Jansson J H, Olofsson B O, Nilsson T K
Department of Medicine, Skellefteå Hospital, Umeå, Sweden.
Circulation. 1993 Nov;88(5 Pt 1):2030-4. doi: 10.1161/01.cir.88.5.2030.
The fibrinolytic system is part of the defense against thrombotic and cardiovascular events, but so far no study has shown that clinical measurements of fibrinolytic key components such as tissue plasminogen activator (t-PA) or plasminogen activator inhibitor type 1 (PAI-1) have any predictive value beyond 3 years.
In 1983 through 1985, 213 consecutive patients with angina pectoris and angiographically verified coronary artery disease were sampled, and the mass concentration of t-PA and the activity of PAI-1 were measured in citrated plasma samples. At a mean follow-up time of 7 years, the all-cause mortality was checked. No patient was lost to follow-up. The data were analyzed by Cox regression, and t-PA mass concentration was found to be the only laboratory risk factor significantly related to mortality in all patients (P < .022) and also in the major subgroup (78% of all patients) subjected to coronary bypass surgery (P < .027). In the latter subgroup, body mass index was also related to mortality.
An increased mass concentration of t-PA is a new risk factor of long-term mortality in patients with angina pectoris and coronary artery stenosis. This paradoxical effect probably reflects increased t-PA levels attributable to enzyme inhibitor complex formation in subjects with increased plasma levels of t-PA inhibitors.
纤维蛋白溶解系统是抵御血栓形成和心血管事件的防御机制的一部分，但迄今为止，尚无研究表明对纤维蛋白溶解关键成分（如组织纤溶酶原激活物（t-PA）或1型纤溶酶原激活物抑制剂（PAI-1））进行临床测量在3年以上具有任何预测价值。
在1983年至1985年期间，对213例连续的心绞痛患者和经血管造影证实的冠状动脉疾病患者进行了采样，并在枸橼酸盐血浆样本中测量了t-PA的质量浓度和PAI-1的活性。在平均7年的随访时间里，检查了全因死亡率。没有患者失访。通过Cox回归分析数据，发现t-PA质量浓度是所有患者（P <.022）以及接受冠状动脉搭桥手术的主要亚组（占所有患者的78%）中与死亡率显著相关的唯一实验室危险因素（P <.027）。在后一个亚组中，体重指数也与死亡率相关。
t-PA质量浓度升高是心绞痛和冠状动脉狭窄患者长期死亡的一个新危险因素。这种矛盾的效应可能反映了在血浆t-PA抑制剂水平升高的受试者中，由于酶抑制剂复合物形成导致t-PA水平升高。
