实验性兔急性肺动脉栓塞溶栓前后血浆t-PA、PAI-1和sTM水平的变化

Changes of plasma t-PA,PAI-1 and sTM in acute pulmonary embolism of rabbits

目的探讨实验性兔肺血栓栓塞症(PTE)的纤溶凝血系统、肺血管内皮功能的变化。方法 24只大耳白兔随机均分为对照(C)组、急性PTE模型(PTE)组和尿激酶(UK)治疗组。采用自体血栓回输法建立急性PTE动物模型。行动脉血气分析;ELISA法定量测定血清组织型纤溶酶原激活剂(t-PA)、纤溶酶原激活剂抑制物1(PAI-1)和可溶性血栓调节蛋白(sTM)变化,并行肺病理学检查。结果 PTE组栓塞后PaO2和PaCO2明显低于C组;UK组的变化较PTE组轻。PTE组栓塞2、4 h的t-PA、PAI-1均明显低于C组(P<0.01);UK组各时点值与C组无统计学差异。PTE组栓塞后sTM持续升高,4 h后明显高于C组(P<0.01);但UK组虽然也有升高,均较PTE组低,且与C组无统计学差异(P>0.05)。病理检查显示,C组无明显变化,PTE组兔肺组织病理损伤明显,UK组肺组织损伤较PTE组减轻。结论急性PTE时,兔纤溶凝血系统及肺血管内皮功能均有明显损伤,UK溶栓治疗对其有明显缓解效果。

Objective To investigate the changes of plasma t-PA,PAI-1 and sTM in acute pulmonary embolism of rabbits.Methods Twenty four rabbits were randomly divided into three groups of C（normal control）,PTE（acute pulmonary thromboembolism model） and UK（PTE plus urokinase therapy） with 8 rabbits each.The PTE model was established by intravenous injection of autologous blood clots.Arterial blood gas was analyzed and plasma concentrations of tissue type plasminogen activator（t-pA）,plasminogen activator inhibitor-1（PAI-1） and soluble thrombomodulin（sTM） were examined by ELISA before and at 1,2,4,8 and 12h after clots injection.Pathological changes of the lungs was observed with light microscope at last.Results PaO2 and PaCO2 were obviously lower in group PTE than those in group C,the changes of which were less in group UK than those in group PTE.Plasma t-PA and PAI-1 at 2 and 4h were lower in group PTE than those in group C（P〈0.01）,which were not significantly different between groups of UK and C（P〉0.05）.Plasma sTM after PTE was increasing in group PTE and it was higher than that in group C at 4h（P〈0.01）,which of group UK was increased but still lower than that in group PTE and had no significant difference between groups of UK and C（P〉0.05）.Histopathological study showed that lung injury was obvious in group PTE,which was less in group UK.Conclusion Remarkable injury of anticoagulation,fibrinolysis and pulmonary vascular endothelial function exists,which can be attenuated with urokinase therapy.