阿替普酶联合华法林和低分子肝素对急性肺栓塞患者凝血功能、血管内皮功能、血清指标的影响  

Effect of alteplase combined with warfarin and low molecular weight heparin on coagulation function,vascular endothelial function and serum indicators in patients with acute pulmonary embolism

作　　者：张建新[1] 石金河[1] 陈希妍[1] 李广鹏[1] 翟世从 崔俊伟[2] ZHANG Jianxin;SHI Jinhe;CHEN Xiyan;LI Guangpeng;ZHAI Shicong;CUI Junwei(Department of Emergency Medicine,the First Affiliated Hospital of Xinxiang Medical College,Weihui,Henan,China,453100;Department of Tuberculosis,the First Affiliated Hospital of Xinxiang Medical College,Weihui,Henan,China,453100)

机构地区：[1]新乡医学院第一附属医院急救医学科,河南卫辉453100 [2]新乡医学院第一附属医院结核内科,河南卫辉453100

出　　处：《分子诊断与治疗杂志》2023年第7期1151-1155,共5页Journal of Molecular Diagnostics and Therapy

基　　金：河南省医学科技攻关计划项目(2018020344)。

摘　　要：目的探究阿替普酶联合华法林+低分子肝素对急性肺栓塞(APE)患者凝血功能、血管内皮功能及血清指标的影响。方法选取2015年12月至2021年12月新乡医学院第一附属医院收治的90例APE患者,根据治疗方法的不同分为观察组47例和对照组43例,对照组皮下注射低分子肝素钠,同时给予华法林口服,观察组在此基础上增加阿替普酶治疗。观察两组患者凝血功能[凝血酶原时间(PT)、纤维蛋白原(FIB)、活化部分凝血活酶时间(APTT)]、血管内皮功能[可溶性细胞间黏附分子⁃1(sICAM⁃1)、内皮素⁃1(ET⁃1)、血栓素B2(TXB2)、一氧化氮(NO)]、血清学指标[肝细胞生长因子(HGF)、生长刺激表达基因2蛋白(ST2)及血清淀粉样蛋白A(SAA)水平]和出血情况(皮肤出血、牙龈出血、鼻出血及尿血情况)。结果治疗后,两组的PT和APTT水平升高,且观察组高于对照组,FIB水平降低,且观察组低于对照组,差异均有统计学意义(P<0.05)。治疗后,两组患者的sICAM⁃1、ET⁃1、TXB2水平降低,且观察组低于对照组,NO水平升高,且观察组高于对照组,差异均有统计学意义(P<0.05)。治疗后,两组患者的HGF、SAA水平降低,且观察组低于对照组,ST2水平升高,且观察组高于对照组,差异均有统计学意义(P<0.05)。观察组的出血率为6.38%,对照组的出血率为9.30%,两组的出血情况比较差异无统计学意义(P>0.05)。结论阿替普酶联合华法林+低分子肝素治疗APE效果显著,可改善患者凝血功能、血管内皮功能以及血清指标,且不会增加患者出血风险,具有良好的临床应用价值。Objective To investigate the effect of alteplase combined with warfarin and low molecular weight heparin on coagulation function,vascular endothelial function,and serum indicators in patients with acute pulmonary embolism(APE).Methods The data of 90 patients with APE admitted to the First Affiliated Hospital of Xinxiang Medical College from December 2015 to December 2021 were retrospectively collected.According to different treatment methods,the patients were divided into the observation group(47 cases)and the control group(43 cases).Patients in the control group were treated with subcutaneous injection of low molecular weight heparin sodium and oral warfarin.On this basis,patients in the observation group were treated with alteplase.Coagulation function[prothrombin time(PT),fibrinogen(FIB)and activated partial thromboplastin time(APTT)],vascular endothelial function[soluble intercellular adhesion molecule⁃1(sICAM⁃1),endothelin⁃1(ET⁃1),thromboxane B2(TXB2)and nitric oxide(NO)],serological indicators[hepatocyte growth factor(HGF),growth stimulating gene 2(ST2)and serum amyloid A(SAA)]and bleeding(dermatorrhagia,gingival bleeding,epistaxis and hematuria)in the two groups were observed.Results After treatment,PT and APTT increased in the two groups,and were longer in the observation group than in the control group.The level of FIB decreased and was lower in the observation group than in the control group(P<0.05).After treatment,the levels of sICAM⁃1,ET⁃1 and TXB2 decreased in the two groups and were lower in the observation group than in the control group.The level of NO increased and was higher in the observation group than in the control group(P<0.05).After treatment,the levels of HGF and SAA decreased in the two groups and were lower in the observation group than in the control group.The level of ST2 increased and was higher in the observation group than in the control group(P<0.05).The bleeding rates in the observation group and the control group were 6.38%and 9.30%,without statistically significant

关 键 词：阿替普酶 华法林 低分子肝素 急性肺栓塞 凝血功能 

分 类 号：R563.5[医药卫生—呼吸系统]