羊水中の凝固線溶系とカリクレイン・キニン系およびキニナーゼ活性の研究 ＩＩ

Abstract

In our previous paper (1), the coagulation-fibrinolytic and kallikrein-kinin systems in the utero-placental circulation and amniotic fluid was studied in the full term pregnancy before and during labour. We observed thatc in amniotic fluid, hypercoagulability with secondary hyperfibrinolysis and the production of kinin increased significantly during labour. However, these systemic information based on multifactorial and stage dependent analysis have not been investigated.In this study, the amniotic fluid was collected by amnioticentesis from 72 pregnant women in 17-20 weeks of gestation as a control group and full term women before and during labour (Table 2). We tried to find out the changes of plasminogen activator (urokinase and tissue plasminogen activator), α2-plasmin inhibitor (TD-80), α2PI-plasmin-complex (TD-80C), D-dimer, glandular kallikrein activity and quantity (anti-human urinary kallikrein antibody), kallikrein inhibitor and kininase activity (Table 1).1. Coagulation-fibrinolytic system; The levels of α2-PI was high (1.04±0.21μg/ml, M±SE) and unchanged during preg., but slightly decreased during labour (0.93±0.11μg/ml, M±SE). This finding indicated the fibrinolytic system was depressed on the whole, while the homeostatic plasmin activity in amniotic fluid was exhibited by multifactorial analysis.1) Control group; The levels of UK, α2PI-Pm-C and Bβ15-42 were slightly increased, and D-dieter increased significantly as compared to the full term preg. These finding suggested that the secondary fibrinolytic activity was markedly increased after the hypercoagulable state.2) Full term preg; The low levels of UK, α2PI-Pm-C, Bβ15-42 and Ddimer showed that the coagulable and fibrinolytic system was depressed.3) During labour; The levels of UK, Bβ15-42, α2PI-Pm-C and D-dimer were significantly increased and α2PI wes slightly decreased. This pattern suggested the hypercoagulability with secondary hyperfibrinolytic activity.2. Kallikrein-kinin system, The levels of kallikrein activity was unchanged during normal preg. but slightly increased during labour, and kall. quantity was markedly increased in full term preg. (20.9±4.9ng/ml, M±SE) and significantly increased during labour (32.3±5.8ng/ml, M±SE) as compared to the control group (≤4.0ng/ml, M±SE). The levels of kall. inhibitor and kininase activity were significantly decreased, and LMW-, HMW-kininogen (1) were markedly decreased in full term preg. before and during labor (kall. inhibitor 0.2±0.1%, kininase activity 592.8±103.1pg/min/ml, M±SE) as compared to the control group (kall. inhibitor 41.7±7.2%, kininase activity 2099.5±265.9pg/min/ml, M±SE). These findings suggested that with the significantly increased kall. quantity and decreased kall. inhibitor and kininase activity during labor exhibited the hyperproduction of kinin.