIC, but decreased slightly in those with TTP. Plasma TFPI levels were significantly decreased in patients with TTP compared with those in healthy volunteers. The concentration of plasma thrombomodulin (TM) antigen was significantly higher in those with TTP than in normal volunteers. One month after treatment, TTP patients showed a significant decrease in plasma TM levels, and a significant increase in plasma TFPI levels, but plasma levels of TF antigen were not significantly increased. As plasma TFPI/TF ratio was significantly increased after treatment, the hypercoagulable state was therefore improved after treatment. There was no significant difference in plasma TF and TFPI levels between those who achieved complete remission (CR) and those who died. However, plasma TM levels were significantly higher in those who died than in those who achieved CR. Plasma TFPI levels might reflect injury of vascular endothelial cells as do plasma TM levels, and decreased plasma TFPI/TF ratio and vascular endothelial cell injuries might play causative roles in TTP.
我们检测了血栓性血小板减少性紫癜（TTP）和弥散性血管内凝血（DIC）患者血浆中组织因子（TF）和组织因子途径抑制物（TFPI）的水平，以研究TFPI与血管内皮细胞损伤之间的关系。在健康志愿者血浆中检测到TF抗原，DIC患者血浆中TF抗原水平显著升高，而TTP患者血浆中TF抗原水平略有下降。与健康志愿者相比，TTP患者血浆TFPI水平显著降低。TTP患者血浆血栓调节蛋白（TM）抗原浓度显著高于正常志愿者。治疗1个月后，TTP患者血浆TM水平显著下降，血浆TFPI水平显著升高，但TF抗原血浆水平未显著升高。由于治疗后血浆TFPI/TF比值显著升高，因此治疗后高凝状态得到改善。完全缓解（CR）者与死亡者的血浆TF和TFPI水平无显著差异。然而，死亡者的血浆TM水平显著高于CR者。血浆TFPI水平可能与血浆TM水平一样反映血管内皮细胞损伤，血浆TFPI/TF比值降低和血管内皮细胞损伤可能在TTP发病中起致病作用。
