長期血栓溶解療法の効果をCT・凝固線溶系分子マーカーにより追跡しえた肺血栓塞栓症の2例

Effect of Long-term Thrombolytic Therapy in Two Cases of Massive Pulmonary Thromboembolism

　長期間のウロキナーゼ（UK）投与を行い，その血栓溶解効果を画像およびD-dimerの変化にて詳細に観察しえた肺血栓塞栓症（PTE）を経験した．症例は70歳と90歳の男性2例で，いずれも合成黄体ホルモン製剤を投与中に発症した亜急性PTE例と広範性急性PTE例である．血栓溶解療法としてUK 48万単位／日の投与が行われ，UK開始後4〜5日目頃より超高速CTにて血栓像の縮小傾向とD-dimerの著明な上昇を認めた．そこでUKを3〜5日間追加投与したところD-dimerはさらに著明に上昇したのち正常値近くに復し，血栓像はほぼ消失した．これよりPTEでは十分な血栓溶解効果を得るために長期UK投与が必要となる症例が存在することが示され，また血栓溶解効果判定の定量的な指標としてD—dimerが有用であることが示唆された．

For acute pulmonary thromboembolism, short-term thrombolytic therapy is effective for improving gas exchange, preventing pulmonary hypertension and decreasing mortality. However, for subacute or acute massive pulmonary thromboembolism, a thrombolytic regimen has not yet been established. We report cases of one subacute and one acute massive pulmonary thromboembolism treated by long-term thrombolytic therapy, both of which had been diagnosed by clinical features, perfusion lung scans and thoracic enhanced ultrafast CT. The patients received thrombolysis with 480,000 UI of urokinase (UK) daily for 10 days (in case 1) and 8 days (in case 2). D-dimer, which is thought to be an index for clot lysis, increased markedly after a five-day period of UK infusion, and findings of per-fusion lung scans and CT improved. If there are no contraindications, thrombolytic therapy performed by continuous infusion of UK for at least about one week is beneficial to achieve complete thrombolysis, and D-dimer is a useful index in thrombolytic therapy.