The role of heparin and allied compounds in the treatment of sepsis
The role of heparin and allied compounds in the treatment of sepsis
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DOI：
10.1160/th07-01-0006
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发表时间：
2007-09-01
影响因子：
6.7
通讯作者：
Groeneveld, A. B. Johan
中科院分区：
文献类型：
--
作者：
Cornet, Alexander D.;Smit, Ellen G. M.;Groeneveld, A. B. Johan
凝血和炎症之间的相互作用以及脓毒症期间微血栓栓塞性疾病的倾向要求采取抗凝措施来防止组织缺氧并减轻器官损伤和功能障碍。只有一种抗凝剂重组人活化蛋白 C（aPC，drotrecogin-a）在用作人类败血症的辅助治疗时具有已被证明的生存益处，部分原因是其抗炎作用。然而，尽管抗凝治疗窗口相对较窄，但肝素（类化合物）可能发挥与 aPC 相似的有益抗炎作用。这篇叙述性综述基于 Medline 对英文发表的相关基础和临床研究的检索，讨论了肝素在治疗动物模型和人类脓毒症及其有害后遗症中调节炎症反应的潜在作用。无论如何，基于动物数据的荟萃分析结果表明，肝素（类化合物）在脓毒症治疗中具有潜在的挽救生命的作用。因此，需要进行前瞻性随机临床试验来研究对人类脓毒症的影响。
The crosstalk between coagulation and inflammation and the propensity for microthromboembolic disease during sepsis calls for anticoagulant measures to prevent tissue hypoxygenation and to attenuate organ damage and dysfunction. Only one anticoagulant, recombinant human activated protein C (aPC, drotrecogin-a) has a proven survival benefit when used as an adjunctive therapy for human sepsis, partly because of its anti-inflammatory effect. However, heparin (-like compounds) may exert similar beneficial anti-inflammatory actions as aPC, in spite of the relatively narrow therapeutic window for anticoagulation. This narrative review is based on a Medline search of relevant basic and clinical studies published in English and discusses the potential role of heparin in modulating inflammatory responses in the treatment of animal models and human sepsis and its harmful sequelae. In any case, the results of a metaanalysis based on animal data suggest a potentially life-saving effect of heparin (-like compounds) in the treatment of sepsis. Therefore, a prospective randomized clinical trial is called upon to study effects in human sepsis.