Terapevticheskii arkhivTerapevticheskii arkhivТерапевтический архив0040-36602309-5342LLC Obyedinennaya Redaktsiya30281Editorial articleПередовая статьяRegulators of fibrinolysis in chronic viral pathology of the liverPегулятоpы фибpинолиза пpи хpонической виpусной патологии печениYagodaAleksandr ValentinovichЯгодаАлександр Валентинович

проф., зав. кафедрой внутренних болезней № 1 с курсом поликлинической терапии; Ставропольская государственная медицинская академия

say@mail333.comKopoyP VКоpойП ВYagodaA VKoroiP VСтавропольская государственная медицинская академия15022009812NO2 (2009)ТОМ 81, №2 (2009)505309042020Copyright ©; 2009, Consilium MedicumCopyright ©; 2009, ООО "Консилиум Медикум"2009Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://ter-arkhiv.ru/0040-3660/article/view/30281

Aim. To investigate a clinicopathogenetic role of fibrinolysis regulators in chronic viral hepatitis (CVH) and viral cyrrhosis of the liver (CL). Material and methods. Seventy patients entered the study: 10 patients with CVH B, 33 - with CVH C, 6 - with CVH D, 21 - with viral CL (HCV-associated in 14 cases and HBV-associated in 7 cases. A concentration and activity of tissue plasminogen activator (TPA), the level of plasminogen-1 activator inhibitor (PAI-1) in blood plasma were estimated with enzyme immunoassay (Technoclone GmbH, Austria). PAI-1/TPA was estimated. Results. Increased TPA, PAI-1 concentrations and TPA activity in plasma with maximal values in CL were found. Most severe imbalance in the system of fibrinolysis regulators occurs in poor-prognosis cirrhosis and decompensated portal hypertension. High TPA concentration and activity in CL have a positive correlation with the Child-Pugh index, while low PAI-1/TPA correlates negatively with this index. Conclusion. TPA and PAI-1 correlations with hemorrhagic manifestations and prognosis of the disease suggest an essential clinical role of fibrinolysis regulators in chronic viral pathology of the liver.

Цель исследования. Изучить состояние регуляторов фибринолиза и оценить их клинико-патогенетическое значение при хроническом вирусном гепатите (ХВГ) и вирусном циррозе печени (ЦП). Материалы и методы. Обследованы 70 больных: у 10 установлен ХВГ B, у 33 - ХВГ C, у 6 - ХВГ D. ЦП вирусной этиологии диагностирован у 21 больного, в том числе у 14 - ассоциированный с вирусом гепатита C и у 7 на фоне инфекции вируса гепатита B. Концентрацию и активность тканевого активатора плазминогена (ТАП), уровень ингибитора активатора плазминогена 1-го типа (ИАП-1) в плазме крови определяли с помощью систем иммуноферментного анализа (Technoclone GmbH; Австрия), вычисляли соотношение между ИАП-1 и ТАП (ИАП-1/ТАП). Результаты. Установлено увеличение содержания ТАП, ИАП-1 и активности ТАП в плазме с максимальными значениями в случаях ЦП. Наибольший дисбаланс в системе регуляторов фибринолиза определяется при тяжелом прогностическом классе ЦП и декомпенсированной портальной гипертензии. Увеличение концентрации и активности ТАП при ЦП положительно, а снижение отношения ИАП-1/ТАП - отрицательно коррелирует с индексом тяжести ЦП по классификации Child-Pugh. Заключение. Взаимосвязь показателей ТАП и ИАП-1 с наличием геморрагических проявлений и прогнозом заболевания свидетельствует о важной клинической роли регуляторов фибринолиза при хронической вирусной патологии печени.

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