慢性阻塞性肺疾病急性加重期血栓前状态及抗凝干预效果

Prethrombolic state and efficacy of anticoagulation of patients with acute exacerbations of chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病急性加重期（AECOPD）患者的血栓前状态，并观察低分子肝素钙的治疗效果。方法住院的AECOPD患者随机分为对照组和抗凝组。对照组给予AECOPD常规治疗，抗凝组在常规治疗基础上加用低分子肝素钙6000IU／d，7～10d。所有患者均于治疗前后测定血流变指标、血小板颗粒膜蛋白140（GMP-140）、血管性假血友病因子（vWF）、组织型纤溶酶原激活物（t-PA）、纤溶酶原激活剂抑制物1（PAI-1）和动脉血气等指标。结果抗凝组患者全血黏度、血浆黏度、红细胞变形指数（EDI）较治疗前明显降低，红细胞聚集指数（EAI）明显升高（P〈0．01）；抗凝组患者治疗后各血流变指标改善程度较对照组差异有统计学意义（P〈0．05）。抗凝组患者治疗后GMP-140、vWF、PAI-1较治疗前明显降低，t-PA较治疗前明显升高（P〈0．01）；抗凝组患者治疗后各指标改善程度较对照组差异有统计学意义（P〈0．05）。治疗后抗凝组患者动脉血氧分压（PaO2）较对照组升高（P〈0．05）。AECOPD患者PaO2变化与GMP-140、vWF、PAI的变化呈显著负相关（r=-0．570、-0．909、-0．915，P〈0．05），与t-PA的变化呈显著正相关（r=0．625，P〈0．05）。抗凝组与对照组临床疗效相比，差异有统计学意义（P〈0．05）。结论住院AECOPD患者存在凝血-纤溶功能异常及血栓前状态，加用低分子肝素钙抗凝治疗，可纠正其血液高凝状态及异常的凝血功能，更好的改善患者临床症状。

Objective To investigate prethrombolic state and observe the effect of anticoagulation therapy in patients with acute exacerbations of chronic obstructive pulmonary disease（AECOPD）. Methods The patients with AECOPD were randomly divided into anticoagulation group and control group. In anticoagulation group low molecular weight heparin（6 000 IU, Qd） was added besides the conventional therapy for 7-10 days,and in control group patients only accepted the conventional therapy. The indexes of hemorheology,vWF,GMP-140,t-PA,PAI-1 and blood gas indexes were detected before and after therapy. Results Blood viscosity, plasma viscosity, erythrocyte deformability index significantly decreased and erythrocyte aggregability index significantly increased in anticoagulation group after therapy compared with those before therapy（ P〈0. 01, respectively）, whose degrees of improvement in anticoagulation group were significantly higher than those of control group （ P 〈 0.05, respectively）. GMP-140, vWF, PAI significantly decreased and t-PA increased in anticoagulation group after therapy compared with those before therapy（ P 〈0. 01, respectively）, whose degrees of improvement in anticoagulation group were significantly higher than those of control group（ P 〈0.05, respectively）. Compared with control group, PaO2 was significantly increased in anticoagulation group（ P 〈0.05）. The changes of GMP-140, vWF,PAI were negatively correlated with the improvement of PaO2 （ r = -0. 570, -0. 909, -0. 915, P 〈0.05）and the change of t-PA was positively correlated with the improvement of PaO2 （ r = 0. 625, P 〈 0.05）. There was statistical significance in the curative effect between two groups （P 〈 0.05）. Conclusions Prethrombolic state exists in patients with AECOPD in hospital. Anticoagulation therapy can contribute to correct coagulation-fibrinolysis abnormalities and hypercoagulabale state to improve the curative effect.