利伐沙班配合低分子肝素对肺癌患者血栓发生率及凝血功能的影响观察

The effect of rivaroxaban combined with low molecular weight heparin on the incidence of thrombosis and coagulation in patients with lung cancer

目的探讨利伐沙班配合低分子肝素对肺癌患者血栓发生率及凝血功能的影响。方法选取我院2018年1月-2019年11月收治的肺癌患者92例,根据随机数字表分为研究组、对照组,各46例。对照组采取低分子肝素,研究组联合采取低分子肝素及利伐沙班。统计两组治疗前后凝血功能指标[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)、D-二聚体(D-D)]、血液流变学指标、血清血管内皮生长因子(VEGF)、基质金属蛋白酶-9(MMP-9)水平、不良事件发生率。结果治疗后研究组D-D、PAI-1、t-PA水平低于对照组(P<0.05);治疗后研究组血浆黏度、全血高切黏度、全血低切黏度、纤维蛋白原水平低于对照组(P<0.05);治疗后研究组血清VEGF、MMP-9水平低于对照组(P<0.05);研究组血栓发生率(2.17%)低于对照组(17.39%)(P<0.05),两组出血、肾肝损伤、皮肤反应发生率组间比较无显著差异(P>0.05)。结论联合采取利伐沙班及低分子肝素治疗肺癌,可有效调节患者血液流变学状态,改善其凝血功能,降低VEGF及MMP-9血清水平,并能降低血栓发生风险。

Objective To investigate the effect of rivaroxaban combined with low molecular weight heparin on the incidence of thrombus and coagulation in patients with lung cancer.Methods 92lung cancer patients admitted to our hospital from January 2018to November 2019were selected and divided into study group and control group according to the random number table,46cases in each group.Low molecular weight heparin was used in the control group,and low molecular weight heparin and rivaroxaban were used in the study group.Before and after treatment,the coagulation function indexes[tissue plasminogen activator(t-PA),plasminogen activator inhibitor-1(PAI-1),D-Dimer(D-D)],hemorheology indexes,serum vascular endothelial growth factor(VEGF),matrix metalloproteinase-9(MMP-9)levels and the incidence of adverse events were counted.Results The levels of D-D,PAI-1and t-PA in the study group were lower than those in the control group(P<0.05).After treatment,the plasma viscosity,whole blood high shear viscosity,whole blood low shear viscosity and fibrinogen level in the study group were lower than those in the control group(P<0.05).After treatment,the levels of VEGF and MMP-9in the study group were lower than those in the control group(P<0.05).The incidence of thrombosis in the study group(2.17%)was lower than that in the control group(17.39%)(P<0.05),There was no significant difference in the incidence of bleeding,kidney and liver injury,and skin reaction between the two groups(P>0.05).Conclusion The combination of rivaroxaban and low molecular weight heparin in the treatment of lung cancer can effectively regulate the hemorheology of patients,improve their coagulation function,reduce serum levels of VEGF and MMP-9,and reduce the risk of thrombosis.