低分子肝素序贯利伐沙班与华法林治疗急性肺栓塞的短期疗效比较研究  

Comparative Study on Short-term Efficacy of Low Molecular Weight Heparin Sequential Rivaroxaban and Warfarin in the Treatment of Acute Pulmonary Embolism

作　　者：潘龙飞 孟燕[2] 牛泽群[1] 李丽君[3] 张磊[4] 高彦霞 彭卓 党晓燕 吕俊华 张瑞[1] PAN Longfei;MENG Yan;NIU Zequn;LI Lijun;ZHANG Lei;GAO Yanxia;PENG Zhuo;DANG Xiaoyan;LYU Junhua;ZHANG Rui(Department of Emergency,the Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,China;Department of Peripheral Vascular Diseases,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Cardiovascular,the Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,China;Department of Clinical Laboratory,the Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,China)

机构地区：[1]西安交通大学第二附属医院急诊科,陕西省西安市710004 [2]西安交通大学第一附属医院周围血管科,陕西省西安市710061 [3]西安交通大学第二附属医院心内科,陕西省西安市710004 [4]西安交通大学第二附属医院检验科,陕西省西安市710004

出　　处：《实用心脑肺血管病杂志》2020年第10期25-31,共7页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：陕西省重点研发计划项目(2017SF-254)。

摘　　要：背景针对高度可疑急性肺栓塞(APE)后至确诊APE患者,由低分子肝素(LMWH)过渡到利伐沙班的序贯治疗方法各不相同,目前临床关于其对APE患者的短期疗效也鲜有报道。目的比较LMWH序贯利伐沙班与华法林治疗APE的短期疗效。方法回顾性选取2018—2019年西安交通大学第二附属医院收治的APE患者65例,根据患者和/或家属自主意愿分为华法林组34例和利伐沙班组31例。华法林组患者给予LMWH序贯华法林治疗,利伐沙班组患者采用LMWH序贯利伐沙班治疗,两组患者均持续治疗3个月及以上。比较两组患者的临床疗效及治疗前、治疗后1个月炎性因子、凝血功能指标及血管内皮功能指标,并观察两组患者治疗期间不良反应发生情况。结果利伐沙班组患者临床疗效优于华法林组(P<0.05)。两组患者治疗前C反应蛋白(CRP)、白介素6(IL-6)、肿瘤坏死因子α(TNF-α)、D-二聚体(D-D)、蛋白C(PC)、蛋白S(PS)、内皮素1(ET-1)、血栓素B2(TXB2)、一氧化氮(NO)水平及治疗前后D-D水平的差值比较,差异无统计学意义(P>0.05);利伐沙班组患者治疗后1个月CRP、IL-6、TNF-α、D-D、ET-1、TXB2水平低于华法林组,PC、PS、NO水平高于华法林组(P<0.05)。利伐沙班组患者治疗前后CRP、IL-6、TNF-α、PC、PS、ET-1、TXB2、NO水平的差值大于华法林组(P<0.05)。两组患者治疗期间不良反应发生率比较,差异无统计学意义(P>0.05)。结论LMWH序贯利伐沙班治疗APE患者的短期疗效优于华法林,其可更有效地减轻患者的炎性反应,改善凝血功能及血管内皮功能,且安全性高。Background For the patients who were diagnosed with acute pulmonary embolism(APE)after been highly suspected as APE,the methods of sequential therapy from low molecular weight heparin(LMWH)to rivaroxaban are different,and there are few reports on the short-term efficacy in patients with APE.Objective To compare the shortterm efficacy of LMWH sequential rivaroxaban and warfarin in the treatment of APE.Methods A total of 65 patients with APE admitted to the Second Affiliated Hospital of Xi'an Jiaotong University from 2018 to 2019 were selected,and they were divided into warfarin group(n=34)and rivaroxaban group(n=31)according to the self-determination of the patients and/or their families.Patients in warfarin group were given LMWH sequential warfarin,patients in rivaroxaban group were treated with LMWH sequential rivaroxaban,both groups were treated for 3 months or more.The clinical efficacy,inflammatory factors,coagulation function and vascular endothelial function before and 1 month after treatment were compared between the two groups,and the incidence of adverse reactions during treatment was observed.Results The clinical efficacy of rivaroxaban group was better than that of warfarin group(P<0.05).There was no significant difference in levels of C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),D-dimer(D-D),protein C(PC),protein S(PS),endothelin-1(ET-1),thromboxane B2(TXB2)and nitric oxide(NO)before treatment and the difference of D-D level before and after treatment between the two groups(P>0.05).1 month after treatment,the levels of CRP,IL-6,TNF-α,D-D,ET-1 and TXB2 in rivaroxaban group were lower than those in warfarin group,while levels of PC,PS and NO in rivaroxaban group were higher than those in warfarin group(P<0.05).The differences of levels of CRP,IL-6,TNF-α,PC,PS,ET-1,TXB2 and NO before and after treatment in rivaroxaban group were greater than those in warfarin group(P<0.05).There was no significant difference in incidence of adverse reactions between the two groups(P>0.05

关 键 词：肺栓塞 利伐沙班 华法林 低分子肝素 炎性因子 凝血功能 血管内皮功能 治疗结果 

分 类 号：R563.5[医药卫生—呼吸系统]