纤溶系统失衡与肺血栓栓塞症的关系

本文对纤溶系统的主要组成成分组织型纤溶酶原激活剂(t-PA)、尿激酶(u-PA)和Ⅰ型纤溶酶原激活物抑制剂(PAI-1)的动态变化在肺血栓栓塞症(PTE)发生发展中的作用进行综述,表明纤溶系统失衡在PTE早期血栓形成中起重要作用。     

急性心肌梗死患者内皮纤溶储备功能的研究

目的 :探讨急性心肌梗死 (AMI)患者全身纤溶状态及内皮纤溶储备功能的变化规律。方法 :2 1例 AMI患者于入院第 1天和入院后第 10天采集静脉血测定纤溶指标 ,并与 15例正常人作对比 ,同时做静脉闭塞试验以确定最大内皮组织纤溶酶原激活剂 (t PA)释放。结果 :AMI患者 t PA含量、纤溶酶原激活剂抑制物 - 1(PAI- 1)活性均较正常人明显为高。最大内皮 t PA释放于入院第 1天降低为 (2 .3± 0 .9) μg/ L(P<0 .0 1) ,第 10天恢复至(4.5± 1.2 ) μg/ L(P >0 .0 5 )。结论 :内皮纤溶功能紊乱与血管内血栓形成的联系要比全身纤溶指标的变化更为密切 ,在 AMI早期纠正内皮纤溶功能异常更为重要     

老年心肌梗塞患者血浆组织型纤溶酶原激活剂及其抑制物浓度的变化

本文对40例急性心肌梗塞患者血浆组织型纤溶酶原激活剂(tPA)含量,活性及纤溶酶原激活剂抑制物(PAI)活性进行测定。结果显示,发病时患者血浆tPA含量、PAI活性分别显著高于对照组(P<0.01),而tPA活性明显低于对照组(P<0.01),65岁以上老年患者的上述指标的异常变化尤为显著,对可能的机制进行了讨论。     

急性心肌缺血氧自由基与血液高凝状态的实验研究

本文研究急性心肌缺血氧自由基及其清除剂对抗凝血酶及纤溶系统的影响。结果表明:心肌缺血4小时引起血浆丙二醛(MDA)增高,血浆抗凝血酶Ⅲ(AT-Ⅲ)及组织型纤溶酶原激活剂(t-PA)活性降低。纤溶酶原激活剂抑制物(PAI)活性增高。MDA与AT-Ⅲ呈负相关,与PAI呈正相关。自由基清除剂超氧化物歧化酶(SOD)及过氯化氢酶(CAT)可降低自由基,升高AT-Ⅲ与t-PA活性,降低PAI活性。作者认为氧自由基可能对急性心肌缺血产生高凝状态起重要作用。     

缺血性心脑血管疾病患者血浆纤溶酶原激活物及纤溶酶原激活物抑制剂1的测定及临床意义

目的研究缺血性心脑血管疾病患者血浆尿激酶型纤溶酶原激活物及其受体、组织型纤溶酶原激活物及其抑制剂1的水平及意义。方法应用酶联免疫吸附试验测定急性脑梗死、急性心肌梗死及不稳定型心绞痛患者血浆尿激酶型纤溶酶原激活物及其受体、组织型纤溶酶原激活物及其抑制剂1的水平。结果(1)脑梗死患者急性期血浆尿激酶型纤溶酶原激活物轻度升高(P>0.05),恢复期明显回落(P<0.05),尿激酶型纤溶酶原激活物受体水平在急性期明显升高(P<0.01),恢复期进一步升高;血浆中组织型纤溶酶原激活物含量在急性期明显低于对照组(P<0.01),而纤溶酶原激活物抑制剂1含量则明显高于对照组(P<0.01),恢复期纤溶酶原激活物抑制剂1水平趋于正常,而血浆中组织型纤溶酶原激活物水平与对照组比较仍存在一定差异(P<0.05)。(2)急性心肌梗塞患者血浆尿激酶型纤溶酶原激活物受体水平急性期明显升高(P<0.05),恢复期进一步升高(P<0.01),尿激酶型纤溶酶原激活物水平均大致正常;急性期血浆中血浆中组织型纤溶酶原激活物及纤溶酶原激活物抑制剂1含量均明显高于对照组(P<0.01),恢复期明显回落,纤溶酶原激活物抑制剂1趋于正常,血浆中组织型纤溶酶原激活物水平仍高于对照组(P<0.05)。(3)不稳定型心绞痛患者急性期(入院时)血浆尿激酶型纤溶酶原激活物受体水平明显升高(P<0.01),恢复期(入院后二周)回落,但仍明显高于对照组(P<0.05),尿激酶型纤溶酶原激活物水平与对照组比较均未见明显差异(P>0.05);急性期血浆中组织型纤溶酶原激活物含量明显低于正常组(P<0.01),而纤溶酶原激活物抑制剂1含量略高于对照组(P>0.05),恢复期两者含量均趋于正常(P>0.05)。结论缺血性心脑血管疾病患者存在不同程度的凝血纤溶系统失平衡,对疾病的发生发展起重要作用。     

尿激酶型纤溶酶原激活物受体与炎性关节病

尿激酶型纤溶酶原激活物受体(uPAR)与其配体尿激酶型纤溶酶原激活物(uPA)介导的细胞外基质蛋白裂解作用与炎性关节疾病中关节软骨和骨的破坏密切相关。本文就uPAR的结构与功能及其在炎性关节病中的病理作用、临床应用等方面的研究进展进行综述。     

重组组织型纤溶酶原激活剂与尿激酶治疗急性心肌梗死疗效比较

急性心肌梗死(AMI)是临床危害性极大的心血管急症,尽早实行静脉溶栓是目前国内外治疗AMI使冠状动脉血管再通的重要手段。本文回顾分析69例AMI患者采用重组组织型纤溶酶原激活剂(rt-pA)及国产尿激酶(UK)溶栓治疗结果,报告如下。     

氯沙坦对高血压病患者尿白蛋白及纤溶活性的影响

目的　探讨尿白蛋白排泄率与纤溶活性的关系及氯沙坦对其影响。方法　选择 6 2例高血压病伴轻、中度肾功能损害 (肌酐清除率 <70mL/min ,但≥ 30mL/min)患者 ,经随机分为两组分别予氯沙坦 5 0～ 10 0mg/d或卡托普利75～ 15 0mg/d降压治疗 12周。同时选择 2 4例高血压病伴肾功能完全正常 (肌酐清除率≥ 80mL/min)患者作为对照组 ,降压治疗前后分别测定尿白蛋白排泄率 (UAE)、纤溶酶原激活剂活性 (tPA)、纤溶酶原激活抑制剂活性 (PAI)。结果　肾功能异常组UAE、PAI均升高 (P <0 0 1) ,tPA降低 (P <0 0 5 ) ;UAE与tPA ,PAI,PAI/tPA相关系数分别为 0 2 0 (P >0 1)、0 32 (P <0 0 5 )、0 34(P <0 0 1) ,UAE与纤溶活性降低正相关 ;降压治疗后两组均降低UAE、PAI(P <0 0 1) ,卡托普利组还升高tPA(P <0 0 5 )。结论　肾功能异常时纤溶活性降低 ,肾功能损害与纤溶降低有关 ,氯沙坦及卡托普利改善肾功能 ,也改善纤溶活性。     

尿激酶型纤溶酶原激活物及其抑制物与肝纤维化

肝纤维化是肝脏对慢性损伤的一种修复反应,以细胞外基质(ECM)在肝内过多沉积为特征。尿激酶型纤溶酶原激活物(uPA)及其抑制物(PAI)是调节基质金属蛋白酶(MMP)活性和ECM降解的关键因素。uPA通过uPA-纤溶酶-MMP级联反应途径,最终可产生活化的纤溶酶和MMP,后两者是降解ECM的重要物质。因而调控uPA的表达,可能为肝纤维化的治疗提供新的途径。     

组织型纤溶酶原激活剂治疗心血管血栓相关性疾病的研究近况

组织型纤溶酶原激活剂(tPA)能够特异性地激活纤溶酶原,不易引起系统性纤溶状态,是一种理想的溶栓药物.现将有关tPA的作用机理及其在治疗心血管血栓相关性疾病中的研究近况作一综述.     

VEGF、uPA及uPAR与胃癌侵袭和转移的相关性

目的探讨血管内皮生长因子(VEGF)、尿激酶型纤溶酶原激活物(uPA)及其受体(uPAR)与胃癌侵袭、转移的关系及其相关性。方法采用免疫组化SP方法检测198份胃癌组织标本(胃癌组)、60份正常胃黏膜组织标本(对照组)VEGF、uPA、uPAR表达。结果与对照组比较,胃癌组VEGF呈高表达,并与浸润深度、淋巴结转移和临床分期呈正相关,与肿瘤的分化程度呈负相关,P均<0.05;胃癌组uPA和uPAR呈高表达,与病理分级、浸润深度、淋巴转移、临床分期有关,P均<0.05。胃癌组VEGF与uPA表达呈正相关,P<0.01;uPA与uPAR表达呈正相关,P<0.01。结论 VEGF、uPA、uPAR在胃癌发生、发展、侵袭和转移中起促进作用;三者相互促进,相互协调,关系密切。三者均可作为胃癌诊断和预后估计的指标及胃癌治疗的新靶点。     

食管癌组织中纤溶成份的表达及其意义

目的 研究肿瘤组织中纤溶成份的表达与肿瘤进展和术后生存时间的关系,方法 用Ｎｏｒｔｈｅｒｎ印迹和免疫组化法研究１０例正常食管和４１例食管癌标本中的尿激酶型纤溶酶原激活物（ｕＰＡ）,尿激酶型纤溶酶原激活物受体和纤溶激活抑制物－１（ＰＡＩ－１）。     

类风湿关节炎中尿激酶型纤溶酶原激活物及其受体蛋白和基因的表达

目的　检测尿激酶型纤溶酶原激活物 (uPA)及其受体 (uPAR)蛋白和mRNA在类风湿关节炎 (RA)的表达 ,探讨uPA、uPAR基因在RA细胞外基质降解中的作用。方法　采用免疫组化和cDNA mRNA原位分子杂交技术分别检测了 2 4例RA、18例骨关节炎 (OA)和 6例正常滑膜组织中uPA、uPAR蛋白和mRNA的分布及表达情况。结果　 2 4例RA滑膜组织均呈uPA、uPAR蛋白和mRNA的阳性表达 ,uPA、uPAR蛋白的强阳性率高于mRNA。uPA、uPAR蛋白和mRNA阳性信号主要分布在RA滑膜衬里细胞、滑膜下层单核细胞、巨噬细胞样细胞及血管内皮细胞 ;18例OA滑膜组织中 ,uPA、uPAR蛋白和mRNA的表达部位类似于RA ,但阳性率、阳性程度及分布范围均明显低于RA滑膜组织 ,两组之间蛋白和mRNA表达的差异均有显著性 (P <0 0 1或P <0 0 0 1)。 6例正常滑膜组织呈阴性反应。结论　RA滑膜组织存在高水平uPA、uPAR蛋白和mRNA的表达 ,提示在RA的发生发展过程中 ,uPA和uPAR基因起着重要作用 ;RA和OA中uPA、uPAR基因表达水平的差异 ,可能与这两种疾病软骨和骨基质降解的程度及进程等临床表现密切相关     

Correlative studies on uPA mRNA and uPAR mRNA expression with vascular endothelial growth factor, microvessel density, progression and survival time of patients with gastric cancer

AIM: TO investigate the correlations between the expression of urokinase-type plasminogen activator (uPA) mRNA, uPA receptor (uPAR) mRNA and vascular endothelial growth factor (VEGF) protein and clinicopathologic features, microvessel density (MVD) and survival time. METHODS: In situ hybridization and immuno-histochemistry techniques were used to study the expressions of uPA mRNA, uPAR mRNA, VEGF and CD34 protein in 105 gastric carcinoma specimens. RESULTS: Expressions of uPA mRNA, uPAR mRNA and VEGF protein were observed in 61 (58.1%) cases, 70 (66.7%) cases and 67 (63.8%) cases, respectively. The uPA mRNA and uPAR mRNA positive expression rates in infiltrating-type cases (73.7%, 75.4%), stageⅢ-Ⅳ(72.1%, 75.4%), vessel invasion (63.2%, 69.9%), lymphatic metastasis (67.1%, 74.4%) and distant metastasis (88.1%, 85.7%) were significantly higher than those of the expanding-type (X2= 15.57, P= 0.001; X2=6.91, P=0.046), stageⅠ-Ⅱ(X2 = 19.22, P = 0.001; X2= 16.75, P= 0.001), non-vessel invasion (X2 = 11.92, P = 0.006; X2 = 14.15, P = 0.002), non-lymphatic metastasis (X2 = 28.41, P = 0.001; X2= 22.5, P=0.005) and non-distant metastasis (X2 = 12.32, P= 0.004; X2= 17.42, P = 0.002; X2 = 11.25, P = 0.012; X2 = 18.12, P = 0.002).The VEGF positive expression rates in infiltrating-type cases (75.4%), stageⅢ-Ⅳ(88.5%), vessel invasion (82.9%), lymphatic metastasis (84.3%) and distant metastasis (95.2%) were significantly higher than those of the expanding-type (X2 = 9.61, P = 0.021), stage I-II (X2=16.66, P = 0.001), non-vessel invasion (X2= 29.38, P = 0.001), non-lymphatic metastasis (X2 = 18.68, P = 0.005), and non-distant metastasis (X2= 22.72, P = 0.007; X2 = 21.62, P = 0.004). The mean MVD in the specimens positive for the uPA mRNA, uPAR mRNA and VEGF protein was markedly higher than those with negative expression groups. Moreover, a positive relation between MVD and uPA mRNA (rs = 0.199, P = 0.042), uPAR mRNA (rs = 0.278, P = 0.035), and VEGF (rs = 0.398, P = 0.048) expressions was observed. The mean survival time in cases with positive uPA mRNA, uPAR mRNA and VEGF protein expression or MVD value≥54.9 was significantly shorter than those in cases with negative expression or MVD value < 54.9. CONCLUSION: uPA and uPAR expressions are correlated with enhanced VEGF-induced tumor angiogenesis and may play a role in invasion and nodal metastasis of gastric carcinoma, thereby serving as prognostic markers of gastric cancer.     

Expression of urokinase-type plasminogen activator and its receptor in gastric fibroblasts and effects of nonsteroidal antiinflammatory drugs and prostaglandin

In acute inflammatory condition, little is known about the expression of the urokinase-type plasminogen activator (uPA) and its receptor (uPAR) in the gastric fibroblasts. To clarify the role of human gastric fibroblasts in acute inflammatory conditions such as gastric ulcer, the effects of interleukin (IL)-1beta and tumor necrosis factor (TNF)-alpha on the expression of uPA and uPAR, which were suggested to be associated with tissue remodeling, in gastric fibroblasts were investigated. The expression level of uPA mRNA and the amount of uPA antigen increased significantly on treatment with each concentration of IL-1beta (1 and 10 ng/ml) and 10 ng/ml TNF-alpha. On the other hand, the amounts of uPA antigen on cell surfaces were not affected significantly by IL-1beta and TNF-alpha stimulation. The expression level of uPAR mRNA increased in a dose-dependent manner on IL-1beta stimulation. The effect of indomethacin on uPA and uPAR expression in these cells was also examined. When gastric fibroblasts were treated with 50 microM indomethacin, the expression level of uPA mRNA decreased significantly, and the amount of uPA antigen in the culture medium and on cell surfaces decreased significantly with indomethacin in a dose-dependent manner. The increased uPAR mRNA expression caused by IL-1beta was reduced to the basal level by treatment with 50 microM indomethacin. Furthermore, we investigated the role of prostaglandin E2 (PGE2), which is suggested to play major roles in acute inflammation of the stomatch, on uPA and uPAR expression in gastric fibroblasts. The expression level of uPAR mRNA and the amount of uPA antigen on cell surfaces increased in a dose-dependent manner on treatment with PGE2 (10 and 50 ng/ml). These results suggest that uPA and uPAR expression in gastric fibroblasts is involved in the regulating system of PGE2 and that NSAIDs may delay healing of gastric mucosal injury in part through suppressing uPA production via inhibition of endogenous PG production.     

Lysophosphatidylcholine induces urokinase-type plasminogen activator and its receptor in human macrophages partly through redox-sensitive pathway

Urokinase-type plasminogen activator (uPA) and its cell surface receptor (uPAR) have been shown to be expressed in macrophages in atherosclerotic arterial walls, but the regulatory mechanisms of their expression remain unclear. The present study was performed to examine the effects of lysophosphatidylcholine (lysoPC), an important atherogenic lipid, on the expression of uPA and uPAR in human monocyte-derived macrophages. LysoPC upregulated the mRNA expression of uPA and uPAR, and it increased the protein expression of uPA in the culture medium and bound to the cell surface and of uPAR in the particulate fraction of the cells. LysoPC significantly increased the binding of the amino-terminal fragment of uPA to the treated cells and the cell-associated plasminogen activator activity. LysoPC stimulated superoxide anion production and increased intracellular oxidant levels in the cells. The combined incubation with reduced glutathione diethyl ester or N-acetylcysteine, antioxidants, suppressed the upregulation of uPA and uPAR mRNA and the increase in plasminogen activator activity by lysoPC. uPA and uPAR mRNA expression was also induced by the incubation with xanthine and xanthine oxidase, a superoxide anion-generating system. The results suggest that lysoPC increased the expression of uPA and uPAR and their functional activities in human monocyte-derived macrophages, at least in part through a redox-sensitive mechanism. This coordinate increase in the expression of uPA and uPAR in human macrophages by lysoPC could play an important role in plaque formation and disruption, arterial remodeling, and angiogenesis in atherosclerotic arterial walls.     

Deflazacort modulates the fibrinolytic pattern and reduces uPA-dependent chemioinvasion and proliferation in rheumatoid arthritis synoviocytes

OBJECTIVE: Extracellular fibrinolysis, controlled by the cell-associated fibrinolytic system (urokinase plasminogen activator, uPA; uPA receptor, uPAR; plasminogen activator inhibitor type-1, PAI-1), is involved in cartilage damage generation and in rheumatoid arthritis (RA) synovitis. Since steroids reduce the rate of radiological progression of RA, we planned to evaluate in healthy and RA synoviocytes the effects of the steroid deflazacort on uPA, uPAR and PAI-1 expression, and subsequent phenotypic modifications in terms of uPA/uPAR-dependent invasion and proliferation. METHODS: uPA, uPAR and PAI-1 levels were studied by ELISA, RT-PCR (uPAR) and zymography (uPA) in synoviocytes from four RA patients and four healthy controls. Chemoinvasion was assessed by the Boyden chamber invasion assay, using Matrigel as the invasion substrate. Proliferation was evaluated by cell counting. Both invasion and proliferation were measured upon treatment with deflazacort 5 muM with or without parallel stimulation with uPA 500 ng/ml or in the presence of monoclonal anti-uPA and anti-uPAR antibodies. RESULTS: Invasion and proliferation of RA synoviocytes require a proper functional balance of the fibrinolytic system. Both deflazacort and monoclonal antibodies against uPA and uPAR reduced expression and activity of the system, thus inhibiting invasion and proliferation. In RA synoviocytes, deflazacort induced higher PAI-1 and lower uPA and uPAR levels, as well as a decrease in uPA enzymatic activity. The levels of uPAR mRNA were concomitantly reduced, as was uPA-induced chemoinvasion. All these effects were also shown in controls, though to a lesser extent. CONCLUSIONS: Deflazacort might control RA synovial proliferation and invasion by differential modulation of single members of the fibrinolytic system.     

Expression of Urokinase-Type Plasminogen Activator and Its Receptor in Gastric Fibroblasts and Effects of Nonsteroidal Antiinflammatory Drugs and Prostaglandin

In acute inflammatory condition, little is known about the expression of the urokinase-type plasminogen activator (uPA) and its receptor (uPAR) in the gastric fibroblasts. To clarify the role of human gastric fibroblasts in acute inflammatory conditions such as gastric ulcer, the effects of interleukin (IL)-1β and tumor necrosis factor (TNF)-α on the expression of uPA and uPAR, which were suggested to be associated with tissue remodeling, in gastric fibroblasts were investigated. The expression level of uPA mRNA and the amount of uPA antigen increased significantly on treatment with each concentration of IL-1β (1 and 10 ng/ml) and 10 ng/ml TNF-α. On the other hand, the amounts of uPA antigen on cell surfaces were not affected significantly by IL-1β and TNF-α stimulation. The expression level of uPAR mRNA increased in a dose-dependent manner on IL-1β stimulation. The effect of indomethacin on uPA and uPAR expression in these cells was also examined. When gastric fibroblasts were treated with 50 μM indomethacin, the expression level of uPA mRNA decreased significantly, and the amount of uPA antigen in the culture medium and on cell surfaces decreased significantly with indomethacin in a dose-dependent manner. The increased uPAR mRNA expression caused by IL-1β was reduced to the basal level by treatment with 50 μM indomethacin. Furthermore, we investigated the role of prostaglandin E₂ (PGE₂), which is suggested to play major roles in acute inflammation of the stomatch, on uPA and uPAR expression in gastric fibroblasts. The expression level of uPAR mRNA and the amount of uPA antigen on cell surfaces increased in a dose-dependent manner on treatment with PGE₂ (10 and 50 ng/ml). These results suggest that uPA and uPAR expression in gastric fibroblasts is involved in the regulating system of PGE₂ and that NSAIDs may delay healing of gastric mucosal injury in part through suppressing uPA production via inhibition of endogenous PG production.     

类风湿关节炎患者滑液和血浆中尿激酶型纤溶酶原激活物及其受体测定的临床意义

目的 检测尿激酶型纤溶酶原激活物（uPA）及其受体uPAR在类风湿关节炎（RA）患者滑液和血浆中的含量,并结合临床和实验室资料分析其实际意义。方法 运用酶联免疫吸附法（ELISA）双抗体夹心法分别测定46例RA、8例骨关节炎（OA）和12名健康对照个体的血浆以及15例RA患者滑液中的uPA和uPAR含量,同时将类风湿因子阳性（RF^ ）和阴性（RF^-）组之间uPA和uPAR含量进行比较,并采用直线相关与回归方法分析血浆和滑膜中uPA、uPAR的含量与相评价RA病情活动指标之间的相互关系。结果 RA患者滑液中uPA、uPAR的含量均显著高于其自身血浆（P＜0．001,P＜0．01）;RA血浆中uPA、uPAR的含量又明显高于OA组（P＜0．05,P＜0．0001）和正常对照组（P＜0．0001,P＜0．001);RF^ 和RF^-组之间uPA、uPAR在滑液和血浆中的含量差异均无显著性（P＞0．05）。RA滑液和血浆中uPA、uPAR在滑液和血浆中的含量差异均无显著性（P＞0．05）。RA滑液和血浆中uPA、uPAR的含量还与反映RA病情活动的指标C反应蛋白（CRP）和类风湿因子（RF）之间均呈正相关;RA滑液中uPA、uPAR的含量还与关节肿胀个正相关。结论 RA患者滑液和血浆中uPA和uPAR的含量是反映RA病情活动的有用指标,提示uPA和uPAR基因可能通过降解细胞外基质的蛋白裂解作用参与RA的免疫作用机制并发挥重要作用。