Endothelial cell rescue therapy of multiorgan failure after severe sepsis

前言：预计重组人可溶性血栓调节蛋白(RTM)不仅可以通过激活蛋白C来逆转高凝状态，还可以预防多器官功能衰竭。RTM可改善脓毒症和DIC患者28天内的生理评分和介质含量，降低病死率。我们为脓毒症和弥散性血管内凝血患者增加了RTM，从而开始了一项新的治疗方案。材料与方法：收集并分析2008年5月至10月收治的21例弥漫性血管内凝血合并脓毒症患者的临床资料。我们的主要终点是28天内的死亡率。以急性生理学与慢性健康评估(APATCHE II)评分、序贯器官衰竭评分(SOFA)、急性期弥漫性血管内凝血分数(DIC)、血清可溶性血栓调节蛋白、肿瘤坏死因子-α、白介素1-β、白介素6、hMGB-1、蛋白C、S为观察指标。统计学处理采用Wilcoxon秩和检验。P&lt；0.05被认为具有统计学意义。结果：我们发现，在第10天，所有的评分和中介因子都有改善，但在第28天，没有明显的改善。各评分或死亡率的中位数如下：APATCHII评分：第1天32分至第10天26分(p=0.0048)，SOFA评分12分至8分(p=0.0096)，急性期弥漫性血管内凝血评分5分至3分(p

Introduction: It is expected that recombinant human soluble thrombomodulin (rTM) not only reverses hyper-coagulative status through activating protein C but also prevents multiple organ failure. rTM may improve both physiological scores and the amount of mediators, and reduces the mortality of sepsis and DIC patients in 28 days. We started a new protocol by adding rTM for sepsis and disseminated intravascular coagulation patients. We introduce the preliminary report in this paper.Material & Methods: We enrolled and analyzed 21 patients who were treated for DIC accompanied by sepsis from May to October 2008. Our primary endpoint was mortality in 28 days. As composite outcomes, we followed Acute Physiology and Chronic Health Evaluation (APATCHE II) score, Sequential Organ Failure Assessment (SOFA) score, acute phase DIC score, and serum soluble thrombomodulin, TNF-α, IL-1β, IL-6, HMGB-1, protein C, protein S levels during 10 days. Statistical analysis was performed by Wilcoxon rank-sum test. P < 0.05 was regarded as statistically significant.Results: We found that all scores and mediators improved after administration of rTM in Day 10, but there was no significant improvement in at 28 days. Median of each score or mortality was as follows; APATCH II score: 32 at Day 1 to 26 at Day 10 (p=0.0048), SOFA score: 12 to 8 (p=0.0096), acute phase DIC score: 5 to 3 (p