阿加曲班治疗急性下肢深静脉血栓的临床效果

Clinical effect of Argatroban on acute lower extremity deep venous thrombosis

目的 观察阿加曲班治疗急性下肢深静脉血栓的临床效果。方法 选取2014年1月至2016年12月于中国中医科学院望京医院血管外科病房治疗的急性下肢深静脉血栓症患者共68例。根据随机数字表法,将患者分为观察组和对照组，各34例。观察组给予阿加曲班注射液治疗，疗程7 d；对照组给予普通肝素治疗，疗程7 d；2组患者均治疗第5天开始口服华法林 3 mg, 1 次/d（首剂加倍），连续服用3～6个月。比较2组治疗前后大腿和小腿双侧肢体周径差值、凝血功能、血小板计数、D-二聚体水平，记录不良反应发生情况。结果 观察组和对照组治疗后大腿和小腿双侧肢体周径差明显小于治疗前［观察组：（1.5±0.6）cm比（5.3±2.1）cm、（1.3±0.7）cm 比（4.4±1.0）cm；对照组：（1.3±0.5）cm比（5.6±2.1）cm、（1.3±0.5）cm 比（5.8±1.2）cm］,差异均有统计学意义（均P＜0.05）。观察组治疗前及治疗后大腿和小腿周径差与对照组比较，差异均无统计学意义（均P＞0.05）。治疗后1、3、7 d，观察组和对照组的凝血酶原时间及国际标准化比值均在正常范围［（11.0±1.8）s比（12.0±1.2）s、（13.0±2.1）s比（12.0±0.5）s、（12.0±1.7）s比（13.0±0.7）s； （0.93±0.17）比（1.01±0.23）、（1.03±0.32）比（1.21±0.55）、（1.17±0.46）比（1.26±0.87）］，差异无统计学意义（P＞0.05）。观察组无1例发生血小板减少症（HIT）；而对照组有4例（11.8%）发生了HIT，2组HIT发生率比较，差异有统计学意义（P＜0.05）。观察组治疗前D-聚体水平与对照组比较［（236±80）μg/L比（223±68）μg/L］，差异无统计学意义（P＞0.05）；治疗后1、5 d，观察组患者D-聚体水平均明显低于对照组［（85±27）μg/L比（91±39） μg/L、（66±29）μg/L比（72±11）μg/L］，差异均有统计学意义（均P＜0.05）。2组患者治疗期间均未发生口腔黏膜出血、皮下瘀点、瘀斑、呕血、黑便、血尿等不良反应。结论 阿加曲班治疗急性下肢深静脉血栓症安全、有效，同时不会引起患者血小板减少。

Objective To observe the clinical effect of argatroban on acute lower extremity deep venous thrombosis. Methods Totally 68 patients with acute lower extremity deep venous thrombosis from January 2014 to December 2016 in Wangjing Hospital, Chinese Academy of Traditional Chinese Medicine were randomly divided into observation group and control group, with 34 cases in each group. The observation group had argatroban injection for 7 d; the control group had heparin for 7 d. Both groups took warfarin 3 mg, 1 time/d（the initial loading-dose was doubled） on the 5th day of treatment; the course lasted for 3-6 months. Bilateral thighs/calves peripheral diameters, blood coagulation function, platelet count, D-dimer level and adverse reactions were analyzed. Results Difference values of bilateral thighs and calves peripheral diameters after treatment were significantly lower than those before treatment in both groups[observation group： （1.5±0.6）cm vs （5.3±2.1）cm, （1.3±0.7）cm vs （4.4±1.0）cm; control group： （1.3±0.5）cm vs （5.6±2.1）cm, （1.3±0.5）cm vs （5.8±1.2）cm]（P〈0.05）; there were no significant differences between groups（P〉0.05）. Prothrombin time on 1, 3, 7 d after treatment in observation group and control group was （11.0±1.8）s vs （12.0±1.2）s, （13.0±2.1）s vs （12.0±0.5）s, （12.0±1.7）s vs （13.0±0.7）s; the international normalized ratio was （0.93±0.17） vs （1.01±0.23）, （1.03±0.32） vs （1.21±0.55）, （1.17±0.46） vs （1.26±0.87）, respectively; there were no significant differences between groups（P〈0.05）. Heparin-induced thrombocytopenia occurred in 4 patients （11.8%） in control group. The level of D-dimer before treatment had no significant difference between observation group and control group[（236±80）μg/L vs （223±68）μg/L]（P〉0.05）; the levels of D-dimer on 1, 5 d after treatment in observation group were significantly lower than those in control group[（85±27）μg/L vs （91±39）μg/L, （66±29）μg/L vs （72±11）μg/L]（P〈0.05）. Both groups had no adverse reactions of oral mucosal bleeding, subcutaneous petechia, ecchymosis, hematemesis, melena and hematuria. Conclusion Argatroban is safe and effective in the treatment of acute lower extremity deep venous thrombosis.