Cornet Alexander D, Smit Ellen G M, Beishuizen Albertus, Groeneveld A B Johan
Department of Intensive Care, Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
Thromb Haemost. 2007 Sep;98(3):579-86.
The crosstalk between coagulation and inflammation and the propensity for microthromboembolic disease during sepsis calls for anticoagulant measures to prevent tissue hypoxygenation and to attenuate organ damage and dysfunction. Only one anticoagulant, recombinant human activated protein C (aPC, drotrecogin-alpha) has a proven survival benefit when used as an adjunctive therapy for human sepsis, partly because of its anti-inflammatory effect. However, heparin (-like compounds) may exert similar beneficial anti-inflammatory actions as aPC, in spite of the relatively narrow therapeutic window for anticoagulation. This narrative review is based on a Medline search of relevant basic and clinical studies published in English and discusses the potential role of heparin in modulating inflammatory responses in the treatment of animal models and human sepsis and its harmful sequelae. In any case, the results of a meta-analysis based on animal data suggest a potentially life-saving effect of heparin (-like compounds) in the treatment of sepsis. Therefore, a prospective randomized clinical trial is called upon to study effects in human sepsis.
脓毒症期间凝血与炎症之间的相互作用以及发生微血栓栓塞性疾病的倾向，需要采取抗凝措施以防止组织缺氧，并减轻器官损伤和功能障碍。在用于人类脓毒症的辅助治疗时，只有一种抗凝剂，即重组人活化蛋白C（aPC，活化蛋白C）已被证实具有生存获益，部分原因是其抗炎作用。然而，肝素（类肝素化合物）尽管抗凝治疗窗相对较窄，但可能发挥与aPC类似的有益抗炎作用。本叙述性综述基于对以英文发表的相关基础和临床研究的Medline检索，讨论了肝素在调节动物模型和人类脓毒症治疗中的炎症反应及其有害后遗症方面的潜在作用。无论如何，基于动物数据的荟萃分析结果表明，肝素（类肝素化合物）在脓毒症治疗中可能具有挽救生命的作用。因此，需要进行一项前瞻性随机临床试验来研究其对人类脓毒症的影响。
