法[10]。315重组的活化因子Ⅶ(rFⅦa)Moscardo等[11]报道1例剖宫产术后腹腔内出血患者,使用冷冻血浆、纤维蛋白原、血小板输注后仍持续出血,采用rFⅦa静脉内给药后迅速起效,无不良反应,提出rFⅦa除用于治疗血友病外,也可用于与DIC有关严重、顽固出血。316凝血酶调节蛋白(TM)凝血块结合的活化凝血酶在凝血系统激活过程中起到时间及空间上的弥散作用,而TM则可与凝血酶结合成复合物并激活蛋白C,体外研究及动物模型均显示,重组人凝血酶调节蛋白(rhTM)可显著增加凝血块激活蛋白C,抑制凝血酶活性,在DIC治疗中十分有效。日本进行的临床治疗试验也已取得满意效果。317抗细胞因子治疗已有试验证明,IL21受体拮抗剂能阻断败血症DIC患者的凝血及纤溶过程。最近,Pajkrt等[12]发现具有抗炎作用的IL210可完全阻断受试者凝血与纤溶系统的改变。经过多年不断探索和研究,目前大部分典型的DIC都能为临床医生所识别和诊断,但对早期DIC的诊断仍缺乏足够的认识和及时治疗,建立一套易检测、特异性强的DIC早期诊断指标,是当今医者重点研究的项目之一。DIC治疗首当其冲是治疗原发病,同时根据DIC病理生理进程,DIC的治疗应从抗凝、补充消耗的凝血因子的替代治疗、维持生命体征的支持治疗等方面着手。随着对DIC诊治认识的深入,特别是DIC治疗措施的大规模临床试验开展,将使DIC治疗更为科学化和个体化。参考文献[1]刘泽霖,贺石林,李家增.血栓性疾病的诊断与治疗[M].第2版.北京:人民卫生出版社,2006:135.[2]DalainasI.Pathogenesis,diagnosis,andmanagementofdissemina2tedintravascularcoagulation:aliteraturereview[J].EurRevMedPharmacolSci,2008,12(1):19-31.[3]TaylorJRFB,TohCH,HootsWK,etal.Towardsdefinition,clini2calandlaboratorycriteria,andascoringsystemfordisseminatedintravascularcoagulation-onbehalfoftheScientificSubcommit2teeondisseminatedintravascularcoagulation(DIC)oftheInterna2tionalSocietyonThrombosisandHaemostasis(ISTH)[J].ThrombHaemost,2001,86:1327-1230.[4]LeviM,TenCH.Disseminatedintravascularcoagulation[J].NEnglJMed,1999,341:586-592.[5]BernardGR,VincentJL,LaterrePF,etal.RecombinanthumanProteinCworldwideevaluationinseveresepsis(PROWESS)studygroup.EfficacyandsafetyofrecombinanthumanactivatedproteinCforseveresepsis[J].NEnglJMed,2001,344:699-709.[6]AbrahamE,LaterrePF,GargR,etal.Administrationofdrotrecog2inAlfa(activated)inearlystageseveresepsis(address)studygroup.Drotrecoginalfa(activated)foradultswithseveresepsisandalowriskofdeath[J].NEnglJMed,2005,353:1332-1341.[7]KesslerCM,TangZ,JacobsHM,etal.ThesuprapharmacologicaldosingofantithrombinconcentrateforStaphylococcusaureusin2duceddisseminatedintravascularcoagulationinguineapigs:sub2stantialreductioninmortalityandmorbidity[J].Blood,1997,89:4393-4401.[8]ElsayyedYA,NakagawaK,KamikuboYI,etal.Effectsofrecombi2nanthumantissuefactorpathwayinhibitoronthrombusformationanditsinvivodistributioninaratDICmodel[J].AmJClinPathol,1996,106:574-583.[9]AbrahamE,ReinhartK,OpalS,etal.OptimistTrialStudyGroup.Efficacyandsafetyoftifacogin(recombinanttissuefactorpathwayinhibitor)inseveresepsis:arandomizedcontrolledtrial[J].JA2MA,2003,290:238-247.[10]FujitaM,IzutaniW,KomurasakiY.EffectofurinaryproteinCinhibitoronlipopolysaccharide2induceddisseminatedintravascu2larcoagulationinrats[J].ThrombHaemost,2000,84(1):54-58.[11]MoscardoF,PerezF,DeLaRJ,etal.Successfultreatmentofse2vereintra2abdominalbleedingassociatedwithdisseminatedintra2vascularcoagulationusingrecombinantactivatedfactorⅦ[J].BrJHaematol,2001,114(1):174-176.[12]PajkrtD,VanDerPT,LeviM,etal.Interleukin210inhibitsacti2vationofcoagulationandfibrinolysisduringhumanendotoxmia[J].Blood,1997,89:2701-2705.2008-07-10收稿本文编辑:刘瑾作者单位:...
