藻酸双酯钠联合利伐沙班治疗下肢深静脉栓塞并发肝素诱导血小板减少症临床研究  

Clinical observation of alginic sodium diester combined with rivaroxaban in treatment of lower limb deep vein thrombus complicated with heparin-induced thrombocytopenia

作　　者：郭俊勇[1] 温涛[2] 单泓[3] 方建华[4] GUO Junyong;WEN Tao;SHAN Hong;FANG Jlanhua(Recruitment Office;Quality Control Office;Composition of Laboratory;Clinical Laboratory,Henan Red Cross Blood Center,Zhengzhou,He＇nan 450012,China)

机构地区：[1]河南省红十字血液中心招募办公室,河南郑州450012 [2]河南省红十字血液中心质管办,河南郑州450012 [3]河南省红十字血液中心成分室,河南郑州450012 [4]河南省红十字血液中心检验科,河南郑州450012

出　　处：《安徽医药》2018年第10期1979-1982,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探究藻酸双酯钠联合利伐沙班对急性肝素诱导下肢深静脉栓塞(DVT)并发血小板减少症(HIT)患者的治疗作用。方法本研究针对河南省郑州大学第二附属医院2015年3月至2016年3月血清学确诊的82位DVT并发的急性HIT患者(4Ts评分≥4分、血小板因子4/肝素免疫测试阳性、血清素释放试验阳性),信封法随机分成对照组(利伐沙班治疗)和治疗组(藻酸双酯钠联合利伐沙班治疗),每组41例,两组均连续治疗超过30 d。观察两组患者的临床疗效,并比较两组治疗前后血小板计数变化及血小板回升时间、血栓形成的情况,同时检测用药后D-二聚体以评估药物的安全性。结果 DVT并发的急性HIT患者在治疗后,治疗组和对照组总有效率分别为97.56%和75.61%,差异有统计学意义(t=2.242,P<0.05)。血小板计数在治疗前两组差异无统计学意义(P>0.05),血小板回升时间对照组为(8.78±2.49)d,治疗组为(7.02±2.62)d,两者差异有统计学意义(t=3.113,P<0.05),而且藻酸双酯钠联合利伐沙班治疗期间未发生新的或者复发的血栓形成,而利伐沙班治疗期间有4例DVT并发急性HIT患者出现新的血栓,两组的D-二聚体均呈现下降趋势,在组间、时间及二者交互作用上均差异有统计学意义(P<0.05),且治疗组D-二聚体水平在d3、d7、d30显著低于对照组,差异有统计学意义(P<0.05),同时治疗组D-二聚体水平在d3、d7、d30与治疗前差异有统计学意义(P<0.05)。结论对于接受肝素治疗后的DVT并发的急性HIT患者,临床上可以应用藻酸双酯钠联合利伐沙班进行替代抗凝治疗。Objective To study the clinical effeCT of the alginic sodium diester tablets combined with rivaroxaban on lower limb deep vein thrombus（ DVT） complicated with heparin-induced thrombocytopenia（ HIT）. Methods Eighty-two cases with DVT complicated with acute HIT were diagnosed by the 4 Ts score ≥4 points,platelet faCTor 4/heparin immunoassay positive and serotonin-release assay positive in the Second Affiliated Hospital of Zhengzhou University,Henan Province from March 2015 to March 2016,and they were randomly assigned into control group（ administered with Rivaroxaban） and treatment group（ administered with alginic sodium diester tablets combined with rivaroxaban tablets）,41 cases in each group,and both groups were treated continuously for more than 30 days. After treatment,the efficacy was evaluated,and the changes of the blood platelet count,platelet recovery time and the event of the thrombogenesis between the two groups were compared. In addition,the D-dimer after drug administration was deteCTed so as to evaluate the safety of drugs. Results The total effeCTive rates of patients with acute HIT complicated with DVT in the control and treatment groups were 75. 61% and 97. 56%,respeCTively,and the difference was statistically significant（ t = 2. 242,P〈0. 05）. There was no different significance in the blood platelet count between the control and treatment groups before treatment（ P〉0. 05）. And blood platelet recovery time in the control group was（ 8. 78 ± 2. 49） day,while platelet recovery time in the treatment group was（ 7. 02 ± 2. 62） day,and the difference was statistically significant（ t = 3. 113,P〈0. 05）. No new or recurrent thrombosis occurred during the treatment with sodium alginate and rivaroxaban,while 4 cases with acute HIT complicated with DVT formed new thrombosis during the treatment with rivaroxaban. The D-dimer of the two groups showed a downward trend,and there were significant differences in the intergroup,time and interaCTion between the two groups�

关 键 词：血小板减少症 静脉血栓栓塞 肝素 利伐沙班 藻酸双酯钠 治疗结果 

分 类 号：R558.2[医药卫生—血液循环系统疾病]