肝素干预对急重症心力衰竭患者血小板相关指标及血管内皮细胞功能的影响

Effects of heparin intervention on platelet-related parameters and vascular endothelial cell function in patients with acute and severe heart failure

目的 探讨肝素干预对急重症心力衰竭患者血小板相关指标及血管内皮细胞功能的影响.方法 选取2013年2月至2014年5月急重症心力衰竭患者66例为研究对象,采用随机数表法分为观察组和对照组,每组33例,对照组给予常规药物（利尿剂、强心剂、血管扩张药等）治疗,观察组在此基础上给予肝素干预,均治疗2个月,治疗结束检测两组凝血酶原时间（PT）、血小板计数（PLT）、血栓烷素B2（TXB2）水平,同时比较其内皮缩血管肽-1（ET-1）、人内皮细胞粒细胞集落刺激因子（G-CSF）、白细胞介素-6（IL-6）水平,并记录不良反应发生情况.结果 治疗后观察组PT[（15.08±1.26）s]较对照组[（14.05±1.02）s]明显延长（P〈0.05）,PLT[（137.25±1.88）×10^9/L]、TXB2[（180.19±1.23）pg/ml]、ET-1[（40.27±2.65）ng/ml]、G-CSF[（215.27±2.37）ng/L]、IL-6[（216.54±2.78）ng/L]明显低于对照组[（144.36±1.65）×10^9/L、（55.38±2.17）ng/ml、（254.32±2.04）ng/L、（280.37±1.75）ng/L,P〈0.05];两组不良反应发生率（9.1%比6.1%）比较差异未见统计学意义（P〉0.05）.结论 肝素干预可有效降低危重症心力衰竭患者血小板活化,改善血管内皮功能,值得临床推广应用.

Objective To investigate the effects of heparin intervention on platelet-related parameters and vascular endothelial cell function in patients with acute and severe heart failure.Methods Sixty-six patients with acute and severe heart failure from February 2013 to May 2014 were selected as study subjects, they were divided into the observation group and the control group, with 33 cases in each group,the control group received routine medication（diuretics,cardiotonics,vasodilator and others）for 2 months,the observation group was given heparin intervention on the basis of the above for 2 months.The prothrombin time（PT）,platelet count（PLT）and thromboxane B2（TX B2）levels in the two groups at end-of-treatment were tested,meanwhile,the levels of endothelin-l（ET-I）,human endothelial cells leukocytes colony stimulating factor（G-CSF）and interleukin-6（IL-6）levels were compared,and the incidences of adverse reaction were recorded.Results Compared with the control group [（14.05±1.02）s],PT in the observation group[（15.08±1.26）s]after the treatment was significantly prolonged（P〈0.05）,the levels of PLT[（137.25±1.88）10^9/L],TXB2[（180.19±1.23）pg/ml],ET-l[（40.27±2.65）ng/ml],G-CSF[（215.27±2.37）ng/L],IL-6[（216.54±2.78）ng/L]in the observation group were significantly lower than those in the control group[（144.36±1.65）×10^9/L,（55.38±2.17）ng/ml,（254.32±2.04）ng/L,（280.37±1.75）ng/L,P〈0.05];there was no significant difference in adverse reaction rate between the two groups （9.1% vs 6.1%,P〉0.05）.Conclusions Heparin intervention can reduce platelet activation in patients with acute and severe heart failure effectively,improve the function of vascular endothelium,so it is worthy of clinic application.