老年溃疡性结肠炎患者D-二聚体、部分凝血活酶时间及纤维蛋白原的变化与意义

Change and significances of D-d,APTT and FIB in aged patients with ulcerative colitis

目的探讨老年溃疡性结肠炎(UC)患者D-二聚体(D-D)、部分凝血活酶时间(APTT)及纤维蛋白原(FIB)的变化及意义。方法将56例老年溃疡性结肠炎活动期患者随机分为抗凝治疗组和非抗凝治疗组各28例,非抗凝治疗组采用常规治疗方法,惠迪(美莎拉嗪)每日2.0g口服,惠迪2.0g+生理盐水50ml每日1次睡前保留灌肠,四联活菌片500mg 3次/d,口服;抗凝治疗组在常规治疗同时采用低分子肝素5000U每日1次皮下注射进行抗凝治疗;两组治疗总疗程均为6周,选择同期健康体检者30例作为对照组,治疗前后检测各组患者血浆中的D-D、APTT及FIB水平,同时采用临床活动度评分计算临床活动性指数。结果治疗前,D-D、APTT及FIB水平UC组分别为(360.6±105.7)μg/L、(25.4±6.4)s、(4.1±1.1)g/L,对照组分别为(150.8±66.6)μg/L、(29.8±5.6)s、(2.3±0.5)g/L,各指标差异均有统计学意义(P<0.05);治疗后,抗凝治疗组D-D、APTT及FIB水平组分别为(212.6±62.0)μg/L、(27.2±3.4)s、(2.2±1.0)g/L,非抗凝治疗组分别为(288.5±102.6)μg/L、(26.2±4.0)s、(3.2±1.4)g/L,D-D及FIB治疗前后及组间比较差异均有统计学意义(均P<0.05),而APTT则差异无统计学意义,抗凝治疗组临床活动性指数,治疗后与治疗前比较明显下降,与非抗凝治疗组治疗后比较差异均有统计学意义(均P<0.05)。结论 UC患者血液存在高凝状态和继发纤溶,D-D、FIB可作为判定UC活动性的指标,给予适当的抗凝治疗后可明显改善血中D-D及FIB水平。

OBJECTIVE To observe the changes and significances of D-d, APTT and FIB in elder patients with ulcerative colitis. METHODS A total of 56 eldely patients with UC were randomly divided into anticoagulant group and non-anticoagulant group with 28 cases in each group. Non-anticoagulant group received sarah hydrochloride 2. 0 g orally daily, Sarah hydrochloride 2.0 g＋50 ml normal saline enema once daily at bedtime, quadruple viable tablets of 500 mg oral administration three times daily. Anticoagulant group were given 5000 U low molecular weight heparin subcutaneously once daily based on the conventional treatment. The total course in both groups were 6 weeks. 30 healthy cases were selected as control group at the same period. Before and after treatment, DD, APTT and FIB level and clinical activity score were detected and calculated using the clinical activity index. RESULTS Before treatment, D-D, APTT and FIB levels were separately （360.6±105.7） ug/L, （25.4±6.4） s, （4.1±1.1） g/L in UC group and （150.8±66.6） ug/L,（29.8±5.6） s, （2.3-1-0.5）g/L in control group, with significant difference（all P〈0.05）. After treatment, D-D, APTT and FIB levels were 212.6±62.0 ug/L, （ 27.2 ±3.4 ）s,（ 2.2±1.0 ）g/L in anticoagulant group and （288.5±102.6）ug/L,（ 26.2±4.0 ）s, （3.2±1.4） g/L in non-anticoagulant group. D-D and FIB were significantly different before and after treatment（P〈0.05）, while APTT was not different（P〉0.05）. The clinical activity index in anticoagulant group decreased after treatment（P 〈0.05）, compared with non-anticoagulant group, there was significant difference（P〈0.05）. CONCLUSION D-D and FIB can be used as an indicator to determine UC activity, and appropriate anticoagulant therapy can significantly improve the blood levels of DD and FIB.