低剂量华法林治疗泛发性钙质沉着症。

Treatment of calcinosis universalis with low-dose warfarin.

作者信息

Berger R G, Featherstone G L, Raasch R H, McCartney W H, Hadler N M

出版信息

Am J Med. 1987 Jul;83(1):72-6. doi: 10.1016/0002-9343(87)90499-2.

Abstract

Patients with calcinosis universalis secondary to dermatomyositis or systemic sclerosis have increased levels of the calcium-binding amino acid, gamma-carboxyglutamic acid. The enzyme that effects gamma carboxylation of glutamic acid is warfarin-sensitive. Four patients with calcinosis universalis were treated with 1 mg per day of warfarin for 18 months in a non-blind initial study. Two patients had both decreased gamma-carboxyglutamic acid urinary concentration and decreased extra-skeletal uptake on technetium 99m-diphosphonate whole-body nuclear scanning. In a subsequent double-blind placebo study, two thirds of the patients receiving 1 mg per day of warfarin had decreases in extra-skeletal nuclear tracer uptake after 18 months, compared with none of the four patients receiving placebo. No patient had a change in clinical assessment, bleeding complication, or baseline normal prothrombin time. This low-dose warfarin regimen appears to have no demonstrable adverse effects, and these results suggest a beneficial effect on the progression of calcinosis in these rheumatic diseases.

摘要

皮肌炎或系统性硬化症继发泛发性钙质沉着症的患者，其钙结合氨基酸γ-羧基谷氨酸水平升高。影响谷氨酸γ-羧化作用的酶对华法林敏感。在一项非盲法初步研究中，4例泛发性钙质沉着症患者接受了为期18个月、每日1毫克华法林的治疗。2例患者的γ-羧基谷氨酸尿浓度降低，且99m锝二膦酸盐全身核扫描显示骨骼外摄取减少。在随后的一项双盲安慰剂研究中，每日接受1毫克华法林治疗的患者中有三分之二在18个月后骨骼外核素示踪剂摄取减少，而接受安慰剂的4例患者均未出现这种情况。没有患者的临床评估、出血并发症或基线正常凝血酶原时间发生变化。这种低剂量华法林方案似乎没有明显的不良反应，这些结果表明其对这些风湿性疾病中钙质沉着症的进展有有益作用。