华法林对老年心房颤动患者内皮功能及凝血系统的作用

The effects of warfarin on endothelial function and coagulation system in elderly patients with atrial fibrillation

目的观察华法林对老年心房颤动(房颤)患者内皮功能和凝血系统的影响。方法对2007年3月至2010年12月住院的126例老年房颤患者进行分组观察,将患者分为华法林组(57例,予华法林抗凝治疗)和阿司匹林组(69例,予阿司匹林抗血小板凝集治疗),并和42例无房颤的同期患者(对照组)进行对照;3组性别、年龄、BMI、血压、基础疾病、常规治疗药物等基线资料均衡(P均>0.05)。观察治疗前后患者内皮功能及凝血系统的变化。结果华法林组及阿司匹林组患者血浆血管性假血友病因子(vWF)、纤维蛋白原(Fg)、D-二聚体(D-Dimer)浓度均较对照组明显增高(P均<0.01)。与阿司匹林组相比,华法林组抗凝治疗后,vWF、Fg、D-Dimer浓度都有明显下降(P均<0.05);体循环栓塞事件发生率有所降低,但差异无统计学意义(5.26%vs13.0%,P>0.05)。结论华法林可以显著降低房颤患者的血浆vWF、Fg、D-Dimer浓度,改善其内皮细胞功能和凝血功能,从而减少血栓栓塞的风险。

Objective To observe the effects of warfarin on endothelial function and coagulation system in elderly patients with atrial fibrillation （AF）. Methods A total of 126 elderly patients with AF hospitalized between March 2007 and December 2010 were divided into two groups： warfarin group （n =57 ,using warfarin） and aspirin group （ n = 69, using aspirin）, and 42 non-AF patients admitted at corresponding period were selected as control group. The basic data including sex, age, body mass index, blood pressure, underlying diseases, routine therapy were matched（ all P 〉 O. 05 ）. The changes of endothelial function [ von willebrand factor （vWF） as an index] and coagulation system [ fibrinogen （Fg） and D-Dimer as indexes ] before and after warfarin or aspirin therapy were observed and compared with control group. Results Compared with control group, concentrations of plasma vWF, Fg and D-Dimer before therapy in warfarin and aspirin groups increased significantly （ all P 〈 0. O1 ）. Compared with aspirin group after aspirin therapy, the concentrations of plasma vWF, Fg and D-Dimer after warfarin therapy significantly declined （ all P 〈 0.05 ）, and the incidence of thromboembolism events of systemic circulation decreased,but there was no singnifieant difference （ 5.26% vs 13.0%, P 〉 0.05 ）. Conclusion Warfarin could significantly reduce the concentrations of vWF, Fg and D-Dimer in elderly AF patients, and improve endothelial function and coagulation function thereby lower the risk of thromboembolism.