Toschi V, Rocchini G M, Motta A, Fiorini G F, Cimminiello C, Violi F, Castelli C, Sironi D, Gibelli A
Department of Haematology and Blood Transfusion, Ospedale S Carlo Borromeo, Milan, Italy.
Biomed Pharmacother. 1993;47(8):345-52. doi: 10.1016/0753-3322(93)90084-x.
We evaluated coagulation and fibrinolytic parameters in both plasma and ascitic fluid of 39 patients with ascites secondary to liver cirrhosis and in 14 cirrhotic patients without ascites, in order to verify if the peritoneal compartment could be involved in the pathogenesis of the hyperfibrinolytic state of the disease. An activation of fibrinolysis, as suggested by increased levels of FDP, D-dimer and tissue plasminogen activator (t-PA) was demonstrated in both ascitic fluid and to a lesser extent in plasma. A positive correlation was also observed between plasma and ascitic fluid plasminogen, anti-plasmin and fibrinogen, while a negative correlation was found between plasma and ascitic fluid plasminogen activator inhibitor-1 (PAI-1). Moreover, plasma PAI-1 was significantly lower in patients with ascites than in those without ascites and among ascitic patients in those who had bleeding into soft tissues when compared to those who did not present haemorrhagic events. Finally, a significant association was also shown between positivity for plasma D-dimer (> 200 ng/ml) and the presence of ascites. Taken together, our data suggest an exchange of some coagulation and fibrinolytic proteins between plasma and ascitic fluid and point out the key role of PAI-1 in regulating plasma fibrinolytic potential and in bleeding complications in cirrhotic patients.
我们评估了39例肝硬化腹水患者及14例无腹水的肝硬化患者血浆和腹水中的凝血及纤溶参数，以验证腹膜腔是否参与了该疾病高纤溶状态的发病机制。腹水中FDP、D - 二聚体和组织纤溶酶原激活物（t - PA）水平升高提示纤溶激活，血浆中也有较轻程度的纤溶激活。血浆和腹水中的纤溶酶原、抗纤溶酶和纤维蛋白原呈正相关，而血浆和腹水中的纤溶酶原激活物抑制剂 - 1（PAI - 1）呈负相关。此外，腹水患者的血浆PAI - 1显著低于无腹水患者，在腹水患者中，有软组织出血的患者血浆PAI - 1低于无出血事件的患者。最后，血浆D - 二聚体阳性（> 200 ng/ml）与腹水的存在也显示出显著相关性。综上所述，我们的数据表明血浆和腹水之间存在一些凝血和纤溶蛋白的交换，并指出PAI - 1在调节肝硬化患者血浆纤溶潜能及出血并发症中的关键作用。
