Fibrinolytic system related to pulmonary arterial pressure and lung function of patients with idiopathic pulmonary fibrosis

作者：Ban, Chengjun; Wang, Tongde; Zhang, Shu; Xin, Ping; Liang, Lirong; Wang, Chen; Dai, Huaping^*

来源：Clinical Respiratory Journal, 2017, 11(5): 640-647.

DOI：10.1111/crj.12397

• idiopathic pulmonary fibrosis
• PAI-1 pulmonary arterial pressure
• pulmonary function
• plasminogen activator

Objectives and AimsTo investigate urokinase-(uPA) and tissue-type (tPA) plasminogen activator and plasminogen activator inhibitor type-1 (PAI-1) levels in patients with idiopathic pulmonary fibrosis (IPF) and to determine the relationship between fibrinolytic system and pulmonary arterial pressure and pulmonary function. @@@ MethodsSeventy-nine patients with IPF were included. Bronchoalveolar lavage fluid (BALF) and blood samples were collected. The concentrations of tPA, uPA and PAI-1 were measured using enzyme-linked immunosorbent assay. Doppler echocardiography was used to detect tricuspid regurgitation pressure gradient (TRPG) to estimate pulmonary arterial pressure. @@@ ResultsBALF tPA elevated (P<0.005), circulatory PAI-1 decreased (P=0.05) and the ratio of uPA and PAI-1 decreased (P=0.01) in BALF in IPF patients with pulmonary hypertension (PH) compared to those without PH. Positive linear correlations were found: BALF tPA and TRPG (r=0.558, P=0.013); the predicted percentage of diffusion capacity of lung for carbon monoxide adjustments for alveolar volume and BALF uPA (r=0.319, P=0.035). Negative linear correlations were as follows: BALF PAI-1 and the predicted percentage of VCmax (r=-0.325, P=0.020), or total lung capacity (r=-0.312, P=0.033); circulatory PAI-1 and TRPG (r=-0.697, P=0.003). @@@ ConclusionsThe change of alveolar fibrolytic system in IPF, especially the uPA reduction and the PAI-1elevation, contributes to the deterioration of lung function. During the lung injury initiating fibrosis, tPA and PAI-1 might be leaked out of the pulmonary capillaries into alveoli, resulting in their elevation in alveoli and reduction in circulation, and finally contributing to the development of PH in IPF.

• 出版日期2017-9
• 单位首都医科大学