Okajima K
Department of Laboratory Medicine, Kumamoto University Medical School.
Rinsho Byori. 1994 Jan;42(1):45-55.
The clinical relevance of determination of plasma antithrombin III(ATIII) and alpha 2-plasmin inhibitor (alpha 2 PI) activities in patients with disseminated intravascular coagulation (DIC) was analyzed. Although the plasma ATIII activity was decreased in patients with DIC, no significant correlation was observed between plasma level of ATIII and that of thrombin-antithrombin III complex or prothrombin fragment 1+2. The extent of the decrease of ATIII in DIC was the most marked in cases associated with septicemia. The plasma level of ATIII in septicemia without DIC was significantly lower than that in DIC cases without septicemia, suggesting that the decrease of ATIII level could not be related to the pathophysiology of DIC, but to that of septicemia. The plasma half-life of ATIII in septicemia without DIC was significantly shortened in the absence of the increase of TAT level, suggesting that the extravasation of ATIII might be induced probably due to the endothelial damage in septicemia. The alpha 2-Plasmin inhibitor level was decreased in DIC patients. The decrease was the most marked (lower than 60% of normal) in patients with excessive fibrinolysis in which fibrinogen degradation was induced. The plasma level of alpha 2PI was significantly higher in the DIC cases with septicemia than in those without septicemia. The ATIII/alpha 2PI ratio was significantly lower in DIC cases with septicemia than in those with solid tumor or acute leukemia. Moreover, the ATIII/alpha 2PI ratio was significantly lower in MOF cases than in non-MOF cases in septicemia. The mortality of the MOF cases did not correlate with the ATIII/alpha 2PI ratio, but with the plasma level of PAI-1, suggesting that the decrease of ATIII/alpha 2PI ratio might not reflect the irreversible endothelial cell damage. Based on these observations, the calculation of ATIII/alpha 2PI in DIC patients would provide the following information; (1) a low ATIII/alpha 2PI ratio (less than 0.6) was frequently observed in septicemia, which could be related to the occurrence of organ dysfunction; (2) a high ATIII/alpha 2PI ratio (higher than 1.0) with the marked decrease of alpha 2PI level (lower than 60% of normal) suggests the occurrence of excessive fibrinolysis in which anti-fibrinolytic therapy should be considered when clinical bleeding was present; (3) The ATIII/alpha 2PI ratio near 1.0 was observed in DIC associated with the pathological conditions other than described above, such as solid tumors, in which the coagulation and fibrinolysis was almost equally activated.
分析了弥散性血管内凝血（DIC）患者血浆抗凝血酶III（ATIII）和α2 - 纤溶酶抑制剂（α2PI）活性测定的临床相关性。虽然DIC患者血浆ATIII活性降低，但未观察到血浆ATIII水平与凝血酶 - 抗凝血酶III复合物或凝血酶原片段1 + 2水平之间存在显著相关性。DIC中ATIII降低程度在败血症相关病例中最为明显。无DIC的败血症患者血浆ATIII水平显著低于无败血症的DIC病例，这表明ATIII水平降低可能与DIC的病理生理无关，而与败血症的病理生理有关。在无DIC的败血症中，ATIII的血浆半衰期在TAT水平未升高的情况下显著缩短，这表明ATIII外渗可能是由于败血症中的内皮损伤所致。DIC患者的α2 - 纤溶酶抑制剂水平降低。在诱导纤维蛋白原降解的纤溶亢进患者中降低最为明显（低于正常的60%）。有败血症的DIC病例血浆α2PI水平显著高于无败血症的病例。有败血症的DIC病例中ATIII/α2PI比值显著低于实体瘤或急性白血病患者。此外，败血症中多器官功能衰竭（MOF）病例的ATIII/α2PI比值显著低于非MOF病例。MOF病例的死亡率与ATIII/α2PI比值无关，而与血浆纤溶酶原激活物抑制剂 - 1（PAI - 1）水平有关，这表明ATIII/α2PI比值降低可能不反映不可逆的内皮细胞损伤。基于这些观察结果，计算DIC患者的ATIII/α2PI比值可提供以下信息：（1）败血症中经常观察到低ATIII/α2PI比值（低于0.6），这可能与器官功能障碍的发生有关；（2）高ATIII/α2PI比值（高于1.0）且α2PI水平显著降低（低于正常的60%）提示发生了纤溶亢进，当出现临床出血时应考虑抗纤溶治疗；（3）在与上述病理状况不同的DIC中，如实体瘤，观察到ATIII/α2PI比值接近1.0，其中凝血和纤溶几乎同等程度地被激活。
