低分子量肝素、肝素钙对不稳定性心绞痛患者凝血系统影响的对比研究

Effects of antithrombotic therapy with different molecular weight heparins on coagulation system in patients with unstable angina pectoris

目的 比较不稳定性心绞痛患者不同分子量肝素治疗后体内凝血系统的变化。方法 6 3例不稳定性心绞痛患者随机分为皮下注射低分子量肝素组 (A组 ,依诺肝素组 ) 33例和皮下普通肝素组 (B组 ,肝素钙组 ) 30例 ,疗程为 5d ,观察临床效果、不良反应及凝血指标。结果 治疗后A、B组缓解心绞痛总有效率分别为 97%和 80 % (P <0 0 5 ) ,出血发生率显著性差异 (P >0 0 5 )。治疗 5d后两组血浆抗因子Xa活性 (anti Xa)、抗因子IIa活性 (anti IIa)均明显升高 (P <0 0 1) ,anti Xa活性A组明显高于B组 (P <0 0 1) ,而anti IIa活性B组明显高于A组 (P <0 0 5 )。血浆抗凝血酶III(AT III)活性在A组无明显变化 (P >0 0 5 ) ,B组明显下降 (P <0 0 1)。血浆凝血酶原片段1+ 2 (F1+ 2 )水平两组均明显下降 (P <0 0 1)。血浆激活部分凝血活酶时间 (APTT)A、B组均明显延长 (P <0 0 1) ,第 5天时B组APTT稍长于A组 (P =0 0 5 )。结论 治疗 5d后 ,普通肝素以抗因子IIa为主 ,低分子量肝素以抗因子Xa为主 ;普通肝素导致血浆AT III活性明显下降 ,而低分子肝素则无此不良作用 ;低分子量肝素抑制凝血酶产生的作用明显优于普通肝素。低分子量肝素组心绞痛的缓解率明显高于肝素钙组 ,与凝血系统的变化相符合 。

Objective To compare the changes of the coagulation system after different molecular weight heparins′therapy in 63 cases with unstable angina pectoris Methods The included cases were randomly divided into two groups:Group A were assigned to receive the subcutaneous low molecular weight heparin(LMWH);Group B to subcutaneous unfractionated heparin (UFH) Results Compared with Heparin calcium, Clexane had a higher efficacy rate in controlling the onsets of angina pectoris after 5 days′treatment( P <0 05) There was no difference of the side effects between the two groups ( P >0 05) Group A had a higher anti factor Xa(anti Xa)activity than group B( P <0 01) and a lower anti factor IIa(anti IIa) activity than groupB ( P <0 05) Clexane didn′t affect the activity of plasma antithrombin III(AT III) while Heparin calcium reduced the activity of AT III( P <0 01) Both of the two heparins reduced the activity of prothrombin fragment 1+2 (F 1+2 )( P <0 01) The values of activated partial thrombin time (APTT)prolonged in both two groups ( P <0 01). In the fifth day, the average value of APTT in group B had a more prolonged tendency than group A( P =0 05) Conclusion UFH had a strong effect on anti IIa, LMWH had a strong effect on anti Xa The former reduced the AT III LMWH had a stronger effect on reducing the level of F 1+2 than UFH It showed that LMWH had a more significant effect on inhibiting the production of the thrombin than UFH These data were consistent with the clinical outcomes in the two groups In side effect, there was no difference between the two groups