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Prevention and treatment of “cytokine-induced” vasculitis


To reduce the damaging effect of inflammatory mediators on the capillary endothelium, it is already shown in the first hours of treatment:
1. The use of glucocorticoids that inhibit the activity of phospholipase A, which reduces the formation of arachidonic acid from phospholipids of cell membranes damaged by hypoxia. Dosadexazone is 40-60 mg, for prednisone, 300-450 mg per day in a decreasing dose for 4-5 days.
2. Inhibition of cyclooxygenase, which potentiates the formation of hydroperoxides of lipids, prostaglandins, thromboxane (significantly damages the endothelium of capillaries thromboxane A2). Inhibition is achieved by the systematic use of non-steroidal anti-inflammatory drugs in small doses (for example, acetylsalicylic acid - 5-7 mg / kg). The simultaneous administration of a thromboxane antagonist, prostacyclin, which acts as a disaggregant, increasing the level of cAMP in platelets by potentiating (increasing the activity) of adenylate cyclase is shown. A similar effect can be obtained using dipyridamole, which also increases the level of cAMP in platelets by inhibiting phosphodiesterase.
3. Inhibition of thromboxane synthetase by the use of ibuprofen to reduce thromboxane production
four.
To prevent the negative effect of cytokines on the capillary endothelium, monocytes and enhancement of DIC, it is also recommended to prescribe toxin receptor blockers, antibodies to lipopolysaccharides of gram-negative bacteria.
The use of efferent methods
Since one of the factors that largely determine the severity of DIC is the degradation products of fibrinogen and fibrin, one of the components of corrective therapy may be hemocarboperfusion through carbon sorbents to remove them from the bloodstream. This contributes to a more effective restoration of the function of the system of mononuclear phagocytes (reticuloendothelial system), reduction of intoxication phenomena.


According to many authors, plasmapheresis with transfusion of large quantities (1-2 l) of freshly frozen plasma is the most effective treatment for chronic and acute DIC.
In septic processes, the use of concentrated anti-endotoxin gamma globulin and antibodies to leukocyte integrins to protect the vasculature of the lungs from the development of pulmonary distress syndrome and hypoxia is promising.
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Prevention and treatment of “cytokine-induced” vasculitis

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