严重脓毒症中抗凝对炎症的调节作用
Anticoagulant modulation of inflammation in severe sepsis.
作者信息
Allen Karen S, Sawheny Eva, Kinasewitz Gary T
机构信息
Karen S Allen, Eva Sawheny, Gary T Kinasewitz, Section of Pulmonary and Critical Care, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, United States.
出版信息
World J Crit Care Med. 2015 May 4;4(2):105-15. doi: 10.5492/wjccm.v4.i2.105.
Inflammation and coagulation are so tightly linked that the cytokine storm which accompanies the development of sepsis initiates thrombin activation and the development of an intravascular coagulopathy. This review examines the interaction between the inflammatory and coagulation cascades, as well as the role of endogenous anticoagulants in regulating this interaction and dampening the activity of both pathways. Clinical trials attempting to improve outcomes in patients with severe sepsis by inhibiting thrombin generation with heparin and or endogenous anticoagulants are reviewed. In general, these trials have failed to demonstrate that anticoagulant therapy is associated with improvement in mortality or morbidity. While it is possible that selective patients who are severely ill with a high expected mortality may be shown to benefit from such therapy, at the present time none of these anticoagulants are neither approved nor can they be recommended for the treatment of sepsis.
炎症与凝血紧密相连，以至于脓毒症发展过程中伴随的细胞因子风暴会引发凝血酶激活和血管内凝血病的发展。本综述探讨了炎症级联反应与凝血级联反应之间的相互作用，以及内源性抗凝剂在调节这种相互作用和抑制两条途径活性方面的作用。对试图通过使用肝素和/或内源性抗凝剂抑制凝血酶生成来改善重症脓毒症患者预后的临床试验进行了综述。总体而言，这些试验未能证明抗凝治疗与死亡率或发病率的改善相关。虽然有可能那些病情严重、预期死亡率高的特定患者可能会从这种治疗中获益，但目前这些抗凝剂均未获批，也不能推荐用于脓毒症的治疗。
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