Clinical evaluation of plasma tissue-plasminogen activator in liver diseases

Abstract

The possible role of plasma tissue-plasminogen activator (t-PA) in patients with liver diseases was investigated. Plasma t-PA levels determined by enzyme immunoassay (EIA) kit (American Diagnostica Inc.) were significantly higher in patients with liver diseases other than chronic hepatitis than those of normal subjects. In particular, Plasma t-PA levels in decompensated liver cirrhosis and hepatocellular carcinoma (HCC) were significantly higher than those of other various liver diseases. In 2 patients with fulminant hepatitis, t-PA levels were markedly higher than in cases of acute hepatitis. Plasma t-PA levels increased as the severity of illness increased in cases of HCC accompanied by liver cirrhosis. Bile obtained from patients with obstructive jaundice was found to contain t-PA. Bile and plasma t-PA levels both decreased following improvement of jaundice after percutaneus transhepatic cholangio drainage. Therefore it was suggested that cholestasis also induces increase of plasma t-PA levels. Since plamsa t-PA levels were related to the DD/E fraction of fibrin degradation products (D-dimer), and α2 plasmin inhibitor plasmin complex (PIC) in patients with disseminated intravascular coagulation, t-PA was thought to be involved in secondary hyperfibrinolysis in these patients. These results suggested that increase of plasma t-PA levels in liver disease was induced mainly by failure of the clearance mechanism in hepato-endothelial system, moreover release of t-PA from vascular endothelial cells stimulated by intravascular coagulation and cholestasis may also be involved. In conclusion, plasma t-PA appears to be a new marker related to hepatic failure.