纤维蛋白溶解在粘连形成中的作用。

L Holmdahl
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引用次数: 0

摘要

术后腹腔粘连及其后遗症仍然是主要的临床和医学经济问题。包括纤溶系统在内的至少5个相互关联的生物系统涉及一个复杂的介质和反应网络,参与了术后粘连的发病机制。纤溶系统通过酶溶酶的作用降解纤维蛋白,酶溶酶作为无活性底物纤溶酶原储存。纤维蛋白溶解,通过介导纤维蛋白降解,似乎在粘连发生中起关键作用。组织型纤溶酶原激活剂(Tissue-type plasminogen activator, tPA)是血液中主要的纤溶酶原激活剂,但其活性受到纤溶酶原激活抑制剂1型(PAI-1)和2型(PAI-2)的限制。腹膜纤维蛋白溶解不足可能是由于tPA降低,PAI-1和PAI-2升高,或两者兼而有之。纤维蛋白溶解能力的降低与粘连形成之间的因果关系已在动物中得到证实。在人体研究中,与正常患者相比,腹膜炎患者的腹膜活检中纤溶酶原激活物活性(PAA)显著降低。手术期间,正常腹膜和炎症腹膜的PAA均显著下降。tPA占PAA的95%与腹膜炎和腹部手术相关的人腹膜纤维蛋白溶解减少与粘连形成增加相关,因此可能是导致粘连形成的重要早期生化事件。纤溶酶介导的腹膜腔纤维蛋白降解的调控尚不清楚。然而,在腹膜组织中纤维蛋白溶解成分的细胞分布的新见解表明,间皮层似乎在腹膜腔的纤维蛋白调节和粘连的早期形成中起主要作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The role of fibrinolysis in adhesion formation.

Postsurgical abdominal adhesions and their sequelae continue to present major clinical and medicoeconomic problems. A complex network of mediators and responses affecting at least five interrelated biological systems, including the fibrinolytic system, are involved in the pathogenesis of postsurgical adhesions. The fibrinolytic system degrades fibrin through the action of the enzyme plasmin, which is stored as the inactive substrate plasminogen. Fibrinolysis, by mediating fibrin degradation, appears to play a pivotal role in adhesiogenesis. Tissue-type plasminogen activator (tPA) is the chief plasminogen activator in the blood, but its activity is restricted by plasminogen activating inhibitors type 1 (PAI-1) and type 2 (PAI-2). Inadequate peritoneal fibrinolysis may result from decreased tPA, increased PAI-1 and PAI-2, or both. The causal relationship between a reduction in fibrinolytic capacity and the formation of adhesions has been demonstrated in animals. In human studies, plasminogen activator activity (PAA) was significantly reduced in peritoneal biopsies from patients with peritonitis compared with those from normal patients. During surgery, PAA declined significantly in both normal and inflamed peritoneum. tPA was responsible for about 95% of PAA. Reduced fibrinolysis in human peritoneum associated with peritonitis and abdominal surgery correlates with increased adhesion formation and may thus be an important early biochemical event leading to adhesion formation. The regulation of plasmin-mediated fibrin degradation in the peritoneal cavity is poorly understood. However, new insights in the cellular distribution of fibrinolytic components in peritoneal tissue suggest that the mesothelium appears to have a principal role in fibrin regulation in the peritoneal cavity and in the early formation of adhesions.

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