重组可溶性血栓调节蛋白治疗与重症急性胆管炎相关弥散性血管内凝血的临床影响。
Clinical Impact of Recombinant Soluble Thrombomodulin for Disseminated Intravascular Coagulation Associated with Severe Acute Cholangitis.
机构信息
Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan.
出版信息
Gut Liver. 2018 Jul 15;12(4):471-477. doi: 10.5009/gnl17489.
BACKGROUND/AIMS: Recently, recombinant human soluble thrombomodulin (rTM) has been developed as a new drug for disseminated intravascular coagulation (DIC). This study aims to evaluate the clinical benefit of rTM in patients with sepsis-induced DIC caused by acute cholangitis who underwent biliary drainage.
METHODS
Patients were divided into two groups: the rTM therapy group and the non-rTM therapy group. The primary outcome was the DIC resolution rate at 7 days, and the secondary outcome was 28-day mortality rate.
RESULTS
Thirty-five patients were treated by rTM, and 36 patients were treated without rTM for DIC. The rate of resolution of DIC at day 7 was significantly higher in the rTM group than in the non-rTM group (82.9% vs 55.6%, p=0.0012). Compared with the non-rTM group, the 28-day survival rate of the r-TM group was significantly higher (rTM vs non-rTM, 91.4% vs 69.4%, p=0.014). According to multivariate analysis, non-rTM (hazard ratio [HR], 2.681) and CRP (HR, 2.370) were factors related to decreased survival.
CONCLUSIONS
rTM treatment may have a positive impact on improving DIC and survival rates in patients with severe acute cholangitis.
背景/目的：最近，重组人可溶性血栓调节蛋白（rTM）已被开发为弥漫性血管内凝血（DIC）的新药。本研究旨在评估 rTM 在接受胆道引流的由急性胆管炎引起的脓毒症诱导的 DIC 患者中的临床获益。
方法
患者分为 rTM 治疗组和非 rTM 治疗组。主要结局是 7 天 DIC 缓解率，次要结局是 28 天死亡率。
结果
35 例患者接受 rTM 治疗，36 例患者接受非 rTM 治疗 DIC。rTM 组 DIC 缓解率在第 7 天明显高于非 rTM 组（82.9% vs 55.6%，p=0.0012）。与非 rTM 组相比，r-TM 组 28 天生存率明显更高（rTM 组 vs 非 rTM 组，91.4% vs 69.4%，p=0.014）。多变量分析显示，非 rTM（风险比 [HR]，2.681）和 CRP（HR，2.370）是与生存率降低相关的因素。
结论
rTM 治疗可能对改善严重急性胆管炎患者的 DIC 和生存率有积极影响。
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