[Effects of pulse-therapy on natural anticoagulant system of the endothelium in nonspecific aortoarteritis].

Aim: To investigate the influence of pulse-therapy on anticoagulant system of the endothelium in patients with nonspecific aortoarteritis.

Material And Methods: Eleven patients (9 females and 2 males, mean age 33.4 +/- 8.8 years, the disease duration 5.8 +/- 5.7 years) with nonspecific aortoarteritis were examined. 9 patients had the third anatomic type of the disease with affection of the aortic arch and abdominal aorta vessels, 2 patients had the first anatomic type with isolated affection of the aortic arch. The patients received a standard three day course of pulse-therapy (PT) with glucocorticosteroids (GCS) (metipred in a dose 1000 mg/day or dexametasone in a dose 2 mg/kg/day) with a single dose of cytostatic (CS) (cyclophosphamide in a dose 10 mg/kg b.w.) during the first infusion. Further PT consisted of monthly single infusion of GCS and CS in the above doses for 9 to 12 months. Examination of the patients was carried out before the treatment and on the treatment day 4 and 20 and follow-up month 3, 6 and 12. Estimation of clinical activity was carried out according to BVAS. Levels of protein C, S, antithrombin III were measured by ELISA in plasma. Activities of protein C, antithrombin III and plasminogen were determined by the optical assay with chromogenic substrates.

Results: Before the start of the treatment BVAS was 6.8 +/- 4.3. During the follow-up mean scores of BVAS were significantly lower than before the pulse-therapy (2.7 +/- 2.2; 2.5 +/- 3.9; 3.1 +/- 5.1; 1.8 +/- 2.6 and 1.7 +/- 1.7, respectively; p < 0.05). Prior to the treatment, a mean level of protein C was 86.6 +/- 37.5% and range of its activity 175.2 +/- 112.9%. On the fourth day after pulse-therapy a mean concentration of protein C increased (128.8 +/- 29.0%; p < 0.05) while activity of protein C tended to a decrease on the 20th day (99.2 +/- 17.6; p > 0.05). There were no significant differences in the levels of protein S, antithrombin III and its activity, activity of plasminogen in the course of PT.

Conclusion: PT has a good anti-inflammatory effect in the absence of unfavorable influence on anticoagulant system of the endothelium in patients with nonspecific aortoarteritis.