Kario K, Matsuo T
Department of Internal Medicine, Hyogo Prefectural Awaji Hospital, Japan.
Atherosclerosis. 1993 Nov;103(2):131-8. doi: 10.1016/0021-9150(93)90256-t.
To clarify age-related and lipid-related hemostatic abnormalities in the elderly, we measured the plasma levels of active PAI-1 antigen (aPAI-1), tPA-PAI-1 complex (TPC), plasminogen, alpha 2-plasmin inhibitor (alpha 2-PI), plasmin-alpha 2-PI complex (PIC), and D-dimer, together with the plasma levels of fibrinogen, factor VII (F VII), and thrombin-antithrombin III complex (TAT) and the serum lipid levels in 68 hyperlipidemic and 82 normolipidemic elderly subjects. The aPAI-1 ratio was calculated as aPAI-1/(aPAI-1 + TPC). In the normolipidemic elderly subjects, plasma PIC and D-dimer levels were much higher when compared with healthy young controls, and there was also a decrease in plasma plasminogen and alpha 2-PI levels, an increase in plasma TPC levels, and high plasma F VII and fibrinogen levels. In elderly subjects with type IIb hyperlipidemia, both the plasma aPAI-1 level and the aPAI-1 ratio were significantly increased, while the plasma PIC and D-dimer levels were reduced despite higher plasma F VII, fibrinogen and TAT levels. Both serum total cholesterol and triglyceride levels were correlated positively with plasma F VII and TAT levels and with the TAT/PIC ratio, while only serum triglyceride levels showed a positive correlation with plasma TPC and aPAI-1 levels and with the aPAI-1 ratio. Thus, an increase of fibrinolytic activity appears to occur as part of normal aging to balance the increase of procoagulant activity. However, an imbalance between thrombin activity (increased procoagulant activity) and plasmin activity (hypofibrinolysis) appears to occur in elderly individuals with hyperlipidemia, perhaps resulting in a predisposition to thromboembolic disease.
为阐明老年人与年龄和脂质相关的止血异常情况，我们检测了68例高脂血症老年受试者和82例血脂正常老年受试者的血浆活性纤溶酶原激活物抑制因子-1抗原（aPAI-1）、组织型纤溶酶原激活剂-纤溶酶原激活物抑制因子-1复合物（TPC）、纤溶酶原、α2-纤溶酶抑制物（α2-PI）、纤溶酶-α2-纤溶酶抑制物复合物（PIC）及D-二聚体水平，同时检测了血浆纤维蛋白原、凝血因子VII（F VII）和凝血酶-抗凝血酶III复合物（TAT）水平以及血脂水平。aPAI-1比率计算公式为aPAI-1/（aPAI-1 + TPC）。在血脂正常的老年受试者中，与健康年轻对照相比，血浆PIC和D-二聚体水平显著升高，同时血浆纤溶酶原和α2-PI水平降低，血浆TPC水平升高，血浆F VII和纤维蛋白原水平升高。在IIb型高脂血症老年受试者中，血浆aPAI-1水平和aPAI-1比率均显著升高，尽管血浆F VII、纤维蛋白原和TAT水平较高，但血浆PIC和D-二聚体水平降低。血清总胆固醇和甘油三酯水平均与血浆F VII和TAT水平以及TAT/PIC比率呈正相关，而仅血清甘油三酯水平与血浆TPC和aPAI-1水平以及aPAI-1比率呈正相关。因此，作为正常衰老的一部分，纤溶活性增加似乎是为了平衡促凝活性的增加。然而，高脂血症老年个体中似乎存在凝血酶活性（促凝活性增加）和纤溶酶活性（纤溶功能减退）之间的失衡，这可能导致血栓栓塞性疾病的易感性增加。
