Patrassi G M, Sartori M T, Livi U, Casonato A, Danesin C, Vettore S, Girolami A
Institute of Medical Semeiotics, University of Padua Medical School, Padova, Italy.
Transplantation. 1997 Dec 15;64(11):1610-4. doi: 10.1097/00007890-199712150-00021.
Thrombotic complications constitute an important risk in transplant recipients, in whom a hypercoagulable state and hypofibrinolysis have been associated with immunosuppressive treatment, especially with cyclosporine. In no case have clotting and fibrinolytic abnormalities been correlated with steroid immunosuppression, even though steroids were always administered. Previous studies found a relationship between hypercorticism and hypofibrinolysis both in Cushing's disease and after renal transplantation. The aim of this investigation was to compare fibrinolytic potential using the venous occlusion test in two similar groups of heart transplant patients treated with or without steroids. Euglobulin lysis time, tissue-type plasminogen activator and plasminogen activator inhibitor-1 (PAI-1) activities, and antigens were determined before and after the venous occlusion test. A reduced fibrinolytic potential (significant prolongation of lysis time) due to a significant increase in PAI-1 activity and antigen levels was found in heart transplant patients treated with steroids, as compared with patients without steroid treatment and control subjects. The prevalence of reduced fibrinolytic potential was 69.2% (18 cases) in the steroid-treated group and 34.8% (8 cases) in the non-steroid-treated group. In every case, the impaired fibrinolytic potential was due to high basal PAI-1 levels. Our results are compatible with the presence of a hypofibrinolytic state secondary to long-term steroid treatment. In heart transplant recipients, steroid-induced hypofibrinolysis may constitute a further risk factor for thrombotic disease.
血栓形成并发症是移植受者的一项重要风险，在这些患者中，高凝状态和纤维蛋白溶解功能减退与免疫抑制治疗有关，尤其是与环孢素有关。在任何情况下，凝血和纤维蛋白溶解异常均与类固醇免疫抑制无关，尽管类固醇一直在使用。先前的研究发现，无论是在库欣病还是肾移植后，皮质醇增多症与纤维蛋白溶解功能减退之间均存在关联。本研究的目的是使用静脉闭塞试验比较两组相似的接受或未接受类固醇治疗的心脏移植患者的纤维蛋白溶解潜力。在静脉闭塞试验前后测定优球蛋白溶解时间、组织型纤溶酶原激活物和纤溶酶原激活物抑制剂-1（PAI-1）的活性及抗原。与未接受类固醇治疗的患者和对照组相比，接受类固醇治疗的心脏移植患者由于PAI-1活性和抗原水平显著升高，出现了纤维蛋白溶解潜力降低（溶解时间显著延长）的情况。类固醇治疗组纤维蛋白溶解潜力降低的发生率为69.2%（18例），非类固醇治疗组为34.8%（8例）。在每种情况下，纤维蛋白溶解潜力受损均归因于基础PAI-1水平较高。我们的结果与长期类固醇治疗继发纤维蛋白溶解功能减退状态的存在相符。在心脏移植受者中，类固醇诱导的纤维蛋白溶解功能减退可能构成血栓性疾病的另一个危险因素。
