阿司匹林或华法林治疗对非瓣膜病持续性心房颤动患者凝血-纤溶指标影响及安全性  

Study of aspirin or warfarrin treatment to coagulation and fibrinolysis indexes and security in nonvalvular atrial fibrillation

作　　者：李曦[1] 谢英[1] 赵瑞祥[1] 张维君[1] 温绍君[1] 周玉杰[1] 张妍[1] 程秀琴[1] 张文[1] 彭新界[1] 王龙华[1] 刘洁琳[1] 郭永和[1] 

机构地区：[1]首都医科大学附属北京安贞医院心内科,北京100029

出　　处：《临床心血管病杂志》2007年第10期754-758,共5页Journal of Clinical Cardiology

基　　金：卫生部保健专项科研基金(No:2001-012)

摘　　要：目的:探讨阿司匹林(150mg/d)、调整剂量华法林[国际标准化比值(INR)1.5～2.5]治疗对中老年非瓣膜病持续性心房颤动(Af)患者凝血-纤溶功能的作用。方法:106例非瓣膜病持续性Af患者随机给予阿司匹林(150mg/d)或调整剂量华法林治疗1年。于治疗前、治疗后6个月和12个月,采用免疫比浊法测定D-二聚体(D-Dimer)水平,采用酶联免疫吸附双抗体夹心法(ELISA法)测定组织型纤溶酶原激活物(t-PA)和纤溶酶原激活剂抑制物(PAI-1)水平,进行前后比较分析。对可能影响D-Dimer、t-PA和PAI-1变化的因素,包括年龄、性别、体质指数、血小板数、肌酐、尿酸、血糖、TC、TG、凝血-纤溶指标治疗前水平和抗凝药物等因素进行Pearson相关分析和多元线性回归分析。随访中观察有无血栓栓塞和出血并发症发生。结果:①阿司匹林(150mg/d)治疗12个月后PAI-1水平显著降低,与治疗前比较,差异有统计学意义[(77.92±12.99)∶(84.86±18.97)μg/L],P<0.05),但对D-Dimer、t-PA无影响。华法林治疗6个月、12个月后D-Dimer均显著降低[分别为(0.10±0.08)、(0.11±0.08)mg/L]与治疗前[(0.17±0.09)mg/L]比较,均P<0.05;治疗12个月后PAI-1水平较治疗前亦显著降低[(77.13±18.53)∶(87.58±19.94)μg/L,P<0.05],但对t-PA无影响。②Pearson相关分析发现,治疗前后D-Dimer、t-PA和PAI-1的变化幅度均与其各自治疗前水平呈正相关,D-Dimer的变化幅度还与体质指数呈正相关,PAI-1的变化幅度还与TG呈正相关。多元线性回归分析也发现,治疗前D-Dimer、t-PA和PAI-1的水平是影响药物治疗后各指标变化幅度的主要因素。③随访期间无血栓栓塞和严重出血并发症发生。结论:阿司匹林(150mg/d)或调整剂量华法林均能不同程度地改善非瓣膜病Af患者的高凝低纤溶状态,治疗是安全的。Objective： To investigate changes of plasma coagulation and fibrinolysis indexes after aspirin or dose-adjusted warfarrin anticoagulation treatment in middle-old age patients with nonvalvular atrial fibrillation. Method：The 106 middle-old aged nonvalvular atrial fibrillation patients had been treated randomly by aspirin（150 mg/d） or dose-adjusted warfarrin（INR1.5-2.5）for one year. The levels of D-Dimer were measured by immune turbidimetry and the levels of t-PA and PAI-1 were measured by enzyme linked immunoadsorbent assay（ELISA） before anticoagulation treatment, after anticoagulation treatment 6 month and 12 month. The changes of plasma coagulation and fibrinolysis indexes between before and after anticoagulation were analyzed with pearson correlation and multiple regression including sex, age, BMI, thrombocyte count, creatinine, uric acid, blood suger, triglyceride, cholesterol , the levels of coagulation and fibrinolysis indexes before anticoagulation treatment. Thromboembolism or hemorrhage was observed. Result： ①The levels of PAI-1 （[84.86±18.97] μg/L before vs [77.92± 12.99]μg/L 12month,P〈0.05） not D-Dimer and t-PA, were reduced by aspirin （150 mg/d）. The levels of D-Dimer（[0.17 ± 0. 09] mg/Lbefore vs [0. 10±0.08] mg/L 6 month vs [0.11± 0.08] mg/L 12 month）,PAI-1 （[87.58±19.94] μg/L before vs [77.13± 18.53]/2g/L 12 month）, not t-PA were reduced by dose-adjusted warfarrin（INR 1.5- 2.5）. ② After analysis of pearson correlation, the changes of D-Dimer, t-PA, were correlated positively with those before anticoagulation treatment. The change of D-Dimer was correlated positively with BMI.The change of PAI-1 was correlated positively with triglyceride. The levels of D-Dimer,t-PA,PAI-1 before anticoagulation treatment affected the changes of coagulation and fibrinolysis indexes with analysis of multiple regression. ③There was no thromboembolism or hemorrhage found during the study. Conclusion：The hypercoagulation and hypofibrinolysis state could been improve

关 键 词：心房颤动 阿司匹林 华法林 D-二聚体 组织型纤溶酶原激活物 纤溶酶原激活剂抑制物 

分 类 号：R541.7[医药卫生—心血管疾病]