Konishi Hirotaka, Okamoto Kazuma, Shoda Katsutoshi, Arita Tomohiro, Kosuga Toshiyuki, Morimura Ryo, Komatsu Shuhei, Murayama Yasutoshi, Shiozaki Atsushi, Kuriu Yoshiaki, Ikoma Hisashi, Nakanishi Masayoshi, Ichikawa Daisuke, Fujiwara Hitoshi, Otsuji Eigo
Hirotaka Konishi, Kazuma Okamoto, Katsutoshi Shoda, Tomohiro Arita, Toshiyuki Kosuga, Ryo Morimura, Shuhei Komatsu, Yasutoshi Murayama, Atsushi Shiozaki, Yoshiaki Kuriu, Hisashi Ikoma, Masayoshi Nakanishi, Daisuke Ichikawa, Hitoshi Fujiwara, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kajii-cho, Kyoto city 6028566, Japan.
World J Gastroenterol. 2017 Feb 7;23(5):891-898. doi: 10.3748/wjg.v23.i5.891.
To investigate the efficacy of thrombomodulin (TM)-α for treatment of disseminated intravascular coagulopathy (DIC) in the field of gastrointestinal surgery.
Thirty-six peri-operative DIC patients in the field of gastrointestinal surgery who were treated with TM-α were retrospectively investigated. The relationships between patient demographics and the efficacy of TM-α were examined. Analysis of survival at 28 d was also performed on some parameters by means of the Kaplan-Meier method. Relationships between the initiation of TM-α and patient demographics were also evaluated.
Abscess formation or bacteremia was the most frequent cause of DIC (33%), followed by digestive tract perforation (31%). Twenty-six patients developed DIC after surgery, frequently within 1 wk (81%). TM-α was most often administered within 1 d of the DIC diagnosis (72%) and was continued for more than 3 d (64%). Although bleeding tendency was observed in 7 patients (19%), a hemostatic procedure was not needed. DIC scores, systemic inflammatory response syndrome (SIRS) scores, quick-sequential organ failure assessment (qSOFA) scores, platelet counts, and prothrombin time ratios significantly improved after 1 wk ( < 0.05, for all). The overall survival rate at 28 d was 71%. The duration of TM-α administration (≥ 4 , ≤ 6) and improvements in DIC-associated scores (DIC, SIRS and qSOFA) at 1 wk were significantly better prognostic factors for 28-d survival ( < 0.05, for all). TM-α was administered significantly earlier to patients with severe clinical symptoms, such as high qSOFA scores, sepsis, shock or high lactate values ( < 0.05, for all).
Early administration of TM-α and improvements in each parameter were essential for treatment of DIC. The diagnosis of patients with mild symptoms requires further study.
探讨血栓调节蛋白（TM）-α治疗胃肠外科领域弥散性血管内凝血（DIC）的疗效。
回顾性研究36例接受TM-α治疗的胃肠外科围手术期DIC患者。考察患者人口统计学特征与TM-α疗效之间的关系。还采用Kaplan-Meier法对部分参数进行了28天生存率分析。同时评估了TM-α起始使用与患者人口统计学特征之间的关系。
脓肿形成或菌血症是DIC最常见的原因（33%），其次是消化道穿孔（31%）。26例患者术后发生DIC，多在1周内（81%）。TM-α最常在DIC诊断后1天内给药（72%），并持续使用超过3天（64%）。虽然7例患者（19%）出现出血倾向，但无需进行止血操作。1周后DIC评分、全身炎症反应综合征（SIRS）评分、快速序贯器官衰竭评估（qSOFA）评分、血小板计数和凝血酶原时间比值均显著改善（均P<0.05）。28天总体生存率为71%。TM-α给药持续时间（≥4天、≤6天）以及1周时DIC相关评分（DIC、SIRS和qSOFA）的改善是28天生存的显著更好的预后因素（均P<0.05）。对于有严重临床症状的患者，如高qSOFA评分、脓毒症、休克或高乳酸值患者，TM-α给药显著更早（均P<0.05）。
早期给予TM-α及各参数改善对DIC治疗至关重要。症状轻微患者的诊断需要进一步研究。
