依诺肝素联合乌司他丁对膝关节置换术患者血栓形成及血清RANKL OPG MMP-9水平的影响  

Effects of Enoxaparin Combined with Ulinastatin on the Thrombogenesis and Serum RANKL,OPG and MMP-9 Levels of Patients after Knee Arthroplasty

作　　者：彭雄[1] 陈嘉联 PENG Xiong;CHEN Jialian(Hanchuan People's Hospital,Hubei Hanchuan 431600,China)

机构地区：[1]湖北省汉川市人民医院骨二科,湖北汉川431600

出　　处：《河北医学》2018年第7期1096-1099,共4页Hebei Medicine

基　　金：湖北省科技计划项目;(编号:2011356)

摘　　要：目的:研究依诺肝素联合乌司他丁对膝关节置换术后血栓形成的预防作用及对血清核因子-κB受体活化因子配基(RANKL)、骨保护素(OPG)、基质金属蛋白酶-9(MMP-9)水平的影响。方法:将2015年7月至2016年6月在我院行膝关节置换术的86例患者纳入本次研究,据患者入院顺序分为观察组和对照组,43例每组。对照组在膝关节置换术基础上采取注射用依诺肝素钠进行预防治疗,观察组在对照组基础上加以乌司他丁治疗。比较两组患者治疗前后血清PANKL、OPG、MMP-9水平、凝血功能指标的变化,术后血栓形成情况及不良反应的发生情况。结果:术后3个月,两组患者血清PANKL、OPG、MMP-9水平均较术前显著降低(P<0.05),而与对照组相比,观察组的血清PANKL水平较高(P<0.05),OPG、MMP-9水平较低(P<0.05);两组患者D-二聚体、血小板、部分凝血活酶时间、小腿肌间静脉血栓、下肢深静脉血栓、血栓平均长度与术前相比差异均无明显统计学意义(P>0.05),观察组血栓多于一条的比例、血栓总长度、血栓条数均显著低于对照组(P<0.05);两组不良反应的发生率比较差异均无明显统计学意义(P>0.05)。结论:依诺肝素联合乌司他丁能有效预防膝关节置换术后下肢深静脉血栓的形成,显著降低PANKL、OPG、MMP-9水平,且安全性较高。Objective:To study the effect of enoxaparin combined with ulinastatin on the thrombus prophylaxis and the serum factor-1 receptor activator ligand(RANKL),osteoprotegerin(OPG),matrix metalloproteinase-9(MMP-9)levels of patients after knee arthroplasty.Methods:From July 2015 to June 2016,80 patients with knee replacement were included in this study in our hospital,and divided into the observation group and control group according to the admission order with 43 cases in each group.The control group was treated with enoxaparin sodium for injection on the basis of knee arthroplasty.The observation group was treated with ulinastatin on the basis of control group.The changes of serum PANKL,OPG,MMP-9 levels,coagulation function indexes before and after treatment,postoperative thrombosis and the incidence of adverse reactions were compared between the two groups.Results:The levels of serum PANKL,OPG and MMP-9 in the two groups after treatment were significantly lower than those before operation(P<0.05).Compared with the control group,the serum PANKL level in the observation group was higher(P<0.05),the serum OPG and MMP-9 levels were lower(P<0.05).There was no significant difference in the D-dimer,platelet,partial thromboplastin time,calf muscle vein thrombosis,deep vein thrombosis and thrombosis length between the two groups(P>0.05).The proportion of thrombus,the total length of the thrombus,the number of thrombosis in the observation group were significantly lower than those of the control group(P<0.05).The was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Enoxaparin combined with ulinastatin can effectively prevent the thrombogenesis of lower extremities after knee arthroplasty,which can effectively reduce the serum levels of PANKL,OPG and MMP-9 with high safety.

关 键 词：依诺肝素 乌司他丁 膝关节置换术 血栓形成 

分 类 号：R687.4[医药卫生—骨科学]