低分子肝素对急性冠状动脉综合征患者的抗Xa活性的影响

发布时间：2018-11-17 18:54

【摘要】：目的研究低分子肝素治疗急性冠状动脉综合征(ACS)对抗Xa活性的影响。方法选取ACS患者59例。以内生肌酸酐清除率(Ccr)30 mL·min~(-1)22例患者为试验组,其余37例患者(Ccr)30 mL·min~(-1)为对照组。2组患者均皮下注射达肝素5000 U,每12 h注射1次;均口服阿司匹林100 mg·d~(-1),1次/天,疗程15 d。治疗第3天、第10天,用发色底物法监测抗Xa活性,用光电比浊法检测部分活化凝血酶原时间(APTT)和国际标准化比值(INR),用血细胞分析仪检测血小板计数。结果治疗第3天、第10天,试验组的抗Xa活性分别为(0.66±0.21),(0.39±0.17)U·mL~(-1),明显高于对照组的(0.40±0.22),(0.34±0.1)U·mL~(-1);试验组的APTT分别为(35.23±6.12),(28.14±5.37)s,INR分别为(1.23±0.25),(1.07±0.21),明显低于对照组的APTT(38.97±5.64),(33.76±5.12)s和INR(1.37±0.27),(1.19±0.23);试验组血小板计数分别为(196.52±56.41),(181.25±46.31)×10~9/L,明显高于对照组(183.47±57.38),(167.17±45.66)×10~9/L,差异均有统计学意义(均P0.05)。结论对于内生肌酸酐清除率较低的ACS患者进行低分子量肝素治疗时,需监测患者的抗Xa活性,并密切关注患者出血风险。
[Abstract]:Objective to study the effect of low molecular weight heparin (LMWH) on Xa activity in patients with acute coronary syndrome (ACS). Methods 59 patients with ACS were selected. The clearance rate of endogenous creatinine (Ccr) was 30 mL min~ (-1) in 22 patients in the trial group and (Ccr) 30 mL min~ (-1) in the other 37 patients as control group. All patients in both groups were subcutaneously injected with heparin 5000 U once every 12 hours. Aspirin 100 mg D1 was taken orally once a day for 15 days. On the 3rd and 10th day of treatment, the activity of anti Xa was detected by chromogenic substrate method, the partial activated prothrombin time (APTT) was detected by photoelectricity turbidimetry, and the platelet count was detected by hematology analyzer with (INR),. Results on the 3rd and 10th day of treatment, the anti- Xa activity of the experimental group was (0.66 卤0.21), (卤0.39 卤0.17) U mL~ (-1), which was significantly higher than that of the control group (0.40 卤0.22), (, 0.34 卤0.1) U mL~ (-1). The APTT of the experimental group was (35.23 卤6.12), (28.14 卤5.37) SINR (1.23 卤0.25), (1.07 卤0.21), which was significantly lower than that of the control group (38.97 卤5.64). (33.76 卤5.12) s and INR (1.37 卤0.27), (, 1.19 卤0.23); The platelet count in the test group was (196.52 卤56.41), (卤46.31) 脳 10 9 / L, which was significantly higher than that in the control group (183.47 卤57.38), (167.17 卤45.66) 脳 10 9 / L (P 0.05). Conclusion low molecular weight heparin therapy for ACS patients with low creatinine clearance should monitor the anti Xa activity and pay close attention to the bleeding risk.
【作者单位】：温州市人民医院心内科;温州市人民医院妇产科实验室;
【基金】：浙江省公益性技术应用研究计划基金资助项目(2014C33158) 温州市科技计划基金资助项目(Y20140094) 温州市医药卫生科学研究基金资助项目(2013A04)
【分类号】：R541.4

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