小剂量肝素对老年AECOPD患者疗效及Fbg、Hs-CRP、TNF-α的影响

Efficacy of low dose of heparin on elderly patients with acute exacerbation of chronic obstructive pulmonary disease and its effects on fibrinogen, high-sensitivity C reactive protein and TNF-α

目的:探讨小剂量肝素对老年AECOPD患者疗效及血纤维蛋白原(Fbg)、高敏C反应蛋白(HsCRP)及肿瘤坏死因子-α(TNF-α)的影响。方法:选取139例老年慢性阻塞性肺疾病急性加重期(AECOPD)患者分为小剂量肝素组、低分子肝素组和常规组,同时选52例健康查体者为对照组;常规组患者使用常规的治疗方法进行,包括给予患者吸氧、抗生素、支气管扩张剂等药物治疗;小剂量肝素组在常规治疗的基础上同步使用小剂量肝素治疗,50 mg/d泵入;低分子肝素组同步给予低分子肝素5 000 U抗皮下注射/d,评价三组的疗效、检测三组AECOPD患者治疗前、治疗2周后及对照组Fbg、Hs-CRP及TNF-α水平。结果:小剂量肝素组和低分子肝素组患者临床疗效高于常规治疗组(P<0.01);Fbg、Hs-CRP及TNF-α水平小剂量肝素组、低分子肝素组两组无明显差别(P>0.05);三组与健康对照组比较显著升高(P<0.05);治疗后小剂量肝素组、低分子肝素组较常规组显著下降(P<0.05)。结论:小剂量肝素通过降低老年AECOPD患者Fbg、Hs-CRP、TNF-α水平,继而抑制气道炎症反应,提高临床疗效。

Objective To investigate the efficacy of low dose of heparin on elderly patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） and its effects on fibrinogen （Fbg）, high- sensitivity C reactive protein （Hs-CRP） and TNF-α. Methods 139 eider patients with AECOPD were divided into heparin group, low molecular weight heparin group and conventional group, 52 healthy controls were included as control group. Patients in conventional group received routine therapy, including： oxygen inhalation, antibiotics, bronchodilators drugs, etc. Those in heparin group additionally received 50 mg/d of heparin administered intravenously ; and those in low molecular weight heparin group received 5 000 U/d of low molecular weight heparin administered subcutaneously. The efficacies of the 3 groups were evaluated and the levels of serum Fbg, Hs-CRP and TNF-α in the three groups were detected. Results The clinical efficacies of heparin group and low molecular weight heparin group were better than that of conventional group （P 〈 0.01 ）. The levels of Fbg, Hs-CRP and TNF-α had no significant difference between heparin group and low molecular weight heparin group （P 〉 0.05）. They were increased significantly in the 3 groups than those in control group （P 〈 0.05）, and were decreased significantly in heparin group and low molecular weight heparin group after the treatment （P 〈 0.05）. Conclusion Small dose of heparin could inhibit airway inflammation in elderly patients with AECOPD through decreasing the levels of Fbg, Hs-CRP and TNF-α, and could finally increase the efficacy.