Summary
Previous studies have shown that the fibrinolytic activity of peritoneum is depressed
in local inflammation. We measured fibrinolytic parameters in peritoneal fluid and
in plasma of 10 women with pelvic inflammatory disease (PID). Nine women, in whom
laparoscopy for sterilisation was performed, served as a control group.
In the peritoneal fluid of women with PID, PAI-Ag, t-PA-Ag and u-PA-Ag were many times
higher than in the control group. In contrast to the antigens which may be present
in inert complexes, the potentially active compounds, measured as t-PA activity and
plasmin-activable scu-PA, were not significantly different in the two groups, and
in none of the samples was the active enzyme tcu-PA detectable. Nevertheless, the
mean peritoneal fluid TDP and FbDP concentrations were about twenty times higher in
the PID group than in the control group. In plasma of PID patients, none of the parameters
except u-PA-Ag differed from those in the control group. The difference between control
and patient plasma u-PA-Ag was statistically significant, but too small to attach
any relevance to the observation.
Our data suggest that, in contrast to the classical concept of decreased fibrinolytic
activity as a cause of adhesion formation, intraperitoneal fibrinolysis is enhanced
in peritoneal inflammation through stimulation of the local production of t-PA and
u-PA. Despite concomitant production of PAI, fibrinolysis occurs at a high rate, resulting
in high levels of fibrin degradation products. Since this activated fibrinolysis does
not meet the demand, therapeutic enhancement should be considered to prevent adhesions.
