针刺联合低分子肝素对股骨颈骨折术后血栓前状态的影响

Effect of Acupuncture Combined with Low-molecular-weight Heparin on the Prethrombotic State After Femoral Neck Fracture Surgery

目的观察针刺联合低分子肝素治疗对股骨颈骨折术后血栓前状态的影响。方法将84例股骨颈骨折术后血栓前状态患者随机分为对照组和观察组,每组42例。对照组予低分子肝素治疗,观察组予针刺联合低分子肝素治疗。比较两组治疗前后血清D-二聚体(D-D)、血管性血友病因子(vWF)、抗凝血酶原Ⅲ(AT-Ⅲ)、纤维蛋白原降解产物(FDP)、巨噬细胞炎性蛋白-1α(MIP-1α)和高迁移率族蛋白1(HMGB1)的水平,比较两组治疗前后血栓弹力图相关参数[凝血反应时间(RT)、血块成形时间(KT)、α角和最大幅度(MA)]和患侧与健侧大腿周径差值的变化,比较两组深静脉血栓(DVT)的发生情况。结果两组治疗后血清D-D、vWF、AT-Ⅲ和FDP均改善(P<0.05),且观察组优于对照组(P<0.05)。两组治疗后RT和KT均延长(P<0.05),α角和MA均减小(P<0.05);且观察组上述血栓弹力图相关参数均优于对照组(P<0.05)。两组治疗后患侧与健侧大腿周径差值均减小(P<0.05),且观察组小于对照组(P<0.05)。两组DVT发生率比较,差异无统计学意义(P>0.05)。对照组治疗后血清MIP-1α和HMGB1水平无明显改变(P>0.05);观察组治疗后血清MIP-1α和HMGB1水平均降低(P<0.05),且均低于对照组治疗后(P<0.05)。结论针刺联合低分子肝素治疗可改善股骨颈骨折术后血栓前状态,减轻患肢肿胀,可能与其降低血清MIP-1α和HMGB1水平有关。

Objective To observe the effect of acupuncture combined with low-molecular-weight heparin on the prethrombotic state(PTS)after femoral neck fracture(FNF)surgery.Method Eighty-four patients in PTS after FNF surgery were randomized into a control group and an observation group,with 42 cases in each group.The control group received low-molecular-weight heparin for treatment,and the observation group was intervened by acupuncture plus low-molecular-weight heparin.Before and after the treatment,the serum levels of D-dimer(D-D),von willebrand factor(vWF),antithrombinⅢ(AT-Ⅲ),fibrinogen degradation products(FDP),macrophage inflammatory protein-1α(MIP-1α),and high mobility group protein 1(HMGB1)were compared.Changes in the thromboelastogram parameters[reaction time(RT),coagulation time(KT),angleα,and maximum amplitude(MA)]and the difference between the affected and healthy thigh circumferences and the occurrence of deep venous thrombosis were also compared between the two groups.Result The serum D-D,vWF,AT-Ⅲ,and FDP levels improved after the treatment in both groups(P<0.05)and were better in the observation group than in the control group(P<0.05).The RT and KT extended in both groups after the treatment(P<0.05),and the angleαand MA were reduced(P<0.05);the observation group surpassed the control group in comparing the above thromboelastogram parameters(P<0.05).The difference between the affected and healthy thigh circumferences decreased after the treatment in both groups(P<0.05)and was smaller in the observation group than in the control group(P<0.05).There was no significant difference in the DVT incidence between the two groups(P>0.05).The serum levels of MIP-1αand HMGB1 showed no notable changes after the treatment in the control group(P>0.05);the serum levels of MIP-1αand HMGB1 decreased after the intervention in the observation group(P<0.05)and were lower than those in the control group(P<0.05).Conclusion Acupuncture plus low-molecular-weight heparin can improve PTS and reduce the swelling of the affected limb after FHF surgery,which is plausibly associated with the down-regulation of serum MIP-1αand HMGB1 levels.