肺高血圧症を伴う慢性肺血栓塞栓症における凝固-線溶系分子マーカー測定の意義

Molecular Markers of Thrombosis and Fibrinolysis in Patients with Chronic Thromboembolic Pulmonary Hypertension

　肺高血圧症を伴う慢性肺血栓塞栓症（CTEPH）における凝固—線溶系の動態を検討する目的で，CTEPH17例についてthrombin-antithrombin III複合体（TAT），fibrinopeptide A（FPA），plasmin-α₂　plasmin inhibitor複合体（PIC），D-dimerの4種の凝固—線溶系分子マーカーを入院時および血栓溶解療法時に測定した．入院時のTATは6.6±7.5ng／ml，FPAは4.1±2.8ng／ml,PICは0.9±0.7μg／ml,D-dimerは221±176ng／mlであり，CTEPHの約半数の症例で凝固—線溶系活性の軽度の亢進を認めた．対象例中9例に対してurokinaseによる血栓溶解療法を施行した．全例でPICは増加し線溶系の亢進が認められたにもかかわらず，血栓溶解を示すD-dimerの増加が確認された例は3例に過ぎず，またその増加量も少なかった．すでに完成したCTEPH例に対する血栓溶解療法の効果は限定されたものであることが推察された．

To evaluate the activity of the hemostatic and fibrinolytic system in 17 patients with chronic throm-boembolic pulmonary hypertension (CTEPH), we mea-sured the plasma concentration of thrombin-antithrom-bin III complex (TAT) and fibrinopeptide A (FPA) as molecular markers of ongoing thrombosis, plasmin-α₂ plasmin inhibitor complex (PIC) and D-dimer as molec-ular markers of fibrinolysis at admission and during thrombolytic therapy. The plasma concentrations of TAT, FPA, PIC and D-dimer at admission were 6.6±7.5ng/ml, 4.1±2.8ng/ml, 0.9±0.7μg/ml, 221±176ng/ml,respectively. In about half of the CTEPH patients, the thrombotic and fibrinolytic system was slightly activat-ed. However, in the remaining half, the activity of the thrombotic and fibrinolytic system was not accentuated. Thrombolytic therapy using urokinase was carried out in 9 cases. In these patients. the PIC and D-dimer showed almost normal values before urokinase infusion. Although PIC increased markedly after urokinase infu-sion, the D-dimer showed no marked changed except in 3 cases. As the D-dimer is considered to be a good index for clot lvsis. these findings suggest that throm-bolytic therapy was ineffective in most patients with CTEPH when their molecular markers of fibrinolysis were within the normal range before thrombolytic ther-apy. The molecular markers of thrombosis and fi-brinolysis were good tools for examining the patho-physiology of CTEPH. and for evaluating the effectiveness of thrombolytic therapy.