依诺肝素和那屈肝素治疗非ST段抬高的急性冠状动脉综合征

Comparison of effects between enoxaparin and nadroparin in patients with non-ST-segment elevation acute coronary syndrome

目的比较依诺肝素(enoxaparin)与那屈肝素(nadroparin)对非ST段抬高的急性冠状动脉综合征患者临床预后的影响以及患者血浆中的血管性血友病因子(von Willebrand factor,vWF)、高敏C反应蛋白(high sensitivity C reactive protein,hs-CRP)水平。方法非ST段抬高的急性冠状动脉综合征患者70例,随机分入依诺肝素组与那屈肝素组,比较两组30d内的终点事件和出血事件的发生率。两组均检测入选时,用药后4,12及66h血浆vWF、hs-CRP水平。结果①30d临床事件:那屈肝素组为10,依诺肝素组为12,差异无统计学差意义(P>0.05);②两组均未发生严重出血事件,微小出血事件:那屈肝素组4例,依诺肝素组2例;③两组各时间点对应的vWF、hs-CRP水平差异无统计学意义(P>0.05)。结论对于NSTE-ACS患者的治疗,两种低分子量肝素治疗非ST段抬高的急性冠状动脉综合征效果及对炎性因子作用基本一致。

Objectives To compare the effects of enoxaparin and nadroparin on clinical results and markers of inflammation such as von Willebrand factor （vWF） and high-sensitivity C-reactive protein （hs-CRP） in patients with non-ST-segment elevation acute coronary syndrome （NSTE-ACS）. Methods In this prospective, open study, 70 patients with NSTE-ACS from Cardiac Department of Beijing Friendship Hospital were randomly divided into enoxaparin group or nadroparin group. The patients received weight-adjusted enoxaparin and weightadjusted nadroparin subcutaneously at 12-hour interval for 60-144 hours. Blood sample were taken at the time of randomization and after 4, 12, 66 hours of treatment respectively to measure the level of vWF and hsCRP. The efficacy end point was a composite of death, myocardial infarction and recurrent ischemia at 30 days. Results （1） There were 10 adverse events in the nadroparin group and 12 in the enoxaparin group （P〉 0.05） ; （2） No major hemorrhage was noted, 4 minor hemorrhages were observed in the nadroparin and 2 in the enoxaparin; （3） Levels of vWF and hs-CRP were similar in the 2 treatment groups at each time point. Conclusions Both low-molecular-weight heparins have shown equivalent efficacy on clinical outcomes and on any such markers of inflammation.