Recombinant Human Soluble Thrombomodulin Treatment for Acute Exacerbation of Idiopathic Pulmonary Fibrosis: A Retrospective Study.
Autor: | Isshiki, Takuma, Sakamoto, Susumu, Kinoshita, Arisa, Sugino, Keishi, Kurosaki, Atsuko, Homma, Sakae |
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Předmět: |
APACHE (Disease classification system)
BIOPSY BLOOD coagulation CELL receptors COMBINATION drug therapy CHI-squared test COMPARATIVE studies COMPUTED tomography HEMORRHAGE LACTATE dehydrogenase LONGITUDINAL method EVALUATION of medical care PROBABILITY theory RECOMBINANT proteins REGRESSION analysis RESEARCH funding PULMONARY function tests SURVIVAL analysis (Biometry) TREATMENT effectiveness PROPORTIONAL hazards models RETROSPECTIVE studies SEVERITY of illness index DISEASE exacerbation FIBRIN fibrinogen degradation products DATA analysis software MEMBRANE glycoproteins DESCRIPTIVE statistics IDIOPATHIC pulmonary fibrosis KAPLAN-Meier estimator MANN Whitney U Test SYMPTOMS PROGNOSIS DIAGNOSIS |
Zdroj: | Respiration; Mar2015, Vol. 89 Issue 3, p201-207, 7p, 3 Charts, 3 Graphs |
Abstrakt: | Background: Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) can be fatal, and abnormalities in the coagulation system of patients with AE-IPF have been reported. Recombinant human soluble thrombomodulin (rhTM) forms a complex with thrombin to inactivate coagulation. It also inhibits high-mobility group box protein 1 (HMGB-1), which results in the suppression of inflammation. Objectives: We aimed to evaluate the effectiveness of rhTM for the treatment of AE-IPF. Methods: We retrospectively reviewed the medical records of 41 patients with AE-IPF who were admitted to our institution during the period 2006-2013. The clinical features and outcomes of 16 patients treated with rhTM (rhTM group) were compared with those of 25 patients treated with conventional therapy (control group). Patients were treated with corticosteroid (CS) pulse therapy for 3 days, followed by maintenance treatment with a tapered dose of CS. Patients in the rhTM group also received rhTM (0.06 mg/kg/day) for 6 days as an initial treatment, in combination with CS. Results: Except for D-dimer level, there were no significant differences in the baseline characteristics of the 2 groups. When compared with the control group, the rhTM group had a significantly higher survival rate at 3 months (40 vs. 69%, p = 0.048). A univariate Cox proportional hazards regression model showed that the predictive factors for survival were lactate dehydrogenase level and rhTM treatment. Regarding adverse events, 1 patient in the rhTM group developed mild bleeding events. Conclusion: rhTM as an add-on to conventional treatment may improve survival in patients with AE-IPF. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR] |
Databáze: | Complementary Index |
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