低分子肝素对慢阻肺急性加重期炎性因子及血管内皮功能的影响

Effect of low molecular weight heparin on inflammatory factors and vascular endothelial function in AECOPD patients

目的评价低分子肝素(LMWH)对AECOPD患者外周血炎症指标及血管内皮功能的影响。方法将AECOPD患者随机分为对照组(n=43)和观察组(n=43),对照组予以常规治疗(抗感染、平喘、祛痰等),观察组在常规治疗的基础上加用LMWH,疗程10d。观察两组在mMRC评分,NLR、PLR,IL-6、TNF-α、ET-1及NO的变化。结果治疗后观察组mMRC评分的改善高于对照组(P<0.01);两组患者外周血NLR、PLR、TNF-α和IL-6等炎症指标较治疗前下降,差异有显著性,且观察组较对照组下降更明显,差异有显著性(P<0.01);血管内皮功能指标ET-1升高,NO水平降低,且经LMWH干预后,ET-1水平显著低于对照组(P<0.01),NO水平显著高于对照组(P<0.01)。结论LMWH可改善AECOPD患者生活质量,可能与影响NLR、PLR、TNF-α、IL-6、ET-1、NO等炎症相关指标有关。

Objective To evaluate the effect of low molecular weight heparin(LMWH)on peripheral blood inflammatory markers and vascular endothelial function in patients with AECOPD.Methods 86 patients with AECOPD were randomly divided into the control group(n=43)and the observation group(n=43).The control group was treated with conventional treatment(anti-infection,relieving asthma,expectoration,etc.),and the observation group was treated with LMWH subcutaneous injection for 10 days on the basis of the control group.The changes of mMRC,neutrophil-lymphocyte ratio(NLR),platelet-lymphocyte ratio(PLR),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α),endothelin-1(ET-1)and nitric oxide(NO)after treatment were observed in both groups.Results The improvement of mMRC score was more pronounced in the observation group than in the control group(P<0.01).The parameters such as peripheral blood NLR,PLR,TNF-αand IL-6 decreased obviously in the two groups after treatment,and the decrease was more pronounced in the observation group than in the control group(P<0.01).ET-1,an index of vascular endothelial function,was elevated,and NO level was reduced,and after LMWH treatment,ET-1 level was significantly lower(P<0.01)and NO level was significantly higher in the observation group than in the control group(P<0.01).Conclusion LMWH can improve the quality of life in AECOPD patients,which may be associated with improvements in inflammatory parameters such as NLR,PLR,TNF-α,IL-6,ET-1 and NO.