周围动脉硬化闭塞病凝血功能变化及华法林的应用  

Variation of coagulation function in patients with peripheral arterial occlusive disease and the application of warfarin

作　　者：陈才旺 王延梅 曲德军 王荣彩 

机构地区：[1]辽宁省本溪市中心医院干诊科,117000

出　　处：《中国临床研究》2013年第3期213-215,共3页Chinese Journal of Clinical Research

摘　　要：目的探讨周围动脉硬化闭塞病(PAOD)血液高凝状态和临床的关系,以及华法林的治疗作用。方法对2007年2月至2010年10月收治的78例PAOD病人(随机分为基线资料匹配的华法林组36例与阿司匹林组42例)进行观察,并和同期无周围动脉病变的34例病人(对照组)做比较,比较血浆D-二聚体(D-Dimer)、血管性假血友病因子(vWF)浓度的变化,及在综合治疗基础上给予华法林的疗效。D-Dimer采用乳胶凝集法、vMF采用免疫火箭电泳法检测。结果 (1)PAOD病人和对照组相比,基础D-Dimer和vMF浓度均升高[(0.68±0.13)vs(0.25±0.07)mg/L,P<0.05;(180.76±29.25)%vs(116.68±32.69)%,P<0.05]。(2)阿司匹林组治疗后的血浆D-Dimer[(0.61±0.11)mg/L]与其基础水平相比无统计学差异(P>0.05),vMF[(155.84±26.43)%]较基础水平明显降低(P<0.05);华法林组治疗后的血浆D-Dimer[(0.37±0.08)mg/L]及vMF[(126.82±25.88)%]较基础水平均明显降低(P均<0.05),且二者均低于阿司匹林组治疗后(P均<0.05)。(3)治疗后主要和次要终点事件合计发生率,华法林组比阿司匹林组有所降低(14.3%vs5.6%),但差异无统计学意义(P>0.05)。华法林改善血液高凝状态的作用明显优于阿司匹林。结论 PAOD病人存在凝血功能的紊乱,提示其血栓前状态参与了病情的进展和恶化;华法林可改善血液高凝状态,因此给予华法林,可能会对病情的控制起到一定的作用。Objective To explore the relationship between blood hypercoagulable state and clinical manifestation in peripheral arterial occlusive disease （PAOD） and the efficacy of warfarin. Methods A total of 78 patients with PAOD treated between February 2007 and October 2010 were included in this study. The PAOD patients were randomly divided into basic data-matched two groups ： wafarin group （ n = 36 ） and aspirin group （ n = 42）, and 34 patients without PAOD in corresponding period at outpatient department were selected as control group. The changes of plasma concentrations of D-Dimer and yon willebrand factor （vWF） were compared, and the effectiveness of warfarin on the basis of comprehensive was observed. D-Dimer was detected by latex agglutination test, and vWF was detected by rocket immunoelectrophoresis. Results （ 1 ） Compared with control group,the plasma concentrations of D-Dimer and vWF in patients with POAD before treatment were significant higher[ （0.68 ± 0.13 ） vs（O. 25 ±0.07） mg/L,P 〈0.05; （ 180.76 ±29.25）% vs（ 116.68 ±32.69）% ,P 〈 0.05]. （2） In aspirin group, there was no significant difference in the levels of D-Dimer before and after treatment [ （0.68 ± 0.13 ）vs （0. 61 ± 0. 11 ） mg/L, P 〉 0.05 ], while vWF level after treatment obviously decreased compared with basic level [ （ 155.84± 26.43 ） % vs （ 180.76 ± 29.25 ） %, P 〈 0.05 ]. In the wafarin group, all the D-Dimer and vWF levels after treatment dropped significantly compared with the basic levels [ （0.37 ±0. 08 ） vs （ O. 68 ± 0.13 ） mg/L, P 〈 0.05 ; （ 126.82 ± 25.88 ） % vs （ 180.76 ± 29.25 ） % , P 〈 0.05 ] , and both of them were lower than those in aspirin after treatment （ all P 〈 0.05 ）. （ 3 ） Compared with aspirin group, the overall incidence of major and secondary endpoint events after treatment in wafarin group was lower,but there was no statistic difference between two groups（ 14.3% vs 5.6% ,P 〉 0. 05 ）. The effects of improving blo

关 键 词：动脉硬化闭塞病 周围 D-二聚体 血管性假血友病因子 华法林 阿司匹林 

分 类 号：R543.5[医药卫生—心血管疾病]