替罗非班治疗老年人急性下肢深静脉血栓形成的临床研究

Clinical study of tirofiban in treatment of the elderly patients with acute deep venous thrombosis

目的评价替罗非班治疗老年人急性下肢深静脉血栓形成的有效性和安全性。方法2011年1月至2013年12月前瞻性纳入42例符合入选标准的患者,采用随机数字表法分为治疗组和对照组,治疗前、治疗第7天和第14天测量下肢周径差,比较下肢周径差变化情况。入院即刻和治疗后48 h检测两组患者血小板最大聚集率(MPAR)、血浆组织型纤溶酶原激活物(t PA)、纤溶酶原激活物抑制物-1(PAI-1)、纤维蛋白原降解产物(FDP)、高敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)水平的变化。结果两组治疗后下肢周径差均较治疗前减少,且治疗组较对照组减少更为明显[在髌骨上缘15 cm为(1.86±1.33)cm比(2.78±1.43)cm,P=0.03;在髌骨下缘10 cm为(1.64±0.86)cm比(2.36±1.29)cm,P=0.03]。治疗组治疗前后比较,MPAR、t PA、PAI-1、FDP、hs-CRP、IL-6差异均达到统计学意义(均为P<0.05)。对照组治疗前后比较,t PA和PAI-1差异达到统计学意义(均为P<0.05)。治疗组与对照组在治疗后比较,MPAR、t PA、PAI-1、FDP、hs-CRP、IL-6差异均达到统计学意义(均为P<0.05)。结论替罗非班可进一步减轻患肢肿胀,促进患肢血栓再通,可能与其抑制血小板聚集,促进纤溶,并降低炎症反应有关。

Objective To investigate the therapeutic efficacy and safety of tirofiban of the elderly patients with acute deep venous thrombosis. Methods A total of 42 patients from January 2011 to December 2013 with acute deep venous thrombosis were divided into tirofiban treatment group and control group. Before treatment,? and 14 days measuring lower limb circumference difference,relatively lower limb W e e k diameter difference changes were recorded ; platelet aggregation rate ( M P A R ) , plasma tissue-type plasminogen activator (tPA) , plasminogen activator inhibitor -1 ( PAI-1 ) , fibrin original degradation products ( F D P ) ,high-sensitivity C-reactive protein (hs-CRP) ,interleukin-6 (IL-6) were tested immediate hospitalization and 48 hours post treatment, and compared between the two groups. Results Comparing the two groups before and after treatment,limb circumference had significantly reduced [ above patella 15 c m ( 1. 86 ± 1. 33 ) c m n(2. 78 ± 1. 43) c m , P =0. 03 ;below patella 10 cm( 1. 64 ±0. 86) c m vs. (2. 36 ±1. 29) c m , P = 0. 03 ] . After treatment,the level of M P A R , t P A , PAI-1, FDP , hs-CRP and IL-6 in treatment group showed significant differences ( all P < 0. 05 ) and the level of tPA and PAI-1 in control group showed significant differences (both P < 0 . 05). Compared with control group, the level of M P A R , tPA, PAI-1, FDP, hs-CRP and IL-6 in treatment group showed significant differences ( all P <0. 05). conclusions Tirofiban can further reduce limb swelling and promote thrombosis recanalization, probably by inhibiting platelet aggregation, to further promote fibrinolytic dissolution and reduce inflammatory reaction.