蛇毒类凝血酶制剂与肝毒性药物对血浆纤维蛋白原水平的影响分析  

Effects of snake venom thrombin-like enzyme preparations and hepatotoxic drugs on plasma fibrinogen levels

作　　者：颜楠 刁艳君 韩峰 刘家云 YAN Nan;DIAO Yanjun;HAN Feng;LIU Jiayun(Department of Clinical Laboratory,Xijing Hospital Affiliated to Air Force Military Medical University,Xi′an,Shaanxi 710032,China)

机构地区：[1]空军军医大学附属西京医院检验科,陕西西安710032

出　　处：《检验医学与临床》2021年第23期3435-3438,共4页Laboratory Medicine and Clinic

摘　　要：目的探讨临床上两种常用蛇毒类凝血酶制剂与两种肝毒性药物在用药前后对纤维蛋白原(FIB)水平的影响。方法选择2018年10月31日至2020年10月31日空军军医大学附属西京医院收治的200例FIB水平降低(<1.5 g/L)的住院患者为研究对象。将使用蛇毒类凝血酶制剂(白眉蛇毒血凝酶、巴曲酶)的70例患者设为有产物组,使用肝毒性药物[丙戊酸(VAP)、培门冬酶(PEG-ASP)]的130例患者设为无产物组。分别于患者使用药物治疗前后检测常规凝血6项指标的水平变化。结果有产物组中的泌尿外科患者其FIB、D二聚体(D-Dimer)、纤维蛋白/纤维蛋白原降解产物(FDP)水平在未手术未使用白眉蛇毒血凝酶治疗前与手术后、用药治疗后比较,差异有统计学意义(P<0.05)。耳鼻喉科患者的FIB与FDP水平在使用巴曲酶治疗前后比较差异有统计学意义(P<0.05)。无产物组中的神经科患者在使用VAP治疗前后的FIB水平比较,差异有统计学意义(P<0.05);血液科患者在使用PEG-ASP治疗前后的FIB水平比较,差异有统计学意义(P<0.05)。结论FIB水平在使用该4种药物前后的显著差异变化可以为临床提供用药指导参考,避免导致严重低纤维蛋白血症引起的出血风险。Objective To investigate the effects of two kinds of snake venom thrombin-like enzyme preparations and two hepatotoxic drugs on fibrinogen(FIB)levels before and after administration.Methods Retrospective analysis was performed on 200 patients with decreased fibrinogen(FIB)levels(<1.5 g/L)in Xijing Hospital Affiliated to Air Force Military Medical University from October 31,2018 to October 31,2020.They were divided into the product group(n=70,patients who used snake venom thrombin-like enzyme preparations,including hemocoagulase and batroxobin)and non-product group[n=130,patients who used hepatotoxic drugs,including valproic acid(VAP)and asparaginase(PEG-ASP)].Six routine coagulation indexes were detected before and after drug treatment,and the changes of their levels were observed.Results Levels of FIB,D-Dimer and fibrin/fibrinogen degradation products(FDP)of patients from department of urology surgery in product group after the surgery and treatment of hemocoagulase had statistical differences with those before the treatment(P<0.05).Levels of FIB and FDP of patients from department of otorhinolaryngology after the treatment of batroxobin had statistical differences with those before the treatment(P<0.05).Levels of FIB of patients from department of neurology in non-product group after the treatment of VAP had statistical differences with those before the treatment(P<0.05).In addition,levels of FIB of patients from department of hematology after the treatment of PEG-ASP had statistical differences with those before the treatment(P<0.05).Conclusion Significant changes in FIB levels before and after the use of the four drugs can provide clinical guidance,as well as avoid the risk of severe hypofibrinemia caused by bleeding.

关 键 词：蛇毒类凝血酶制剂 巴曲酶 丙戊酸 培门冬酶 纤维蛋白原 纤维蛋白/纤维蛋白原降解产物 

分 类 号：R446.1[医药卫生—诊断学]