소아 파종성 혈관내 응고증에서 antithrombin Ⅲ의 치료효과

Abstract

[한글]

파종성 혈관내 응고증 (disseminated intravascular coagulation ;DIC)은 소아사망의 중요한 원인이지만 아직까지 효과적인 치료가 확립되지 않고 있다. 본 연구는 antithrombin Ⅲ의 치료효과를 조사하고 그 효과를 현재 사용되고 있는 gabexate mesilate와 비교하

고자 하였다. 대상은 1992년 1월부터 1993년 9월까지 세브란스 병원 소아과에 입원하여 DIC로 진단받은 23명으로 antithrombin Ⅲ 나 gabexate mesilate를 3일간 투여하면서 혈액 검사 및 임상경과를 추적하여 다음과 같은 결과를 얻었다.

대상환아들의 원인질환은 주로 감염 및 혈액질환이었다. 감염으로는 패혈중이 가장 많았으며(34.8%), 다음은 폐렴과 요로계 감염순이었고 혈액 질환으로는 백혈병이 가장 많았다. 약제 투여전 혈액 검사 소견상 양군간의 차이는 없었다. 3일간의 약제 투여후 각군의

혈액 검사 소견을 비교하면 antithrombin Ⅲ 투여군에서 antithrombin Ⅲ의 농도가 의의있게 증가한 것을 볼수 있었다(p<0.05). 그외에 fibrinogen 과 fibrin degradation produ

cts, DIC score(Japanese Research Committe 지침)도 antithrombin Ⅲ 투여군에서 gabexate mesilate 투여군보다 호전되는 경향을 보였으나 통계학적인 의의는 없었다. 약제투여 시간에 따른 antithrombin Ⅲ의 농도를 측정한 결과 antithrombin Ⅲ 투억군에서는 투여 시작 12시간후부터 gabekate mesilate 투여군보다 통계학적으로 의의 있게 호전이 있었다. 치료후 antithrombin Ⅲ 투여군에서는 DIC가 호전된 경우가 7명(53.8%)으로 gabexate mesilate 투여군의 4명(33.3%)보다 더 많은 수에서 호전되었다.

결론적으로 DIC 환아에서 antithrombin Ⅲ 투여군이 gabexate mesilate 투여군보다 antithrombin Ⅲ 농도가 빨리 정상화되어 혈전 형성을 예방함으로써 DIC의 호전과 치료에 도음이 된 것으로 사료되며 앞으로 더 많은 환아를 대상으로 하는 연구가 필요하리라 생각된다.

AntithroHbin Ⅲ therapy of disseminated intravasclar coagulation in children

Hye Ok Roh

Department of Medical Science The Graduate School, Yonsei University

(Directed by Professor Kir-Young Kim )

The purpose of this study is to evaluate the clinical effect of antithrombin Ⅲ

and to compare their outcomes with effect of conventionally used gabexate mesilate

in disseminated intravascular coagulation(DIC) patients. From January 1992 to

September 1993, 23 patients who were admitted to the pe야atric Department of

Severance Hospital under the diagnosis of DIC were given antithrombin Ⅲ orgabexate

mesilate for 3 days with monitoring the antithrDmbin bloodlevel. The coagulation

tests and clinical results were as follows:

1. The causative diseases of DIC were mainly infections and hematologic diseases.

Sepsis was the leading cause of infections (34.8%) followed by pneumonia and

urinary tract infeclion. Leukemia was the main part of hematologic diseases.

2. There were no differences in the hematologic laboratory findings between the

two groups before the treatment. After 3 days of treatment antithrombin Ⅲ level

were significantly higher in antithrombin Ⅲ treatedgroup compared to gabexate

mesilate treated group(p<0.05). Fibrinogen and fibrin degradation products and DIC

score showed same improvements in antithrombin Ⅲ teated group compared to gabexate

mesilate tented group, but there were no statistical significance.

3. After 12 hours of treatment, antithrombin Ⅲ treated group began to show

significant improvement in antithrombin Ⅲ level compared to gabexate mesilate

treated group(p<0.05).

4. There were 7 out of 13 (15.4%) from antithrombin Ⅲ treated group and 4 out of

12 (33.3%) from gabexate mesilate treated group improved from DIC.

In conclusion, antithrombin Ⅲ treated group showed earlier normalization of

antithrombin Ⅲ level which could be the effect of the prevention of thrombus

formation and produce better improvements in DIC treatment in children.

[영문]

The purpose of this study is to evaluate the clinical effect of antithrombin Ⅲ and to compare their outcomes with effect of conventionally used gabexate mesilate in disseminated intravascular coagulation(DIC) patients. From January 1992 to

September 1993, 23 patients who were admitted to the pe야atric Department of Severance Hospital under the diagnosis of DIC were given antithrombin Ⅲ orgabexate mesilate for 3 days with monitoring the antithrDmbin bloodlevel. The coagulation tests and clinical results were as follows:

1. The causative diseases of DIC were mainly infections and hematologic diseases.

Sepsis was the leading cause of infections (34.8%) followed by pneumonia and urinary tract infeclion. Leukemia was the main part of hematologic diseases.

2. There were no differences in the hematologic laboratory findings between the two groups before the treatment. After 3 days of treatment antithrombin Ⅲ level were significantly higher in antithrombin Ⅲ treatedgroup compared to gabexate mesilate treated group(p<0.05). Fibrinogen and fibrin degradation products and DIC score showed same improvements in antithrombin Ⅲ teated group compared to gabexate mesilate tented group, but there were no statistical significance.

3. After 12 hours of treatment, antithrombin Ⅲ treated group began to show significant improvement in antithrombin Ⅲ level compared to gabexate mesilate treated group(p<0.05).

4. There were 7 out of 13 (15.4%) from antithrombin Ⅲ treated group and 4 out of 12 (33.3%) from gabexate mesilate treated group improved from DIC.

In conclusion, antithrombin Ⅲ treated group showed earlier normalization of antithrombin Ⅲ level which could be the effect of the prevention of thrombus formation and produce better improvements in DIC treatment in children.