Affiliated Hospital of Putian University, Putian, China.
Clin Appl Thromb Hemost. 2021 Jan-Dec;27:10760296211053313. doi: 10.1177/10760296211053313.
The mortality rate of sepsis-associated disseminated intravascular coagulation (DIC) is high. This study aimed to explore the efficacy of therapeutic plasma exchange (TPE) in sepsis-associated DIC patients by improving endothelial function. A total of 112 sepsis-associated DIC patients were randomly divided into the TPE group (n = 40), the heparin (HP) group (n = 36), and the SHAM group (n = 36). The SHAM group received conventional treatment; the HP group was treated with HP based on conventional treatment; and the TPE group received conventional treatment plus TPE. The differences in thromboelastogram (TEG), platelet (PLT), coagulation function, and the endothelial cell (EC) injury biomarkers at 6 h, 24 h, 48 h, 72 h, and 7 days after TPE were compared among the three groups, and the three groups were compared in terms of Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sepsis-Related Organ Failure Assessment (SOFA) score, the length of intensive care unit (ICU) hospitalization, 28-day mortality rate, 28-day cumulative survival rate, the incidence of bleeding events, the incidence of acute kidney injury (AKI), and acute respiratory distress syndrome (ARDS). The efficacy of TPE is superior to the HP in increasing PLT, improving coagulation function, increasing the 28-day cumulative survival rate, and reducing the length of ICU hospitalization, 28-day mortality, and the incidence of bleeding events, AKI, and ARDS with statistically significant differences ( .05). Moreover, the effect of TPE outperforms HP on the EC injury biomarkers with statistically significant differences ( .05). Our results suggest that TPE may be more effective than HP in the treatment of patients with sepsis-associated DIC. The possible mechanism is via improving endothelial function.
脓毒症相关性弥散性血管内凝血（DIC）的死亡率很高。本研究旨在通过改善内皮功能来探讨治疗性血浆置换（TPE）在脓毒症相关性 DIC 患者中的疗效。共纳入 112 例脓毒症相关性 DIC 患者，随机分为 TPE 组（n=40）、肝素（HP）组（n=36）和 SHAM 组（n=36）。SHAM 组接受常规治疗；HP 组在常规治疗基础上加用 HP；TPE 组在常规治疗基础上加用 TPE。比较三组患者 TPE 后 6 h、24 h、48 h、72 h 和 7 d 的血栓弹力图（TEG）、血小板（PLT）、凝血功能及内皮细胞（EC）损伤标志物的差异，比较三组急性生理学与慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分、序贯器官衰竭评估（SOFA）评分、重症监护病房（ICU）住院时间、28 天病死率、28 天累积生存率、出血事件发生率、急性肾损伤（AKI）发生率、急性呼吸窘迫综合征（ARDS）发生率。TPE 组在增加 PLT、改善凝血功能、提高 28 天累积生存率、降低 ICU 住院时间、28 天病死率、出血事件发生率、AKI 发生率、ARDS 发生率方面均优于 HP，差异有统计学意义（ .05）。而且，TPE 在 EC 损伤标志物方面的效果优于 HP，差异有统计学意义（ .05）。我们的研究结果表明，TPE 可能比 HP 更有效地治疗脓毒症相关性 DIC 患者。其可能的作用机制是通过改善内皮功能。
