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Endothelial cell rescue therapy of multiorgan failure after severe sepsis

严重脓毒症后多器官衰竭的内皮细胞挽救治疗

基本信息

批准号：
22390337
负责人：
ISOTANI Eiji
金额：
$ 5.41万
依托单位：
Tokyo Women's Medical University (2011-2012)Tokyo Medical and Dental University (2010)
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (B)
财政年份：
2010
资助国家：
日本
起止时间：
2010 至 2012
项目状态：
已结题

项目摘要

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

简介：重组人可溶性血栓调节蛋白（rTM）不仅可以通过激活蛋白C逆转高凝状态，而且可以预防多器官功能衰竭。rTM可改善脓毒症和DIC患者的生理评分和介质量，并降低28天内的死亡率。我们开始了一项新的方案，增加了败血症和弥散性血管内凝血患者的rTM。材料与方法：收集2008年5月至10月收治的21例DIC合并脓毒症患者的临床资料并进行分析。我们的主要终点是28天内的死亡率。作为复合结局，我们随访了10天内的急性生理学和慢性健康评估（APATCHE II）评分、序贯器官衰竭评估（SOFA）评分、急性期DIC评分和血清可溶性血栓调节蛋白、TNF-α、IL-1β、IL-6、HMGB-1、蛋白C、蛋白S水平。通过Wilcoxon秩和检验进行统计学分析。结果：rTM治疗后第10天各项评分及介质均较治疗前明显改善，但第28天无明显改善。各评分或死亡率的中位数如下：APATCH II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DIC评分：5分至3分（p