ICU中CRRT患者肝素敏感性与AT-Ⅲ和BMI的相关性研究  

Study on correlation of heparin sensitivity with AT-Ⅲand BMI in ICU patients undergoing CRRT

作　　者：刘姗 高恺[1] LIU Shan;GAO Kai(Department of Intensive Care Medicine,Dalian Central Hospital,Dalian 116033,China)

机构地区：[1]大连市中心医院重症医学科,116033

出　　处：《中国实用医药》2023年第17期106-108,共3页China Practical Medicine

基　　金：大连市医学科学研究计划项目(项目编号:1911004)。

摘　　要：目的 分析在重症加强护理病房(ICU)接受连续性肾脏替代治疗(CRRT)患者肝素敏感性与抗凝血酶Ⅲ(AT-Ⅲ)及体质量指数(BMI)的相关性。方法 57例在ICU接受CRRT治疗的患者,根据患者肝素敏感性差异分成甲组(低敏, 17例)、乙组(中敏, 28例)及丙组(高敏, 12例)。三组患者均采用标准CRRT治疗方案。对比三组患者负荷量肝素后第1次测定的活化部分凝血活酶时间(APTT)及肝素敏感指数, AT-Ⅲ-mRNA表达水平,分析肝素敏感性与AT-Ⅲ及BMI的相关性。结果 甲组患者负荷量肝素后第1次测定的APTT为(31.05±3.87)s、肝素敏感指数为(103.57±28.64)s/(mg·kg),乙组患者负荷量肝素后第1次测定的APTT为(65.23±3.69)s、肝素敏感指数为(175.36±27.71)s/(mg·kg),丙组患者负荷量肝素后第1次测定的APTT为(82.35±3.64)s、肝素敏感指数为(310.82±38.54)s/(mg·kg)。三组患者负荷量肝素后第1次测定的APTT及肝素敏感指数对比,差异具有统计学意义(P<0.05);且丙组患者负荷量肝素后第1次测定的APTT显著长于甲组与乙组、肝素敏感指数显著高于甲组与乙组,乙组患者负荷量肝素后第1次测定的APTT显著长于甲组、肝素敏感指数显著高于甲组,差异均有统计学意义(P<0.05)。三组患者AT-Ⅲ-mRNA表达水平对比,差异具有统计学意义(P<0.05);且丙组患者AT-Ⅲ-mRNA表达水平为(2.04±0.57),高于甲组的(1.19±0.65)与乙组的(1.66±0.71),乙组患者AT-Ⅲ-mRNA表达水平高于甲组,差异均有统计学意义(P<0.05)。肝素敏感指数与AT-Ⅲ-mRNA呈正相关,与BMI呈负相关(r=0.379、-0.311, P<0.05)。结论 ICU中CRRT患者肝素敏感性与BMI呈负相关,与AT-Ⅲ呈正相关。临床可根据不同个体对肝素敏感性的差异及BMI状况选择最低有效浓度肝素剂量抗凝。Objective To analyze the correlation of heparin sensitivity with antithrombinⅢ(AT-Ⅲ)and body mass index(BMI)in intensive care unit(ICU)patients undergoing continuous renal replacement therapy(CRRT).Methods A total of 57 ICU patients undergoing CRRT were divided into group A(hyposensitivity,17 cases),group B(moderate sensitivity,28 cases)and group C(hypersensitivity,12 cases)according to their differences in heparin sensitivity.All three groups were treated with standard CRRT.The activated partial thromboplastin time(APTT)measured at the first time after heparin loading and heparin sensitivity index,and AT-Ⅲ-mRNA expression level in the three groups were compared,and the correlation of heparin sensitivity with AT-Ⅲand BMI was analyzed.Results APTT measured at the first time after heparin loading and heparin sensitivity index were(31.05±3.87)s and(103.57±28.64)s/(mg·kg)in group A,(65.23±3.69)s and(175.36±27.71)s/(mg·kg)in group B,and(82.35±3.64)s and(310.82±38.54)s/(mg·kg)in group C.The comparison of APTT measured at the first time after heparin loading and heparin sensitivity index in the three groups showed statistically significant differences(P<0.05).APTT measured at the first time after heparin loading of group C was significantly longer than that of group A and group B,and the heparin sensitivity index was significantly higher than that of group A and group B;APTT measured at the first time after heparin loading of group B was significantly longer than that of group A and the heparin sensitivity index was significantly higher than that of group A;the differences were statistically significant(P<0.05).The AT-Ⅲ-mRNA expression level in three groups was compared,and the difference was statistically significant(P<0.05).AT-Ⅲ-mRNA expression level in group C was (2.04±0.57), which was higher than that of (1.19±0.65) in group A and (1.66±0.71) in group B;AT-Ⅲ-mRNA expression level in group B was higher than that in group A;the differences were statistically significant (P<0.05). Heparin sen

关 键 词：连续性肾脏替代治疗 重症加强护理病房 肝素敏感性 抗凝血酶Ⅲ 体质量指数 相关性 

分 类 号：R473[医药卫生—护理学]