Kyhälä Lea, Lindström Outi, Kylänpää Leena, Mustonen Harri, Puolakkainen Pauli, Kemppainen Esko, Tallgren Minna, Pettilä Ville, Repo Heikki, Petäjä Jari
a Department of Surgery , University of Helsinki and Helsinki University Hospital , Helsinki .
b Intensive Care Units, Department of Anesthesia and Intensive Care Medicine , Helsinki University Central Hospital , Helsinki .
Scand J Clin Lab Invest. 2016;76(1):10-6. doi: 10.3109/00365513.2015.1084041. Epub 2015 Sep 24.
Activated protein C (APC), an endogenous anticoagulant, has antithrombotic, fibrinolytic and anti-inflammatory properties. We recently conducted a controlled study (APCAP, activated protein C in severe acute pancreatitis) of APC treatment of patients with severe acute pancreatitis (SAP). Here we studied the effect of APC on the pivotal coagulation parameters of the surviving patients in the APCAP study.
The study consisted of 20 patients of whom 10 patients had received APC and 10 patients had received placebo. Coagulation parameters, physiological anticoagulants, thrombograms and circulating levels of IL-6 and CRP were determined on admission and at days 1, 3-4 and 6-7.
During follow-up, the temporal levels of prothrombin time (PT) decreased and the temporal levels of thromboplastin time (TT) increased in placebo group (p< 0.001 for both), but not in APC group. The temporal levels of antithrombin (AT) increased less in APC group than in placebo group (p = 0.011). The shapes of the SAP patients' thrombograms were strongly deranged and were marginally affected by APC treatment.
Coagulopathy in SAP, a complex phenomenon, is not alleviated by APC treatment. Rather, the patients receiving APC are heading toward normal homeostasis of coagulation slower than patients receiving placebo.
活化蛋白C（APC）是一种内源性抗凝剂，具有抗血栓形成、纤维蛋白溶解和抗炎特性。我们最近进行了一项关于APC治疗重症急性胰腺炎（SAP）患者的对照研究（APCAP，即重症急性胰腺炎中的活化蛋白C）。在此，我们研究了APC对APCAP研究中存活患者关键凝血参数的影响。
该研究包括20名患者，其中10名患者接受了APC治疗，10名患者接受了安慰剂治疗。在入院时以及第1天、第3 - 4天和第6 - 7天测定凝血参数、生理性抗凝剂、血栓图以及IL - 6和CRP的循环水平。
在随访期间，安慰剂组的凝血酶原时间（PT）随时间下降，凝血活酶时间（TT）随时间增加（两者p均<0.001），而APC组则不然。APC组抗凝血酶（AT）随时间的增加幅度小于安慰剂组（p = 0.011）。SAP患者血栓图的形状严重紊乱，APC治疗对其影响较小。
SAP中的凝血病是一种复杂现象，APC治疗并不能缓解。相反，接受APC治疗的患者比接受安慰剂治疗的患者更慢地趋向于正常的凝血稳态。
