低分子肝素联合甲氨蝶呤治疗难治性溃疡性结肠炎的疗效及对患者凝血功能和炎性因子水平的影响

Effect of low molecular weight heparin combined with methotrexate in the treatment of refractory ulcerative colitis and its influence on blood coagulation function and inflammatory factor levels

目的观察低分子肝素联合甲氨蝶呤治疗难治性溃疡性结肠炎(UC)的疗效及对患者凝血功能和炎性因子水平的影响。方法选取2020年12月—2021年11月福建省龙岩市第二医院收治的难治性UC患者106例,采用随机摸球法分成联合组(n=53)与甲氨蝶呤组(n=53)。2组患者均进行常规治疗,在此基础上,甲氨蝶呤组患者采用甲氨蝶呤治疗,联合组患者采用低分子肝素联合甲氨蝶呤治疗,2组患者均连续治疗8周。比较2组患者的临床疗效,治疗前后凝血功能、症状评分、炎性因子水平、氧化应激指标及不良反应。结果联合组患者的治疗总有效率为96.23%,高于甲氨蝶呤组的79.25%(χ^(2)=7.102,P=0.008)。治疗8周后,2组患者纤维蛋白原(Fib)、血小板计数(PLT)较治疗前明显降低,活化部分凝血酶原时间(APTT)较治疗前明显延长,且联合组优于甲氨蝶呤组(P均<0.01);2组患者便血、腹痛、腹泻评分较治疗前明显降低,且联合组低于甲氨蝶呤组(P均<0.01);2组患者肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白介素-6(IL-6)水平较治疗前明显降低,且联合组低于甲氨蝶呤组(P均<0.01);2组患者谷胱甘肽过氧化物酶(CSF-Px)、超氧化物歧化酶(SOD)、过氧化氢酶(CAT)水平较治疗前明显升高,且联合组高于甲氨蝶呤组(P均<0.01)。联合组患者的不良反应总发生率为3.77%,低于甲氨蝶呤组的18.87%(χ^(2)=6.014,P=0.014)。结论低分子肝素联合甲氨蝶呤治疗难治性UC可有效提高临床疗效,改善凝血功能及临床症状,降低炎性因子水平,提高氧化应激反应,降低不良反应发生率,值得推广。

Objective To observe the effect of low molecular weight heparin combined with methotrexate in the treatment of refractory ulcerative colitis(UC)and its influence on the blood coagulation function and inflammatory factor level.Methods 106 patients with refractory UC admitted to the Second Hospital of Longyan,Fujian Province from December 2020 to November 2021 were selected,they were divided into combined group and methotrexate group by randomly touching the ball with 53 cases each.Both groups of patients received routine treatment,on this basis,patients in the control group were treated with methotrexate,and patients in the combined group were treated with low molecular weight heparin combined with methotrexate,patients in both groups were treated continuously for 8 weeks.The clinical efficacy,coagulation function,symptom score,inflammatory factor level,oxidative stress index before and after treatment and adverse reactions of the two groups were compared.Results The total effective rate of patients in the combined group was 96.23%,higher than 79.25%in the methotrexate group(χ^(2)=7.102,P=0.008).After 8 weeks of treatment,the fibrinogen(Fib)and platelet count(PLT)in the two groups were significantly lower than those before treatment,and activated partial thromboplastin time(APTT)was significantly longer than those before treatment,and the change range in the combined group were greater than those in the methotrexate group(P<0.01);The scores of hematochezia,abdominal pain and diarrhea in the two groups were significantly lower than those before treatment,and the scores in the combined group were lower than those in the methotrexate group(P<0.01);The tumor necrosis factor-α(TNF-α),C-reactive protein(CRP)and interleukin-6(IL-6)levels were significantly lower than those before treatment,and the combined group were significantly lower than those in the methotrexate group(P<0.01);The levels of glutathione peroxidase(CSF-Px),superoxide dismutase(SOD)and catalase(CAT)in the two groups were significantly higher than those before treatment,and those in the combined group were higher than those in the methotrexate group(P<0.01).The total incidence of adverse reactions in the combined group was 3.77%,lower than 18.87%in the methotrexate group(χ^(2)=6.014,P=0.014).Conclusion Low molecular weight heparin combined with methotrexate in the treatment of refractory UC can effectively improve the clinical efficacy,improve the coagulation function and clinical symptoms,reduce the level of inflammatory factors,increase oxidative stress reaction,and reduce the incidence of adverse reactions,which is worthy of promotion.