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Increased Concentrations of Tumor Necrosis Factor and lnterleukin-6 Contribute to the Hemostatic Abnormalities in Advanced Liver Disease

 

作者: J.A. Páramo,   B. Sangro,   F. Prósper,   J. Quiroga,   J. Rifón,   E. Rocha,  

 

期刊: Pathophysiology of Haemostasis and Thrombosis  (Karger Available online 1995)
卷期: Volume 25, issue 6  

页码: 305-311

 

ISSN:1424-8832

 

年代: 1995

 

DOI:10.1159/000217177

 

出版商: S. Karger AG

 

关键词: Liver disease;Tumor necrosis factor;Interleukin-6;Thrombin-antithrombin complexes;Prothrombin fragment 1 + 2;Disseminated intravascular coagulation;Fibrinolysis

 

数据来源: Karger

 

摘要:

Abnormal cytokine levels have been described in patients with chronic liver disease, but studies correlating cytokine homeostasis with abnormalities in coagulation and fibrinolysis are lacking. In order to establish a link between cytokines and the hemostatic changes the following parameters were determined in 44 patients with cirrhosis (alcoholic =15, postnecrotic = 22, others = 7): TNF-α, IL·6, thrombin-antithrombin (TAT) complexes, prothrombin fragment 1 + 2 (F1 + 2) and t-PA by using enzyme-linked immunosorbent assays, and PAI-1, plasminogen and α2-antiplasmin (α2-AP) by using chromogenic substrates. All patients were at stages B and C of Child’s classification when entering the study. Mean cytokine concentrations were significantly higher in cirrhotic patients as compared to age- and sex-matched controls (p < 0.009). There was a significant increase of TAT (p < 0.02) and F1 + 2 (p < 0.001) in the patients groups, suggesting a grade of intravascular coagulation. A hyperfibrinolytic state as demonstrated by an increase of t-PA and decrease of plasminogen and α2-AP was also observed (p < 0.001). We could define a subgroup of patients with cytokine values higher than 20 pg/ml. Interestingly, in this group there was a significant increase of TAT (p < 0.04) and t-PA (p < 0.02) levels and a decrease of plasminogen and α2-AP (p < 0.02) as compared to values observed in patients with cytokines lower than 20 pg/ml. We conclude that high levels of TNF-α and IL-6 may contribute to hyperfibrinolysis and intravascular coagulation in patients with liver cirrhosis, as assessed by the increase of TAT and t-PA levels and the reduction of plasminogen and α2

 

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