2. 凝固亢進状態と血漿キニン，カリクレイン系

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書誌事項

タイトル別名
  • Plasma Kallikrein—Kinin System in Hypercoagulable State
  • 凝固亢進状態と血漿キニン,カリクレイン系
  • ギョウコ コウシン ジョウタイ ト ケッショウ キニン カリクレインケイ

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Factor XII (F. XII), prekallikrein (PK), high molecular weight kininogen (HMW-K), plasminogen (PLG), antithrombin III (AT-III), α2-plasmin inhibitor (α2-PI) and C1-inactivator (C1-INH) levels were assayed of 102 sequential plasma samples from 8 patients with acute promyelocytic leukemia (APL), 8 with metastasized malignancies, 6 with septicemia, all of whom were associated with DIC, and from 8 with advanced cancer without metastasis and 6 with acute myocardial infarction (AMI), who were not with DIC. F. XII and HMW-K activities were assayed by one-stage PTT method with each deficient plasma as a substrate. The activities of PK, PLG, AT-III and α2-PI were measured by amidolytic method with chromogenic substrates (Teatzym) specific to each factor, and the antigen levels of the latter 3 proteins and F. XII were also measured by single radial immunodiffusion technique. C1-INH was measured by the same method.<br>In patients with DIC due to APL and metastasized malignancies, the activities of F. XII, PK and HMW-K were nearly normal in the early to moderately advanced stages of the underlying diseases, although they were reduced to around 50% of normal in the terminal stages with poor nutrition and hepatic dysfunctions. In patients with septic DIC, however, marked and uniform reduction of these activities was noted from the beginning and in patients with advanced cancers without DIC, these were also decreased in various degrees. No significant changes of these factors were found in the plasmas of patients with AMI collected within 7 days after the attack. In DIC, regardless of its precipitating pathologies, the changes of F. XII, PK, HMW-K and PLG levels were similar to each other with significant correlation coefficient.<br>AT-III and α2-PI, in both activities and antigen levels, were decreased not only in DIC but also in patients with advanced cancers without DIC. A mild but significant reduction of AT-III was also demonstrated in patients with AMI. C1-INH levels, on the other hand, were markedly elevated in DIC, moderately elevated in advanced cancers and normal in AMI.<br>From these results it may be concluded that in DIC with septicemia which activates the intrinsic pathways of blood coagulation, fibrinolysis and kinin formation, F. XII, PK, HMW-K and PLG are markedly and invariably decreased due to rapid activation and resultant consumption of these proteins, and that in DIC associated with APL and metastasized malignancies which activate the extrinsic pathways of coagulation and fibrinolysis, F. XII, PK and HMW-K do not become reduced unless decreased synthesis of these proteins are overt in the terminal conditions. Low levels of AT-III and α2-PI seem to be useful parameters for the early diagnosis of DIC of either pathology, but hepatic dysfunction and poor nutrition can also influence these levels. C1-INH level was increased in APL, septicemia and malignancies with and without DIC and this protein seems to be one of the acute phase reactants.

収録刊行物

  • 臨床血液

    臨床血液 21 (6), 704-713, 1980

    一般社団法人 日本血液学会

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