不同剂量肝素对脓毒症患者血栓烷B2／6-酮-前列腺素F1α的影响及意义研究  

The changes and clinical significance of the thromboxane B2 and 6 - keto - prostaglandin F1α alpha in different dose of heparin therapy for septic patients

作　　者：刘超[1] 李建华[1] 程青虹[1] 

机构地区：[1]石河子大学医学院第一附属医院ICU,新疆石河子832008

出　　处：《中国急救医学》2014年第1期39-43,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨不同剂量肝素对脓毒症患者血栓烷B2（TXB2）／6-酮-前列腺素F1α（6-keto—PGF1α）表达的影响。方法将符合纳入标准的75例脓毒症患者随机分为脓毒症对照组（sE组）、脓毒症小剂量肝素抗凝组（UFH组）、脓毒症低分子肝素钠抗凝组（LMWH组），并选择同期门诊体检者25例为空白对照组（s组），分别抽血检测TXB2、6-keto—PGF1α血小板（PLT）计数、凝血酶原时间（PT）、活化部分凝血活酶时间（Am）、凝血酶时间（TT）、纤维蛋白原（FIB）及D-二聚体（D—dimer），并计算当日急性生理和慢性健康状况评分Ⅱ（APACHEII）、28d病死率。结果与S组比较，sE组TXB2、6-keto—PGF1α表达均显著增加（P〈0．05）。与S组比较，UFH组和LMWH组随着时间的延长TXB2表达、TXB2／6-keto—PGF1α比值及APACHElI评分均下降，第7、10天与第1、4天比较差异有统计学意义（P均〈0．008）；APACHEII评分第10天与第1天比较差异有统计学意义（P〈0．008）。与sE组比较，UFH组、LMWH组TXB：表达、TXB：／6-keto—PGF1α比值在第7、10天差异有统计学意义（P均〈0．008）。UFH组和LMWH组28d病死率为24％（6／25）和24％（6／25），较SE组32％（8／25）降低，但差异无统计学意义（P〉0．05）。相关性分析显示，入院时TXB2表达和APACHEⅡ评分呈正相关（r为0．674，P〈0．05）。结论小剂量肝素持续泵入可显著抑制TXB2表达及降低TXB2／6-keto—PGF1α比值，刺激6-keto—PGF1α的生成，TXB2、6-keto—PGF1α较常规凝血功能指标能更敏感地反映凝血功能紊乱。Objective To investigate the dynamic changes and clinical significance of 6 - keto - prostaglandin F1α （6 - keto - PGF1α ） and throm - boxane B2 （ TXB2 ） in septic patients treated with different dose of heparin. Methods In this randomized controlled trial, 75 septic patients who met with the inclusion criteria were randomly divided into three groups ： septic control group （ SE group）, anticoagulation control group of low- dose uniform heparin （UFH group）, anticoagulation control group of low molecular weight heparin （ LMWH group）. At the same time, 25 healthy people came to hospital for physical examination were enrolled into normal control group （S group）. The levels of TXB2 and 6 - keto - PGF1α, platelet （ PLT）, prothrombin time （ PT）, activated partial thromboplastin time （ APTF）, fibrinogen （FIB）, D- dimer （D- dimer） were determined, the score of acute physiology and chronic health evaluation Ⅱ （ APACHE Ⅱ ） were calculated and 28 - day mortality was recorded. Results The expression levels of TXB2, 6 - keto - PGF1α were higher in SE group compared with those in S group, and the difference was statistically significant （ P 〈 0.05 ）. The 6 - keto - PGF1α and thromboxane BE levels and APACHE II in anticoagulation group decreased as the time went on. The differences of TXB2were significant between the results on the day 7,10 and those on the first and fourth day （ all P 〈 O. 008）. The differences of APACHE I1 were significant between the results on the day l0 and those on the first day （P 〈 O. 008）. Compared to S group, the TXB2 and the ratio of T/K in UFH and LMWH groups were significant difference on the day 7 and 10 （ all P 〈 0. 008 ）. 28d mortalities in UFH group and LMWH group were 24% （6/25） and 24% （6/25）, respectively, but were not significantly decreased versus S group, 32% （8/25） （ P 〉 O. 05 ）. The correlation of TXB2 with APACHE 11 score was analyzed in anticoagulation groups, and positive correlations

关 键 词：脓毒症 血栓烷B2(TXB2) 6-酮-前列腺素F1α(6-keto—PGF1α) 抗凝治疗 凝血功能指标 

分 类 号：R544.1[医药卫生—心血管疾病]