弥散性血管内凝血的发病机制及药物治疗进展

Pathogenesis and Drug Treatment Progress of Disseminated Intravascular Coagulation

弥散性血管内凝血(DIC)是一种以全身凝血激活为特征的获得性凝血功能紊乱综合征,是与感染性疾病、恶性肿瘤及产科手术相关的严重并发症,新型冠状病毒感染(COVID-19)的重症患者亦有相伴发生DIC的临床报道。DIC发病机制复杂,涉及凝血、免疫炎症、纤维蛋白溶解等多个系统的共同作用,导致机体凝血-抗凝-纤溶系统失调,大量微血管血栓生成,最终诱发出血、多器官衰竭等症状。该病起病急、进展快、患者死亡率高,属于临床危重综合征之一。国际血栓与止血协会(ISTH)诊治指南推荐肝素/低分子肝素、重组人活化蛋白C、抗凝血酶、重组人血栓调节蛋白等用于DIC的抗凝治疗。此外,中药(血必净注射液、复方丹参注射液、血府逐瘀汤等)以其独特的优势和特色,在DIC的治疗方面也发挥着重要作用。通过对近年来DIC发病机制及药物治疗进展进行分析和综述,以期为DIC的临床药物治疗提供参考。

Disseminated intravascular coagulation(DIC),a serious complication associated with infectious diseases,malignancies,and obstetric procedures,is an acquired coagulation disorder syndrome characterized by systemic coagulation activation.DIC associated with critically ill patients with COVID-19 has also been reported in clinical practice.The pathogenesis of DIC is complex,involving the joint action of coagulation,immune inflammation,fibrinolysis and other systems,resulting in the dysregulation of the coagulationanticoagulation-fibrinolysis system of the body and the generation of a large number of microvascular thrombi,which will eventually induce bleeding,multi-organ failure and other symptoms.DIC is one of the critical clinical syndromes with an acute onset,rapid progression and high patient mortality.The ISTH guidelines recommend heparin/low-molecular heparin,recombinant human activated protein C,antithrombin,and recombinant human thrombomodulin for the anticoagulation treatment of DIC.In addition,Chinese medicines(Xuebijing Injection,Compound Danshen Injection,and Xuefu Zhuyu Decoction,etc.)also play an important role in the treatment of DIC with their unique advantages and characteristics.This article analyzes and reviews the pathogenesis of DIC and the progress of medical therapy in recent years to provide reference for the clinical drug treatment of DIC.