吲哚布芬联合红外线照射在改善血液透析患者凝血状态血管内皮功能和动静脉内瘘功能中的效果分析

Effect of indobufen combined with infrared radiation on improving coagulation status,vascular endothelial function and arteriovenous fistula function in hemodialysis patients

目的探究吲哚布芬联合红外线照射在改善血液透析患者凝血状态、血管内皮功能和动静脉内瘘功能方面的效果。方法随机数字表法将192例在本院肾脏内科建立自体动静脉内瘘(AVF)的维持性血液透析(MHD)患者均分为2组。对照组在AVF建立后每日给予红外线照射处理;研究组在红外线照射的同时服用吲哚布芬。对比2组干预前后血脂[总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]、凝血功能[活化部分凝血活酶时间(APTT)、全血黏度、纤维蛋白原(Fib)、血小板聚集率]、血管内皮功能[内皮素-1(ET-1)、一氧化氮(NO)、血管内皮生长因子-A(VEGF-A)]变化情况;统计2组干预1个月血管成熟率、内瘘口血流量和血管通畅率。结果与对照组比,研究组治疗后血脂TG[(4.16±1.24)mmol/L与(4.32±1.10)mmol/L]、TG[(1.59±0.40)mmol/L与(1.59±0.42)mmol/L]、LDL-C[(2.40±0.60)mmol/L与(2.43±0.69)mmol/L]、HDL-C[(1.28±0.37)mmol/L与(1.26±0.33)mmol/L]水平比较差异无统计学意义(P>0.05),研究组APTT[(33.9±2.2)s与(31.9±2.3)s]明显延长,全血黏度[(4.72±0.43)mPa·s与(5.08±0.47)mPa·s]、血清Fib[(3.10±0.28)g/L与(3.40±0.27)g/L]、血小板聚集率[(50.7±5.3)%与(56.5±4.7)%]均明显下降(P<0.05),血清ET-1[(62±14)μmol/L与(72±14)μmol/L]、NO[(90±12)μmol/L与(80±12)μmol/L]水平降低,VEGF-A[(191±47)pg/ml与(218±43)pg/ml]水平明显升高(P<0.05)。2组血管成熟率间比较差异(74.0%与70.8%)均无统计学意义(P>0.05),但研究组内瘘口血流量[(277±31)ml与(257±33)ml]和血管通畅率(99.0%与87.5%)均明显高于对照组(P<0.05)。结论吲哚布芬联合红外线照射可在不明显影响血脂基础上,抑制血小板聚集,调节机体凝血状态和血管内皮功能,预防AVF狭窄,提高内瘘通畅率。

Objective To explore the effect of indobufen combined with infrared radiation on improving coagulation status,vascular endothelial function,and arteriovenous fistula function in hemodialysis patients.Methods One hundred and ninety-two patients with maintenance hemodialysis(MHD)who established arterio-venous fistula(AVF)in the Nephrology Department of our hospital were divided into two groups by random number table.The control group was treated with infrared radiation every day after AVF was established,and the study group was treated with indobufen in addition to infrared radiation.The lipid[total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C)],blood coagulation function[part activated clotting time(APTT),whole blood viscosity,fibrinogen(Fib),platelet aggregation rate],and blood Endovascular function[endothelin-1(ET-1),nitric oxide(NO),vascular endothelial growth factor-A(VEGF-A)]was compared in the two groups before and after the intervention.The vascular maturation rate,internal fistula blood flow,and vascular patency rate were statistically compared between the two groups after 1 month of intervention.Results Compared to the control group,the study group was treated with serum lipid TG[(4.16±1.24)mmol/L vs(4.32±1.10)mmol/L],TG[(1.59±0.40)mmol/L vs(1.59±0.42)mmol/L]and LDL-C[(2.40±0.60)mmol/L vs(2.43±0.69)mmol/L],HDL-C[(1.28±0.37)mmol/L vs(1.26±0.33)mmol/L]had no significant changes(P>0.05),the APTT[(33.9±2.2)s vs(31.9±2.3)s]was significantly prolonged,whole blood viscosity[(4.72±0.43)mPa·s vs(5.08±0.47)mPa·s],serum Fib[(3.10±0.28)μmol/L vs(3.40±0.27)μmol/L],platelet aggregation rate[(50.7±5.3)%vs(56.5±4.7)%]were significantly decreased(P<0.05),the level of serum ET-1[(62±14)μmol/L vs(72±14)μmol/L],NO[(90±12)μmol/L vs(80±12)μmol/L]decreased,and the level of VEGF-A[(191±47)pg/ml vs(218±43)pg/ml]increased significantly(P<0.05).There was no significant difference in vascular maturity rate between the two groups(74.0%vs 70.8%)(P>0.05).However,the blood flow[(277±31)ml vs(257±33)ml]and the vascular patency rate(99.0%vs 87.5%)in the study group were significantly higher than those in the control group(P<0.05).Conclusion Indobufen combined with infrared radiation can inhibit platelet aggregation,regulate the coagulation state and vascular endothelial function,prevent AVF stenosis,and improve the patency rate of internal fistula without significantly affecting blood lipids.