Okumura N, Matsuzawa A, Terasawa F, Kameko M, Sasaki Y, Nakagoshi R, Ishikawa S, Hashikura Y, Matsunami H, Kawasaki S
Division of Clinical Chemistry and Medical Technology, School of Allied Medical Sciences, Shinshu University, Matsumoto.
Rinsho Byori. 1995 Mar;43(3):269-74.
Antigen levels of blood coagulation factor XIII (XIII) were determined in plasmas from patients with increased levels of fibrin degradation products-D-dimer (FDP-DD), including disseminated intravascular coagulation (DIC), by latex photometric immunoassay using polyclonal anti-XIII a subunit antibody-coated latex reagent. Since stable fibrin is directly degradated by plasmin and FDP-DD is produced, plasma FDP-DD levels correlate with plasmin-alpha 2-plasmin inhibitor complex levels, but not with thrombin-antithrombin III complex (TAT) or XIII levels. In order to clarify other causes of discordant relationships among the related three parameters, we studied the changes in plasma XIII, TAT and FDP-DD levels in fourteen DIC patients induced by various primary disorders. Only in two cases, XIII levels changed up and down irrelevant to the fluctuating levels of TAT and FDP-DD. In seven cases, plasma XIII levels remained low during the clinical courses, indicating possibilities that elevated condition of XIII consumption continued and/or production of XIII was low. On the other hand, in four patients, including two patients with nephrosis, XIII might be produced at higher rate than that of consumption. Same phenomenon was observed in one of eight recipients with living-related liver transplantation who showed remarkably increased levels of FDP-DD without DIC. In conclusion, plasma XIII level in patients with elevated FDP-DD may be influenced by the balance between consumption of XIII by unstable fibrin and/or surgical stress and the following tissue recovery etc. and production of XIII in liver, megakaryocytes and monocytes.
采用包被有抗凝血因子XIII a亚基多克隆抗体的乳胶试剂，通过乳胶比浊免疫测定法，对纤维蛋白降解产物-D-二聚体（FDP-DD）水平升高的患者血浆中的凝血因子XIII（XIII）抗原水平进行了测定，这些患者包括弥散性血管内凝血（DIC）患者。由于稳定的纤维蛋白可被纤溶酶直接降解并产生FDP-DD，血浆FDP-DD水平与纤溶酶-α2-纤溶酶抑制剂复合物水平相关，但与凝血酶-抗凝血酶III复合物（TAT）或XIII水平无关。为了阐明这三个相关参数之间不一致关系的其他原因，我们研究了由各种原发性疾病诱发的14例DIC患者血浆中XIII、TAT和FDP-DD水平的变化。仅在2例中，XIII水平的升降与TAT和FDP-DD的波动水平无关。在7例中，血浆XIII水平在临床病程中持续较低，这表明XIII消耗增加的状况持续存在和/或XIII产生减少的可能性。另一方面，在4例患者中，包括2例肾病患者，XIII的产生速率可能高于消耗速率。在8例活体肝移植受者中的1例也观察到了同样的现象，该患者FDP-DD水平显著升高但无DIC。总之，FDP-DD升高患者的血浆XIII水平可能受不稳定纤维蛋白和/或手术应激导致的XIII消耗与随后的组织恢复等之间的平衡以及肝脏、巨核细胞和单核细胞中XIII产生的影响。
