Elevated levels of plasminogen activator inhibitor-1 in pulmonary edema fluid are associated with mortality in acute lung injury
Elevated levels of plasminogen activator inhibitor-1 in pulmonary edema fluid are associated with mortality in acute lung injury
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DOI：
10.1152/ajplung.00312.2002
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发表时间：
2003-07-01
影响因子：
4.9
通讯作者：
Olman, MA
中科院分区：
文献类型：
--
作者：
Prabhakaran, P;Ware, LB;Olman, MA
急性肺损伤(ALI)时肺泡纤溶系统发生改变。纤溶酶抑制物、纤溶酶原激活物抑制物-1(PAI-1)在支气管肺泡灌洗液中的水平太低，不能说明其预后意义。本研究旨在评估未稀释肺水肿液中PAI-1抗原水平是否可以识别ALI患者并预测其预后。ALI患者血浆和水肿液中PAI-1抗原水平均高于静水性水肿者，且水肿液PAI-1值对ALI的诊断具有较高的敏感性和特异性。ALI患者高血浆和高水肿液PAI-1抗原值均与较高的死亡率和较少的非辅助呼吸机天数有关。PAI-1活性的差异与PAI-1抗原水平一致。尽管两组肺泡内纤维蛋白来源的D-二聚体水平非常相似，但ALI患者中D-单体的相对比例较高。总而言之，水肿液和血浆中的PAI-1水平可确定ALI患者预后较差。这些数据表明，早期ALI的纤维蛋白周转是纤维蛋白原快速流入和部分纤溶抑制的结果。
The alveolar fibrinolytic system is altered in acute lung injury (ALI). Levels of the fibrinolytic protease inhibitor, plasminogen activator inhibitor-1 (PAI-1), are too low in bronchoalveolar lavage to address its prognostic significance. This study was performed to assess whether PAI-1 antigen in undiluted pulmonary edema fluid levels can identify patients with ALI and predict their outcome. PAI-1 antigen levels in both plasma and edema fluid were higher in ALI compared with hydrostatic edema, and edema fluid PAI-1 values identified those with ALI with high sensitivity and specificity. Both the high plasma and edema fluid PAI-1 antigen values were associated with a higher mortality rate and fewer days of unassisted ventilation in patients with ALI. Differences in PAI-1 activity were concordant with levels of PAI-1 antigen. Although the fibrin-derived alveolar D-dimer levels were strikingly similar in both groups, ALI patients had a higher relative proportion of D-monomer. In conclusion, PAI-1 levels in edema fluid and plasma identify those with ALI that have a poor prognosis. The data indicate that fibrin turnover in early ALI is a consequence of a rapid fibrinogen influx and fractional fibrinolytic inhibition.