Nhiễm trùng huyết và đông máu nội mạch lan tỏa

Springer Science and Business Media LLC - Tập 4 - Trang 1-8 - 2016
Kohji Okamoto1,2, Toshihisa Tamura2, Yusuke Sawatsubashi2
1Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Yahatahigashi-ku, Japan
2Department of Surgery 1, School of Medicine, University of Occupational & Environmental Health, Yahatanishi-ku, Japan

Tóm tắt

Nhiễm trùng huyết thường bị biến chứng bởi rối loạn đông máu và, trong khoảng 35% các trường hợp nặng, bởi đông máu nội mạch lan tỏa (DIC). Tại Nhật Bản, việc điều trị tích cực DIC do nhiễm trùng huyết được khuyến khích sử dụng antithrombin và thrombomodulin tái tổ hợp. Các đại thực bào, bạch cầu đơn nhân và bạch cầu trung tính là nguồn cung cấp yếu tố mô (TF) và tham gia vào việc kích hoạt trực tiếp dòng đông máu trong các giai đoạn sớm của nhiễm trùng huyết. Yếu tố kích hoạt X (FXa), liên quan đến hemostasis, hình thành huyết khối, viêm và phản ứng miễn dịch tế bào, kích thích biểu hiện TF ở bạch cầu đơn nhân ngoại vi ở người và, ngược lại, việc ức chế hoạt động của FXa làm giảm biểu hiện TF. Cả viêm và đông máu đều đóng vai trò quan trọng trong DIC do nhiễm trùng huyết. Ngoài các cytokine viêm (TNF-α, IL-1 và các loại khác), HMGB1 gần đây đã được chứng minh là trung gian gây ra giai đoạn muộn nghiêm trọng của nhiễm trùng huyết và gây ra rối loạn đông máu. TM không chỉ liên kết với HMGB1 mà còn hỗ trợ quá trình cắt đứt proteolytic HMGB1 bởi thrombin. Đã có nhiều báo cáo về hiệu quả của TM tái tổ hợp và antithrombin trong điều trị DIC do nhiễm trùng huyết từ Nhật Bản. Việc điều tra thêm về hiệu quả của TM tái tổ hợp và AT ở các quốc gia khác ngoài Nhật Bản, cũng như việc theo dõi chi phí y tế phát sinh trong quá trình nhập viện, sẽ giúp xác thực việc sử dụng TM và AT trong điều trị DIC do nhiễm trùng huyết.

Từ khóa

#Nhiễm trùng huyết #đông máu nội mạch lan tỏa #rối loạn đông máu #yếu tố mô #thrombomodulin tái tổ hợp #antithrombin #HMGB1

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