Effects Of Fibrinolytic System On Deep Venous Thrombosis

Objective: To analysis impact factors on fibrinolytic components and their relationship, investigate effects by fibrinolytic system upon deep venous thrombosis, besides analysis fibrinolytic parameters' early diagnostic values, focused on PLG, t-PA and PAI-1.Materials and methods: Stored up blood of inpatients and outpatients at Huaxi Hospital conformed to inclusion criterion, also comprising healthy people during the same time. There were three groups, consisting of 25 DVT patients(the thrombotic group), 43 patients with high risk factors for DVT (the risk-factor group), 23 healthy people(the control group). Detected routine coagulation (PT, APTT, FIB) and biochemistry (including blood glucose and lipids ) parameters. Tested plasminogen activity (PLG:Ac) and plasminogen avtivator inhibitor-1 activity (PAI:Ac) by chromogenic assays, tissue-type plasminogen activator antigen (t-PA:Ag), plasminogen avtivator inhibitor-1 antigen (PAI-1:Ag), fibrin/firbrinogen degradation prducts antigen (FDP) by ELISA. Coagulative and fibrinolytic parameters between three groups were compared by ANOVA and SNK or Kruskal-Walls and Mann-Whitney non-parametric test. Influence on DVT by coagulative and fibrinolytic parameters were analysed by Logistic regression. Relationship between t-PA:Ag and PAI-1:Ag was calculated by Pearson correlation test. Receiver-operation curve(ROC) analysis and calculated indices such as area under ROC curve(AUC), sensitivity (Sen), specificity(Spe) were used toevaluate and compare the early diagnostic values of the fibrinolytic parameters.Rusults: 1. The levels of t-PA:Ag> PAI-l:Ag> PAI:Ac > FDP in the thrombotic group and risk-factor group were higher than those in the control group, but only PAI:Ac and FDP reached markedly differences(p<0.05). The levels of PLG:Ac in the thrombotic group and risk-factor group were significantly lower than that in the control group(p<0.05). Furthermore, the levels of PALAc and FDP in the thrombotic group were significantly higher than those in the risk-factor group(p<0.05).2. Logistic regression analysis indicated that PAI:Ac was the most important factor on deep venous thrombosis in coagulative and fibrinolytic parameters. Correlation analysis pointed out t-PA:Ag and PAI-l:Ag in the thrombotic group had significantly positive association(r=0.630, p=0.001), and this two parameters had same correlation in the risk-factor group(r=0.430, p=0.005). Neither were this two parameters in the control group (r=0.122, p=0.652).3. In the risk-factor group, the levels of PALAc of patients with normal fasting glucose were significantly lower than those of patients with impaired fasting glucose(0.62+0.08 vs 0.67+0.14 AU/ml, p<0.05). The levels of PAI: Ac of patients with normal total triglyceride were significantly lower than those of patients with hyper- triglyceridemia(0.61 + 0.11 vs 0.66 ± 0.11 AU/ml, p<0.05). Patients with high total cholesterol also had increased tendency of levels (0.63+0.11 vs 0.65 + 0.09 mmol/L, p>0.05).4. Used by ROC analysis, AUC for PLG:Ac> PAI:Ac and FDP were 0.414> 0.674 and 0.551, respectively. Sen and Spe for PALAc were 92% and 26%(5=0.57 AU/ml), which were compared with 90% and 13% for FDP(^1.87ug/ml).Conclusion: 1. Our results suggested that before deep venous thrombosis, patients with high risk factors had hypercoagulable state and reduced fibrinolytic potential. Whether changers of these parameters were early stage hazardous signals and intervening therapy were administerd in time, further clinical investigation were guaranteed.2. In deteted coagulative and fibrinolytic parameters, PALAc was the most important factor upon deep venous thrombosis.3. Higher blood glucose and lipids could enhance plasma levels ofPAI-1.4. Of PLG:Ac, PALAc and FDP, the most early diagnostic values for DVT had PALAc, whose sensitivity and specificity were 92% and 26%. FDP was in the next place, with 90% and 13% respectively. PLG:Ac had no diagnostic values. PALAc and FDP had relatively high sensitive to diagnosis of DVT, whose practicality were requied appraisement in clinical job.