Serum albumin levels anticipate antithrombin III activities before and after antithrombin III agent in critical patients with disseminated intravascular coagulation
Serum albumin levels anticipate antithrombin III activities before and after antithrombin III agent in critical patients with disseminated intravascular coagulation
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DOI：
10.1097/01.shk.0000239762.90335.68
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发表时间：
2007-02-01
期刊：
影响因子：
3.1
通讯作者：
Kikuchi, Satoshi
中科院分区：
文献类型：
--
作者：
Aibiki, Mayuki;Fukuoka, Noriyasu;Kikuchi, Satoshi
凝血酶-抗凝血酶复合物（TAT）升高或血清白蛋白水平降低表明弥散性血管内凝血（DIC）中血管通透性升高。在这种情况下，血浆抗凝血酶 III (AT-III) 可能会因泄漏而减少。因此，我们在 20 名连续的 DIC 患者中检查了 AT-III 药物给药前后 AT-III 活性是否随血浆 TAT 和/或血清白蛋白水平而变化。我们还使用二室模型分析了 AT-III 的药代动力学。 AT-III 给药前的血清白蛋白水平与给药前和给药后的 AT-III 活性相关，但 TAT 水平则不然。无论 TAT 水平如何，第三天的 AT-III 波谷活性显着增加。在白蛋白水平为2.5 g/dL或更低的患者中，第三天的AT-III谷水平显着低于白蛋白水平较高的患者。患者体内 AT-III 药物分布相的半衰期缩短至先天性 AT-III 缺陷报告值的三分之一以下，表明急性状态患者的血管通透性增加。与之前的对照相比，药剂的分布量显着增加。我们在此首次报道，在危重 DIC 患者中，AT-III 给药前后的血浆 AT-III 水平可以通过预先给药的血清白蛋白水平来预测，但不能通过 TAT 来预测。这些发现可以通过在危重患者中观察到的药代动力学特征、血管通透性和分布体积增加来解释。
Elevated thrombin-antithrombin complex (TAT) or decreased serum albumin levels suggest heightened vascular permeability in disseminated intravascular coagulation (DIC). In such a situation, plasma antithrombin III (AT-III) may decrease because of the leakage. We thus examined whether AT-III activity before and after administration of an AT-III agent changed depending on plasma TAT and/or serum albumin levels in 20 consecutive patients with DIC. We also analyzed the pharmacokinetics for AT-III using a two-compartment model. Serum albumin levels before AT-III administration correlated with preadministered and postadministered AT-III activity, but TAT levels did not. Regardless of TAT levels, AT-III trough activity on the third day increased significantly. In patients with albumin levels of 2.5 g/dL or less, AT-III trough levels on the third day were significantly lower than those with higher levels of albumin. The half-life of the distribution phase for AT-III agent in the patients was shortened to less than one third the value reported in congenital AT-III deficiency, suggesting increased vascular permeability in the acute state patients here. The distribution volume of the agent increased remarkably compared with the previous control. We report here for the first time that in critical patients with DIC, plasma AT-III levels before and after AT-III administration could be predicted by preadministered serum albumin levels, but not by TAT. These findings could be explained by the pharmacokinetic profile, increased vascular permeability and distribution volume, observed in critical patients.