Clinical evaluation of tissue plasminogen activator (t-PA) levels in patients with liver diseases

Tissue plasminogen activator (t-PA) levels in plasma or serum were studied in 416 patients with liver diseases: acute hepatitis (AH, n=30); fulminant hepatitis (FH, n=36); chronic inactive hepatitis (CIH, n=57); chronic active hepatitis (CAH, n=39); compensated liver cirrhosis (cLC, n=78); decompensated liver cirrhosis (dLC, n=84); hepatocellular carcinoma (HCC, n=64); advanced hepatocellular carcinoma (aHCC, n=28); and compared with that of a control group (n=106) of healthy subjects. The t-PA levels showed significant increase in patients with AH, FH, CAH, cLC, dLC and HCC, compared with normal controls. The abnormal rates in t-PA levels (higher than 8.3 ng/ml) for each type of liver diseases were 86.1% in FH, 46.2% in CAH, 50% in cLC, 85.7% in dLC, 67.2% in HCC, and 89.3% in aHCC. t-PA levels tended to be higher in more advanced liver diseases. t-PA levels significantly correlated positively with plasminogen activator inhibitor (PAI-1) in AH, cLC, dLC, HCC and aHCC, and negatively with plasmin arplasmin inhibitor complex (PIC), plasminogen (Pig), FDP, AT III and α2-plasmin inhibitor (α2-PI) in dLC, prothrombin time (PT) and fibrinogen (Fbg) in HCC. t-PA levels in patients with FH, CAH and dLC were significantly higher than those in patients with AH, CIH and cLC, respectively. Moreover, the changes of t-PA levels in the clinical courses of various liver diseases revealed that t-PA levels increased sensitively with progression of liver diseases or in advanced liver diseases. These results suggest that t-PA has a potential clinical use to judge the prognosis of liver diseases and is a sensitive marker for severe liver diseases from tjie standpoint of coagulofibrinolysis, especially in relation to PAI-I.