Fleyfel M, Leroy B, Plouvier F, Balin C, Marecaux O, Scherpereel P
Département d'Anesthésie-Réanimation Chirurgicale 2, Centre Hospitalier Universitaire, Lille.
Ann Fr Anesth Reanim. 1991;10(4):406-8. doi: 10.1016/s0750-7658(05)80820-2.
A prostate biopsy was carried out in a 53-year-old male outpatient with disseminated prostatic carcinoma. Two days later, he was admitted with severe acute anaemia (haemoglobin: 48 g.l-1) and macroscopic haematuria. Biological investigations revealed a disseminated intravascular coagulation (DIC). Symptomatic treatment was undertaken (transfusion of packed red blood cells, platelets, fresh frozen plasma and fibrinogen). However, the patient's condition worsened, and he was admitted to the intensive care unit 48 h later. Despite appropriate symptomatic treatment, the patient's condition continued to worsen. The prostatic origin of this condition was therefore suspected, and anti-androgenic treatment was started on day 9 (1,200 mg.day-1 ketoconazole and 2,000 mg.day-1 sodium fosfestrol). Within 48 h, the patient had began to recover in quite a spectacular manner. Ketoconazole starts blocking steroid synthesis within 4 h of giving it. This treatment can be used until oestrogen therapy starts having an effect (about one week). The low levels of testosterone in this case, before starting treatment, suggest that ketoconazole acted on the DIC by a possible cytotoxic effect on the carcinomatous cells.
对一名患有播散性前列腺癌的53岁男性门诊患者进行了前列腺活检。两天后，他因严重急性贫血（血红蛋白：48 g.l-1）和肉眼血尿入院。生物学检查显示为弥散性血管内凝血（DIC）。进行了对症治疗（输注浓缩红细胞、血小板、新鲜冰冻血浆和纤维蛋白原）。然而，患者病情恶化，48小时后被收入重症监护病房。尽管进行了适当的对症治疗，患者病情仍继续恶化。因此怀疑该病起源于前列腺，并在第9天开始抗雄激素治疗（酮康唑1200 mg/天和磷酸雌二醇氮芥钠2000 mg/天）。48小时内，患者开始以相当惊人的方式康复。酮康唑给药后4小时内开始阻断类固醇合成。这种治疗可一直使用到雌激素治疗开始起效（约一周）。在开始治疗前，该病例中的睾酮水平较低，提示酮康唑可能通过对癌细胞的细胞毒性作用对DIC产生影响。
