阿替普酶联合利伐沙班治疗老年肥胖患者急性下肢深静脉血栓的临床研究

Clinical trial of alteplase combined with rivaroxaban in the treatment of elderly obese patients with acute lower extremity deep vein thrombosis

目的观察阿替普酶注射液联合利伐沙班片治疗老年肥胖患者急性下肢深静脉血栓(DVT)的临床疗效及安全性。方法将老年肥胖合并DVT患者按随机数字表法分为对照组和试验组。对照组给予10 mg·d^(-1)利伐沙班片治疗,口服。试验组在对照组治疗的基础上,联合0.9 mg·kg^(-1)·d^(-1)注射阿替普酶治疗,静脉给药。2组患者均治疗1周。比较2组患者的临床疗效、凝血功能指标、下肢静脉血流动力学指标、炎症因子及血管内皮功能相关指标、miR-374b-5p相对表达水平、药物不良反应发生情况及3个月内复发情况。结果试验组和对照组均入组80例患者。治疗后,试验组和对照组的总有效率分别为92.50%(74例/80例)和81.25%(65例/80例),在统计学上差异有统计学意义(P<0.05)。治疗后,试验组和对照组的纤维蛋白原分别为(3.58±0.83)和(3.91±1.04)g·L^(-1),D-二聚体分别为(2.18±0.74)和(2.49±0.93)μg·mL^(-1),血小板活化因子分别为(115.42±10.43)和(119.74±11.37)μg·L^(-1),凝血酶原时间分别为(12.95±1.16)和(13.41±1.27)s,最大血流速度分别为(29.19±6.74)和(26.93±4.58)cm·s^(-1),血流量分别为(92.17±9.61)和(88.63±8.75)mL·min^(-1),内皮缩血管肽-1分别为(51.97±4.86)和(54.02±4.92)pg·mL^(-1),miR-374b-5p相对表达水平分别为2.18±0.73和2.49±0.85,试验组的上述指标对照组比较,在统计学上差异均有统计学意义(均P<0.05)。2组患者的药物不良反应均以出血症状为主。试验组和对照组的药物不良反应总发生率分别为10.00%和13.75%,在统计学上差异无统计学意义(P>0.05)。试验组和对照组的3个月内复发率分别为6.25%和16.25%,在统计学上差异有统计学意义(P<0.05)。结论阿替普酶注射液联合利伐沙班片治疗老年肥胖合并DVT患者的临床疗效良好,可改善患者血液循环,减少炎性反应,安全性较高。

Objective To observe the clinical efficacy and safety of alteplase combined with rivaroxaban in the treatment of acute deep vein thrombosis(DVT)in elderly obese patients.Methods Elderly obese patients with DVT were divided into control group and treatment group according to random number table method.The control group was treated with 10 mg·d^(-1)rivaroxaban tablets orally.The treatment group was treated with 0.9 mg·kg^(-1)·d^(-1)alteplase on the basis of the control group.Both groups were treated for 1 week.Clinical efficacy,coagulation function indexes,lower limb venous blood flow mechanics indexes,inflammatory factors and vascular endothelial function related indexes,relative expression level of miR-3746b-5p,occurrence of adverse drug reactions and recurrence within 3 months were compared between the two groups.Results A total of 80 patients were enrolled in the treatment group and the control group,respectively.After treatment,the total effective rate of treatment group and control group were 92.50%(74 cases/80 cases)and 81.25%(65 cases/80 cases),respectively,and the difference was statistically significant(P<0.05).After treatment,the fibrinogen levels of treatment group and control group were(3.58±0.83)and(3.91±1.04)g·L^(-1),respectively;D-dimer levels were(2.18±0.74)and(2.49±0.93)μg·mL^(-1),respectively;platelet activating factor were(115.42±10.43)and(119.74±11.37)μg·L^(-1),respectively;prothrombin time were(12.95±1.16)and(13.41±1.27)s,respectively;the maximum blood flow velocity were(29.19±6.78)and(26.93±4.58)cm·s^(-1),respectively;the blood flow were(92.17±9.61)and(88.63±8.75)mL·min^(-1),respectively;endothelial vasoconstricting peptide-1 were(51.97±4.86)and(54.02±4.92)pg·mL^(-1);the relative expression levels of miR-374b-5p were2.18±0.73 and 2.49±0.85,respectively.The above indexes of the treatment group were statistically significant compared with the control group(all P<0.05).Bleeding symptoms were the main adverse drug reactions in both groups.The total incidence of adverse drug reactions in treatment group and control group was 10.00%and 13.75%,respectively,with no statistical significance(P>0.05).The 3-month recurrence rates of treatment group and control group was 6.25%and 16.25%,respectively,and the difference was statistically significant(P<0.05).Conclusion Alteplase combined with rivaroxaban has good clinical efficacy in the treatment of elderly obese patients with DVT,which can improve the blood flow of patients,reduce inflammatory response,and has high safety.