低分子肝素治疗对急性加重期慢阻肺合并肺癌患者肺功能、凝血功能及预后的影响

Influences of low molecular weight heparin therapy on lung function,coagulation function and prognosis in patients with acute exacerbation of chronic obstructive pulmonary disease complicated with lung cancer

目的探究低分子肝素治疗对急性加重期慢阻肺合并肺癌患者肺功能、凝血功能及预后的影响。方法选取60例急性加重期慢阻肺合并肺癌患者,采用随机数字表法将其分为常规组(30例)和肝素组(30例)。其中常规组患者给予对症治疗,肝素组在对症治疗的基础上给予低分子肝素治疗,4100 iu/12 h。比较两组凝血功能[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、D-二聚体],血气分析指标[血氧饱和度(SaO_(2))、二氧化碳分压(PaCO_(2))、血氧分压(PaO_(2))],血管内皮功能[一氧化氮(NO)、内皮素1(ET-1)、细胞间黏附分子1(ICAM-1)],肺功能[1s用力呼气容积(FEV1)用力肺活量(FVC)、FEV1占预计值的比例(FEV1%)],C反应蛋白(CRP)、呼吸困难情况(mMRC评分)及生存情况。结果与治疗前比较,肝素组与常规组治疗后APTT[(18.46±1.87)vs(11.58±1.25)s,(18.11±1.82)vs(15.57±1.58)s]、PT[(29.53±3.01)vs(22.57±2.36)s,(29.14±2.93)vs(25.48±2.61)s]、D-二聚体[(842.59±85.12)vs(435.62±44.57)g/L,(846.63±84.75)vs(551.79±55.64)g/L]、PaC0_(2)[(58.79±5.92)vs(42.53±4.26)mmHg,(59.14±5.96)vs(50.38±5.07)mmHg]、ET-1[(106.78±10.72)vs((65.37±6.64)ng/L,(105.96±10.61)vs(72.53±7.31)ng/L]、ICAM-1[(231.48±23.35)vs(142.63±14.57)μg/L,(228.79±23.12)vs(165.48±16.72)μg/L]、CRP水平[(80.39±18.53)vs(9.77±2.08)mg/L,(80.64±19.17)vs(14.86±3.16)mg/L]、mMRC评分[(2.64±0.31)vs(1.42±0.22)分,(2.71±0.34)vs(1.78±0.27)分]均明显降低(P<0.05),且与常规组比较,肝素组明显降低(P<0.05);与治疗前比较,肝素组与常规组治疗后Sa0_(2)[(0.54±0.15)vs 0.82±0.24)mmHg,(0.56±0.16)vs(0.67±0.20)mmHg] Pa0_(2)[(56.32±5.65)vs(80.47±8.12)mmHg,(56.89±5.72)vs(72.13±7.25)mmHg]、NO[(54.31±5.46)vs(96.78±10.02)μmol/L,(53.27±5.35)vs(85.64±8.62)μmol/L]、FEV1[(1.21±0.32)vs(1.89±0.45)%,(1.25±0.34)vs(1.57±0.41)%]、FVC[(3.41±0.35)vs(3.78±0.42)L,(3.37±0.32)vs(3.56±0.36)L].FEV1%[(80.74±8.15)vs(88.46±8.75)%,(79.53±8.02)vs(83.82±8.41)%]水平明显升高(P<0.05),且与常规组比较,肝素组明显升高(P<0.05)。对患者进行为期3年的随访显示,肝素组患者生存者11例(36.67%),占比高于常规组生存者7例(23.33%)(x^(2)=8.31,P=0.004)。结论低分子肝素治疗急性加重期慢阻肺合并肺癌患者可有效提高凝血功能、肺功能及血管内皮功能,调节血气指标,改善呼吸困难情况,提高患者预后。

Objective To investigate the influences of low molecular weight heparin therapy on lung func-tion,coagulation function and prognosis in patients with acute exacerbation of chronic obstructive pulmonary dis-ease complicated with lung cancer.Methods Sixty patients with acute exacerbation of chronic obstructive pulmo-nary disease complicated with lung cancer were gathered and randomly grouped into a routine group(30 cases)and a heparin group(30 cases).The patients in the routine group were given symptomatic treatment,and the pa-tients in the heparin group were given low molecular weight heparin treatment on the basis of the symptomatic treat-ment,4100 iu/12 h.The coagulation function[activated partial thromboplastin time(APTT),prothrombin time(PT),D-dimer],blood gas analysis indexes[blood oxygen saturation(SaO_(2)),carbon dioxide partial pressure(PaCO_(2)),blood oxygen partial pressure(PaO_(2))],vascular endothelial function[nitric oxide(NO),endothelin 1(ET-1),intercellular adhesion molecule-1(ICAM-1)],lung function[forced expiratory volume in first second(FEV1),forced vital capacity(FVC),ratio of FEV1 to predicted value(FEV1%)],C-reactive protein(CRP),dyspnea(mMRC score)and survival were compared.Results Compared with those before treatment,the levels of APTT[(18.46±1.87)vs(11.58±1.25)s,(18.11±1.82)vs(15.57±1.58)sl,PT[(29.53±3.01)vs(22.57±2.36)s,(29.14±2.93)vs(25.48±2.61)sl,D-dimer[(842.59±85.12)vs(435.62±44.57)g/L,(846.63±84.75)vs(551.79±55.64)g/L),PaC0_(2)[(58.79±5.92)vs(42.53±4.26)mmHg,(59.14±5.96)vs(50.38±5.07)mmHgl,ET-1[(106.78±10.72)vs(65.37±6.64)ng/L,(105.96±10.61)vs(72.53±7.31)ng/L),ICAM-1[(231.48±23.35)vs(142.63±14.57)μg/L,(228.79±23.12)vs(165.48±16.72)μg/L),CRP[(80.39±18.53)vs(9.77±2.08)mg/L,(80.64±19.17)vs(14.86±3.16)mg/L] and mMRC[(2.64±0.31)vs(1.42±0.22)points,(2.71±0.34)vs(1.78±0.27)pointsl in both groups were greatly decreased after treatment(P<0.05),and compared with the routine group,the heparin group were greatly lower(P<0.05).Compared with those before treatment,the levels of Sa0_(2)[(0.54±0.15)vs 0.82±0.24)mmHg,(0.56±0.16)vs(0.67±0.20)mmHgl,Pa0_(2)[(56.32±5.65)vs(80.47±8.12)mmHg,(56.89±5.72)vs(72.13±7.25)mmHgl,N0[(54.31±5.46)vs(96.78±10.02)μmol/L,(53.27±5.35)vs(85.64±8.62)μmol/L],FEV1[(1.21±0.32)vs(1.89±0.45)%,(1.25±0.34)vs((1.57±0.41)%1,FVC[(3.41±0.35)vs(3.78±0.42)L,(3.37±0.32)vs(3.56±0.36)L],FEV1%[(80.74±8.15)vs(88.46±8.75)%,(79.53±8.02)vs(83.82±8.41)%]in the two groups after treatment were greatly increased(P<0.05),and compared with the routine group,the heparin group were greatly increased(P<0.05).A 3-year follow-up of the patients showed that there were 11 survivors in the heparin group(accounting for 36.67%),which was more than that of the conventional group(7 survivors,accounting for 23.33%)(x^(2)=8.310,P=0.004).Conclusion Low molecular weight heparin can effectively enhance the coagulation function,pulmonary function and vascular endothelial function,regulate blood gas indexes,ameliorate dyspnea in patients with acute exacerbation of chronic obstructive pulmonary disease and lung cancer,and improve patient prognosis.