Nielsen J D, Gram J, Holm-Nielsen A, Fabrin K, Jespersen J
Department of Surgery, Ribe County Hospital in Esbjerg, Denmark.
Br J Urol. 1997 Dec;80(6):889-93. doi: 10.1046/j.1464-410x.1997.00483.x.
To evaluate whether post-operative blood loss in patients with benign prostatic hyperplasia, undergoing transurethral resection of the prostate (TURP), depends on in situ fibrinolysis in urine, and to determine the relative contributions of the urokinase and tissue-type plasminogen activator systems.
TURP was performed in 24 men (median age 68.5 years, range 52-78) and the weight of resected tissue, the operative and post-operative blood loss determined. The concentrations of the urokinase- (u-PA) and tissue-type plasminogen activator (t-PA)-related fibrinolysis in their urine was followed using sensitive and specific assays, and the changes related to post-operative blood loss. Measurements of the urinary concentrations of free t-PA activity, t-PA antigen, free u-PA activity, u-PA antigen and fibrin degradation products (FbDP) were determined and the area under the curve for each of these quantities correlated with the post-operative blood loss.
The post-operative blood loss correlated significantly with the per-operative loss (P = 0.047) and the weight of resected tissue (P = 0.029). There was a highly significant correlation between the area under the curve of FbDP in the urine and the post-operative blood loss (P < 0.005), while there was no significant positive correlation between the PA concentration or activity in the urine and post-operative blood loss. There was a significant correlation between the urinary t-PA activity and the amount of FbDP in the urine (P = 0.047), and a significant correlation between the weight of resected tissue and the amount of FbDP in the urine (P = 0.014).
The post-operative blood loss after TURP is significantly related to an increase of the urinary fibrinolytic activity and the enhanced fibrinolytic activity is probably caused by t-PA.
评估接受经尿道前列腺切除术（TURP）的良性前列腺增生患者术后失血量是否取决于尿液中的原位纤维蛋白溶解，并确定尿激酶和组织型纤溶酶原激活剂系统的相对作用。
对24名男性（年龄中位数68.5岁，范围52 - 78岁）进行TURP手术，测定切除组织的重量、术中及术后失血量。采用灵敏且特异的检测方法跟踪其尿液中与尿激酶（u-PA）和组织型纤溶酶原激活剂（t-PA）相关的纤维蛋白溶解浓度，并观察与术后失血量相关的变化。测定尿液中游离t-PA活性、t-PA抗原、游离u-PA活性、u-PA抗原和纤维蛋白降解产物（FbDP）的浓度，并将这些指标的曲线下面积与术后失血量进行相关性分析。
术后失血量与术中失血量（P = 0.047）和切除组织重量（P = 0.029）显著相关。尿液中FbDP的曲线下面积与术后失血量之间存在高度显著相关性（P < 0.005），而尿液中PA浓度或活性与术后失血量之间无显著正相关。尿液中t-PA活性与尿液中FbDP量之间存在显著相关性（P = 0.047），切除组织重量与尿液中FbDP量之间存在显著相关性（P = 0.014）。
TURP术后失血量与尿纤维蛋白溶解活性增加显著相关，且纤维蛋白溶解活性增强可能由t-PA引起。
