DDAVP IS NOT A PANACEA FOR CHILDREN WITH BLEEDING DISORDERS
DDAVP IS NOT A PANACEA FOR CHILDREN WITH BLEEDING DISORDERS
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DDAVP 并不是治疗出血性疾病儿童的灵丹妙药
DOI：
10.1046/j.1365-2141.2000.01814.x
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发表时间：
2000
影响因子：
6.5
通讯作者：
Sutor
中科院分区：
文献类型：
--
作者：
Sutor
Mannucci等人(1977)关于去氨加压素(DDAVP[1-去氨基-8-达氨酸加压素])在中、轻度血友病A和von Willebrand病(VWD)患者中的止血作用的历史报告是广泛的理论和临床试验的起点，这些试验迅速扩展到血友病和VWD之外。儿科医生之所以特别感兴趣，是因为DDAVP能为儿童提供下列优势：(A)它对儿童经常发生的疾病出血有效；(B)它可以鼻腔给药，因此避免了注射；(C)它没有感染物，尤其是肝炎病毒(当时还不知道艾滋病毒)；(D)它比血浆衍生因子浓缩物便宜；(E)DDAVP已被批准用作儿童的抗利尿药。因此，关于DDAVP在出血性疾病中的应用的第一次会议的组织并不令人惊讶，第一次会议的作者是儿科医生，大约在20年前(Sutor，1980)。最近的两篇综述描述了DDAVP在许多出血情况下的使用，但主要是在成人中(Lethagen，1997；Mannucci，1997)。然而，不能将其外推到儿科患者。在婴幼儿中，DDAVP的抗利尿作用增加了Risk±Bene®t比率，尤其是在DDAVP止血作用不确定的儿童(Sutor，1998a)。下面的综述试图证明DDAVP绝不是治疗出血性疾病儿童的灵丹妙药。
The historical report of Mannucci et al (1977) on the haemostatic effect of desmopressin (DDAVP [1-deamino-8-Darginine vasopressin]) in patients with moderate or mild haemophilia A and von Willebrand's disease (VWD) was the starting point for extensive theoretical and clinical trials, which rapidly expanded beyond haemophilia and VWD. Paediatricians became particularly interested because DDAVP could offer the following advantages for children: (a) it was effective in bleeding diseases that occur frequently in childhood; (b) it avoided injections as it could be administered intranasally; (c) it was free from infectious agents, especially from hepatitis virus (HIV was not then known); (d) it was less expensive than plasma-derived factor concentrates; and (e) DDAVP had already been approved for treatment of children as an antidiuretic drug. Therefore, it is not surprising that the ®rst conference on the application of DDAVP in bleeding disorders was organized, and the ®rst book was written by paediatricians, some 20 years ago (Sutor, 1980). Two recent reviews described the use of DDAVP in many haemorrhagic situations, but primarily in adults (Lethagen, 1997; Mannucci, 1997). The ®ndings, however, cannot be extrapolated to paediatric patients. In infants and small children, the antidiuretic action of DDAVP increases the risk±bene®t ratio, especially in those in whom the haemostatic action of DDAVP is doubtful (Sutor, 1998a). The following review tries to demonstrate that DDAVP is by no means a panacea for children with bleeding disorders.