Hammar H, Sverdrup B, Borglund E, Blombäck M
Acta Derm Venereol. 1985;65(6):495-503.
Necrotizing fasciitis (NF) is a grave infection of the skin leading to gangrene of the integument and often having a complicated and prolonged course. Studies on blood coagulation and fibrinolysis were done in 15 patients with NF and compared with 5 cases of erysipelas (E). In both conditions local fibrin deposition occurred initially in their course, but it was quantitatively more pronounced in NF than in E. Fibrinolysis decreased and stayed low at the site of NF up to 5 months (median) after discharge from hospital. Fibrinogen and activities of several plasma serine proteinases modifying coagulation were increased during the course of both diseases and even at the follow-up. Factor XII was decreased during the first week in E but a transient drop was present in NF only on days 3 and 4. The treatment of NF consists of high doses of appropriate antibiotics instituted early in its course. A beneficial effect of 300-500 IU heparin/kg/day was suggested from this open study. The hard induration preceding the appearance of skin gangrene was inhibited, if heparin was given early in the course of NF. We conclude that the enhanced fibrin deposition and vascular occlusions in the skin are the basis for most complications present in NF.
坏死性筋膜炎（NF）是一种严重的皮肤感染，可导致皮肤坏疽，病程往往复杂且迁延。对15例坏死性筋膜炎患者进行了凝血和纤溶研究，并与5例丹毒（E）患者进行了比较。在这两种疾病中，局部纤维蛋白沉积在病程初期均会出现，但在坏死性筋膜炎中其数量上比丹毒更明显。坏死性筋膜炎患者出院后长达5个月（中位数），其纤维蛋白溶解减少并维持在较低水平。在两种疾病的病程中甚至随访期间，纤维蛋白原和几种影响凝血的血浆丝氨酸蛋白酶的活性均升高。在丹毒患者中，因子 XII 在第一周降低，但仅在坏死性筋膜炎患者的第3天和第4天出现短暂下降。坏死性筋膜炎的治疗包括在病程早期使用高剂量的合适抗生素。这项开放性研究表明，每天给予300 - 500 IU/kg的肝素具有有益效果。如果在坏死性筋膜炎病程早期给予肝素，可抑制皮肤坏疽出现之前的硬性硬结。我们得出结论，皮肤中纤维蛋白沉积增加和血管闭塞是坏死性筋膜炎中大多数并发症的基础。
