Gazzard B G, Lewis M L, Ash G, Rizza C R, Bidwell E, Williams R
Gut. 1974 Dec;15(12):993-8. doi: 10.1136/gut.15.12.993.
To assess the value of clotting factor concentrate infusions in fulminant hepatic failure, a controlled trial was performed in which nine patients were randomly allocated to treatment with either concentrate alone or concentrate plus heparin. The five patients receiving concentrate alone all died, with major bleeding as the direct cause of death in three, whereas in the four receiving heparin as well there was only one instance of bleeding and one patient survived. Clinical evidence of intravascular coagulation appeared in two patients treated with concentrate alone and the laboratory evidence of this progressed during the period of infusions in all patients in both treatment groups, although to a lesser extent in those receiving heparin. Additional evidence for intravascular coagulation came from the changes observed in factor VIII levels which, although initially high in all patients, fell subsequently, particularly in those given concentrate alone. There was some improvement in the prothrombin ratio in both groups of patients but not complete correction, and serial assays of clotting factors showed that although factor II rose to high levels during treatment, factors IX and X showed little response. Thus, the use of concentrate of factor IX in this trial, as well as potentiating intravascular coagulation, was inadequate as replacement for the clotting factor deficiencies.
为评估凝血因子浓缩物输注在暴发性肝衰竭中的价值，进行了一项对照试验，将9名患者随机分为两组，一组仅接受浓缩物治疗，另一组接受浓缩物加肝素治疗。仅接受浓缩物治疗的5名患者全部死亡，其中3例直接死于大出血，而在同时接受肝素治疗的4名患者中，只有1例出血，1例存活。单独接受浓缩物治疗的2名患者出现了血管内凝血的临床证据，两个治疗组的所有患者在输注期间血管内凝血的实验室证据均有进展，不过接受肝素治疗的患者进展程度较小。血管内凝血的额外证据来自于观察到的因子VIII水平变化，尽管所有患者最初该水平都很高，但随后下降，尤其是仅接受浓缩物治疗的患者。两组患者的凝血酶原比值均有一定改善，但未完全纠正，凝血因子的系列检测表明，尽管治疗期间因子II升至高水平，但因子IX和X几乎没有反应。因此，在该试验中，使用因子IX浓缩物不仅会增强血管内凝血，作为凝血因子缺乏的替代治疗也并不充分。
