急性腎盂腎炎に起因する敗血症性DICに対する遺伝子組み換えトロンボモジュリンの投与期間に関する検討

Clinical investigation in the period of treatment with recombinant thrombomodulin on disseminated intravascular coagulation with acute pyelonephritis

　重症敗血症では播種性血管内凝固症候群を併発することがある．われわれは，急性腎盂腎炎による敗血症性DICにおけるrTMの投与期間は急性期DIC診断基準に基づいて決定しており，その有用性を検討した．2009年4月〜2016年9月に急性腎盂腎炎による敗血症性DICと診断された27例を対象とした．急性期DIC診断基準で4点以上の患者にrTMを投与し，3点以下となった時点で投与終了とした．投与8日目でのDIC離脱率は85.2％で，最終的には全例でDIC離脱の結果が得られた．治療後の28日死亡率は14.0％で，重症合併症は認めなかった．以上より，急性期DIC診断基準に基づくrTM投与期間の設定は有用である可能性が示唆された．

Abstract

We examined the efficacy of the DIC diagnostic criteria established by the Japanese Association for Acute Medicine (JAAM DIC diagnostic criteria) for the period of treatment using recombinant thrombomodulin (rTM) for DIC caused by acute pyelonephritis. We experienced 27 cases of DIC with acute pyelonephritis from April 2009 to September 2016. Score ≧ 4 points of patients at the JAAM DIC diagnostic criteria received rTM therapy until their score decreased to 3 points.After we administrated rTM, score ≦ 3 patients discontinued the rTM. Antibiotics and drainage were performed for some patients. DIC secession rate was 85.2% at day 8 and all patients succeed in withdrawal of DIC finally. Survival rate was 14.0% on the day 28 after treatment and there were no serious adverse events. In conclusion, the setting of the period of rTM therapy according to JAAM DIC diagnostic criteria could be suitable for our clinical use (Rinsho Hinyokika 73 : 762-766, 2019).