Endothelial cell rescue therapy of multiorgan failure after severe sepsis

重组人可溶性凝血调节蛋白（rTM）不仅可以通过激活蛋白C逆转高凝状态，还可以预防多器官衰竭。rTM可提高脓毒症和DIC患者的生理评分和介质的数量，降低28天的死亡率。我们开始了一个新的方案，加入rTM治疗败血症和弥散性血管内凝血患者。我们在本文中介绍了初步报告。材料与方法：2008年5月至10月，我们招募并分析了21例DIC合并脓毒症的患者。我们的主要终点是28天内的死亡率。作为综合结果，我们随访了急性生理和慢性健康评估（APATCHE II）评分、顺序器官衰竭评估（SOFA）评分、急性期DIC评分，以及10天内血清可溶性血栓调节素、TNF-α、IL-1β、IL-6、HMGB-1、蛋白C、蛋白S水平。统计学分析采用Wilcoxon秩和检验。P < 0.05为差异有统计学意义。结果：我们发现rTM给药后第10天所有评分和介质均有改善，但在第28天无显著改善。各项评分或死亡率的中位数如下：APATCH II评分：第1天至第10天的32分（p=0.0048）， SOFA评分：12至8分（p=0.0096），急性期DIC评分：5至3分（p=0.0048）

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