Salat C, Holler E, Kolb H J, Reinhardt B, Pihusch R, Wilmanns W, Hiller E
Medical Klinik III Klinikum Grosshadern der Ludwig-Maximilians-Universitat München, Germany.
Blood. 1997 Mar 15;89(6):2184-8.
Hepatic veno-occlusive disease (VOD) is a frequent and severe complication after bone marrow transplantation (BMT). We previously have described plasminogen activator inhibitor-1 (PAI-1) as a possible marker of VOD. To confirm the significance of this finding, we now determined PAI-1 levels in 31 of 186 consecutive patients undergoing BMT who developed hyperbilirubinemia greater than 3 mg/dL for various reasons. Diagnoses were made by clinical criteria and confirmed by biopsy in 23 of 31 patients. They included VOD (n = 7), acute graft-versus-host disease (GVHD) of the liver (n = 7), and other hepatic injury (n = 17). PAI-1 (mean +/- SD) was significantly (P < .001) elevated in patients with VOD (321.6 +/- 161.2 ng/mL) as compared with patients with GVHD (22.8 +/- 8.4 ng/mL) or other hepatic damage (32.8 +/- 30.8 ng/mL) at the timepoint of bilirubin increase. At the peak bilirubin concentration, the corresponding PAI-1 levels were 426.1 +/- 230.0 ng/mL in patients with VOD, 41.0 +/- 20.6 ng/ mL in patients with GVHD, and 44.6 +/- 32.9 ng/mL in patients with other hepatic injury (P < .001 VOD v GVHD/other hepatic injury). Our results underline the relevance of PAI-1 in the differential diagnosis of hyperbilirubinemia after BMT and its significance as a sensitive and specific marker of severe VOD.
肝静脉闭塞病（VOD）是骨髓移植（BMT）后常见且严重的并发症。我们之前曾描述纤溶酶原激活物抑制剂-1（PAI-1）可能是VOD的一个标志物。为了证实这一发现的重要性，我们现在测定了186例连续接受BMT的患者中31例因各种原因出现胆红素血症大于3mg/dL患者的PAI-1水平。通过临床标准进行诊断，并在31例患者中的23例通过活检得以证实。诊断包括VOD（n = 7）、肝脏急性移植物抗宿主病（GVHD，n = 7）以及其他肝损伤（n = 17）。在胆红素升高的时间点，VOD患者的PAI-1（均值±标准差）显著升高（P <.001），为（321.6 ± 161.2 ng/mL），而GVHD患者为（22.8 ± 8.4 ng/mL），其他肝损伤患者为（32.8 ± 30.8 ng/mL）。在胆红素浓度峰值时，VOD患者相应的PAI-1水平为426.1 ± 230.0 ng/mL，GVHD患者为41.0 ± 20.6 ng/mL，其他肝损伤患者为44.6 ± 32.9 ng/mL（VOD与GVHD/其他肝损伤相比，P <.001）。我们的结果强调了PAI-1在BMT后高胆红素血症鉴别诊断中的相关性及其作为严重VOD敏感且特异标志物的重要性。
