A Pathological Clarification of Sepsis-Associated Disseminated Intravascular Coagulation Based on Comprehensive Coagulation and Fibrinolysis Function.

• Material Type: 博士論文
• Title: A Pathological Clarification of Sepsis-Associated Disseminated Intravascular Coagulation Based on Comprehensive Coagulation and Fibrinolysis Function.
• Author/Editor: Onishi, Tomoko; Nogami, Keiji; Ishihara, Takashi; Inoue, Satoki; Kawaguchi, Masahiko; Nishio, Kenji; Fukushima, Hidetada; Kobayashi, Hiroshi; Amano, Itsuto; Nishikubo, Toshiya; Yamazaki, Masaharu; Kasahara, Masato; Shima, Midori
• Author Heading: Onishi, Tomoko; Nogami, Keiji; Ishihara, Takashi; Inoue, Satoki; Kawaguchi, Masahiko; Nishio, Kenji; Fukushima, Hidetada; Kobayashi, Hiroshi; Amano, Itsuto; Nishikubo, Toshiya; Yamazaki, Masaharu; Kasahara, Masato; Shima, Midori
• Publication, Distribution, etc.: Thieme
• Publication Date: 2020-09
• Publication Date (W3CDTF): 2020-09
• Alternative Title: 包括的凝固/線溶動態に基づく敗血症性DIC（播種性血管内凝固）の病態解明
• Periodical title: Thrombosis and haemostasis
• No. or year of volume/issue: 120 9
• Volume: 120
• Issue: 9
• Pages: 1257-1269
• ISSN (Periodical Title): ISSN : 0340-6245
• Degree grantor/type: 奈良県立医科大学
• Date Granted: 2021-03-15
• Dissertation Number: 甲第786号
• Degree Type: 博士（医学）
• Text Language Code: eng
• Subject Heading: disseminated intravascular coagulation; sepsis; coagulation; fibrinolysis; monitoring
• Target Audience: 一般
• Note (General): type:Thesis; Background: The functional dynamics of coagulation and fibrinolysis in patients with disseminated intravascular coagulation (DIC) vary due to the pathology and severity of various underlying diseases. Conventional measurements of hemostasis such as thrombin-antithrombin complex, plasmin-α2-plasmin-inhibitor complex, and fibrinogen-fibrin degradation products may not always reflect critical pathophysiologic mechanisms in DIC. This article aims to clarify the pathology of sepsis-associated DIC using assessment of comprehensive coagulation and fibrinolysis. Methods: Plasma samples were obtained from 57 patients with sepsis-associated DIC at the time of initial diagnosis. Hemostasis parameters were quantified by clot-fibrinolysis waveform analysis (CFWA) and thrombin/plasmin generation assays (T/P-GA). The results were expressed as ratios relative to normal plasma. Results: CFWA demonstrated that the maximum coagulation velocity (|min1|) ratio modestly increased to median 1.40 (min - max: 0.10 - 2.60) but the maximum fibrinolytic velocity (|FL-min1|) ratio decreased to 0.61 (0 - 1.19). T/P-GA indicated that the peak thrombin (Th-Peak) ratio moderately decreased to 0.71 (0.22 - 1.20), whereas the peak plasmin (Plm-Peak) ratio substantially decreased to 0.35 (0.02 - 1.43). Statistical comparisons identified a correlation between |min1| and Th-Peak ratios (ρ = 0.55, p < 0.001), together with a strong correlation between |FL-min1| and Plm-Peak ratios (ρ = 0.71, p < 0.001), suggesting that CFWA reflected the balance between thrombin and plasmin generation. With |min1| and |FL-min1| ratios, DIC was classified as follows: coagulation-predominant, coagulation/fibrinolysis-balanced, fibrinolysis-predominant, and consumption-impaired coagulation. The majority of patients in our cohort (80.7%) were coagulation-predominant. Conclusion: A pathological clarification of sepsis-associated DIC based on the assessment of coagulation and fibrinolysis dynamics may be useful for the hemostatic monitoring and management of optimal treatment in these individuals.; 博士（医学）・甲第786号・令和3年3月15日; © 2020. Thieme. All rights reserved.; This is a non-final version of an article published in final form in "http://dx.doi.org/10.1055/s-0040-1713890"; identifier:Thrombosis and haemostasis Vol.120 No.9 p.1257-1269 (2020 Sep); identifier:03406245; identifier:http://ginmu.naramed-u.ac.jp/dspace/handle/10564/3910; identifier:Thrombosis and haemostasis, 120(9): 1257-1269
• Access Restrictions: インターネット公開
• Related Material (DOI): 10.1055/s-0040-1713890
• Data Provider (Database): 国立情報学研究所 : 学術機関リポジトリデータベース（IRDB）（機関リポジトリ）; https://irdb.nii.ac.jp
• Original Data Provider (Database): 奈良県立医科大学 : 奈良県立医科大学機関リポジトリ GINMU

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