抄録
Coagulation-fibrinolytic abnormalities in patients were investigated by newly developed bioimmunoassay method for t-PA activity, t-PA antigen (ETA), plasminogen activator inhibitor-1 (PAI-1) and various coagulation-fibrinolytic molecular markers. Plasma levels of t-PA antigen were markedly increased in severe liver diseases involving decompensated liver cirrhosis, hepatocellular carcinoma and fulminant hepatitis. Plasma levels of t-PA activity, however, varied from low to high levels. Consequently, the ratio of t-PA activity versus antigen decreased markedly in the severe state. It was revealed that the majority of increased plasma t-PA antigen obtained from severe liver diseases actually consisted mainly of complexes of t-PA and PAI-1.
After trans-catheter embolization (TAE) therapy for patients with hepatocellular carcinoma, plasma levels of t-PA activity immediately increased and reached peak levels within 6 hours, while symmetrical decreases in PAI-1 were observed. On the other hand, the levels of D-dimer, plasmin-alpha 2 plasmin inhibitor complex (PIC), thrombin-antithrombin 3 complex (TAT) subsequently increased in plasma following the increase in t-PA and decrease in PAI-1. Therefore, plasma t-PA activities evaluated by this bioimmunoassay were considered to be a sensitive indicator of fibrinolysis activation.
Plasma t-PA activity in various liver diseases had significant positive correlation with PIC levels, and negative correlation with PAI-1. However, t-PA activities had no correlation with levels of t-PA antigen, TAT, and D-dimer. It is difficult to correctly evaluate coagulation-fibrinolytic condition with limited specific markers. It was concluded that combination assay for t-PA activity, t-PA antigen, PAI-1 and other molecular markers is required to assess the coagulation-fibrinolytic condition in severe liver diseases.
