晚期恶性肿瘤伴高血压患者凝血和纤溶指标的变化及治疗干预对策

Changes in coagulation and fibrinolysis indexes in patients with advanced malignant tumors complicated with hypertension and the treatment intervention

目的探讨晚期恶性肿瘤伴高血压患者凝血和纤溶指标的变化及治疗干预对策。方法选取2017年1月至2019年1月间陕西省西安高新医院收治的44例晚期恶性肿瘤合并高血压患者参与研究,作为观察A组,按照随机单盲平行法将观察A组分为两个亚组,按照治疗方法差异分别记为依那普利组和氯沙坦组,每组22例。同时,选择同期接受治疗的晚期恶性肿瘤但非合并高血压的43例患者参与研究,记为观察B组,选择同期体检人群中43例健康志愿者作为对照组,对比观察A组、B组以及对照组的凝血和纤溶指标情况,并对其与血压的相关性进行分析。同时,比较依那普利组和氯沙坦组两个亚组的凝血和纤溶指标的变化。结果与对照组比较,观察A组和观察B组的血管性血友病因子(v WF)、P-选择素、纤维蛋白原和D-二聚体水平显著升高,且观察A组显著高于观察B组,差异均有统计学意义(均P <0. 05)。恶性肿瘤伴高血压的观察A组和不伴有高血压的观察B组共计87例患者中,血压与v WF、P-选择素、纤维蛋白原和D-二聚体均呈正相关关系,差异均有统计学意义(均P <0. 05)。治疗前,依那普利组和氯沙坦组的血压水平比较,差异无统计学意义(P>0. 05),在经过为期8周的治疗后,患者血压水平得到改善,与治疗前相比,治疗后血压显著降低,差异均有统计学意义(均P <0. 05),但两组组间比较,差异无统计学意义(P> 0. 05)。治疗前,依那普利组和氯沙坦组凝血纤溶指标比较,差异无统计学意义(P>0. 05),治疗后,两组凝血纤溶指标得到明显改善,优于治疗前,差异均有统计学意义(均P <0. 05),但两组组间比较,差异无统计学意义(P>0. 05)。结论晚期恶性肿瘤伴高血压患者凝血和纤溶指标显著升高,血压与凝血和纤溶指标存在正相关关系,通过给予药物干预,患者血压和凝血纤溶指标能够得到有效改善,患者预后较好。

Objective To investigate the changes of coagulation and fibrinolysis in patients with advanced malignant tumors complicated with hypertension and the intervention strategies. Methods Fortyfour patients with advanced malignant tumors and hypertension who were admitted to Xi’an High-Tech Hospital from January 2017 to January 1919 were enrolled in group A. Patients in group A were divided into enalapril group and losartan group with 22 patients in each group by a randomized single-blind parallel method.At the same time,43 patients with advanced malignant tumors but without hypertension were enrolled in group B. Another 43 healthy volunteers in the physical examination were selected as the control group. The coagulation and fibrinolysis indexes and the correlation with blood pressure were compared between group A and group B. Coagulation and fibrinolysis indicators between the two subgroups of the enalapril and losartan groups were also compared. Results Compared with the control group,the levels of v WF,P-selectin,fibrinogen and D-dimer were significantly increased in group A and group B with group A higher than group B( all P < 0. 05). Blood pressure was positively correlated with v WF,P-selectin,fibrinogen and D-dimer in87 patients in group A and group B( all P < 0. 05). Before treatment,there was no significant difference in blood pressure between the enalapril group and the losartan group( P > 0. 05). After 8 weeks of treatment,the blood pressure level and coagulation and fibrinolysis index were improved. Compared with before the treatment,the blood pressure significantly decreased( all P < 0. 05). However,the difference between the two groups were not significant( P > 0. 05). There was no significant difference in coagulation and fibrinolysis index between the enalapril group and the losartan group before the treatment( P > 0. 05). After the treatment,the coagulation and fibrinolysis index were improved in the two subset in group A. However,the difference between the two subsets were not significant( P > 0. 05). Conclusion The coagulation and fibrinolysis indexes increased in patients with advanced malignant tumors complicated with hypertension.There is a positive correlation between blood pressure and coagulation and fibrinolysis. By administering drug intervention,the blood pressure and coagulation and fibrinolysis indicators can be effectively improved and so that to improve the prognosis.