低分子肝素抗凝治疗对脓毒症患者血清炎性因子、血管内皮功能及凝血功能的影响

Effect of low molecular weight heparin anticoagulant therapy on serum inflammatory factors,vascular endothelial function and coagulation function in patients with sepsis

目的观察低分子肝素抗凝治疗对脓毒症患者血清炎性因子、血管内皮功能及凝血功能的影响。方法选取2022年1月—2023年12月厦门大学附属翔安医院收治的脓毒症患者115例,采用随机数字表法分为低分子肝素组(n=58)和常规组(n=57)。常规组予以常规治疗,低分子肝素组在常规组基础上增加低分子肝素抗凝治疗,2组均治疗1周。比较2组疗效,治疗前后血清炎性因子[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)]、血管内皮功能指标[内皮素-1(ET-1)、一氧化氮(NO)]、凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)]、免疫功能指标[免疫球蛋白G(IgG)、免疫球蛋白A(IgA)、免疫球蛋白M(IgM)]及不良反应。结果低分子肝素组总有效率(91.38%)高于常规组(77.19%)(χ2=4.382,P=0.036)。与治疗前比较,治疗1周后,2组CRP、TNF-α、IL-6水平降低,且低分子肝素组低于常规组(P<0.01);2组ET-1水平降低,NO水平升高,且低分子肝素组低/高于常规组(P<0.01);2组PT、APTT延长,Fib水平降低,且低分子肝素组PT、APTT长于常规组,Fib水平低于常规组(P<0.01);低分子肝素组IgG、IgA、IgM水平升高,且高于常规组(P<0.01);常规组IgG、IgA、IgM水平与治疗前比较差异无显著性(P>0.05)。低分子肝素组与常规组不良反应总发生率比较差异无显著性(1.72%vs.0,χ2=0.991,P=0.319)。结论低分子肝素抗凝治疗脓毒症可有效促进患者体内炎性因子水平下降,改善血管内皮功能、凝血功能,促进免疫调节,获得更满意的疗效,且不良反应少,安全性较高。

Objective To observe the effect of low molecular weight heparin anticoagulation therapy on serum inflammatory factors,vascular endothelial function and coagulation function in patients with sepsis.Methods A total of 115 patients with sepsis admitted to Xiang′an Hospital of Xiamen University from January 2022 to December 2023 were randomly divided into low molecular weight heparin group(n=58)and conventional group(n=57).The conventional group was given conventional treatment,and the low molecular weight heparin group was added with low molecular weight heparin anticoagulant therapy on the basis of the conventional group.Both groups were treated for 1 week.The curative effects,serum inflammatory factors(CRP,TNF-α,IL-6),vascular endothelial function indexes(ET-1,NO),coagulation function indexes(PT,APTT,Fib),immune function indexes(IgG,IgA,IgM)before and after treatment,and adverse reactions were compared between the two groups.Results The total effective rate of low molecular weight heparin group(91.38%)was higher than that of conventional group(77.19%)(χ2=4.382,P=0.036).Compared with before treatment,the levels of CRP,TNF-α,IL-6 in the two groups were decreased after 1 week of treatment,and the levels in the low molecular weight heparin group were lower than those in the conventional group(P<0.01).The levels of ET-1 were decreased and the levels of NO were increased in the two groups,and the low molecular weight heparin group was lower/higher than the conventional group(P<0.01).The PT and APTT of the two groups were prolonged,and the Fib levels were decreased,and the PT and APTT of the low molecular weight heparin group were longer than those of the conventional group,and the Fib level was lower than that of the conventional group(P<0.01).The levels of IgG,IgA and IgM increased in the low molecular weight heparin group,and the levels of IgG,IgA and IgM in the low molecular weight heparin group were higher than those in the conventional group(P<0.01).The levels of IgG,IgA and IgM in the conventional group had no significant difference compared with those before treatment(P>0.05).There was no significant difference in the total incidence of adverse reactions between the low molecular weight heparin group and the conventional group(1.72%vs.0,χ2=0.991,P=0.319).Conclusion Low molecular weight heparin anticoagulation in the treatment of sepsis can effectively reduce the level of inflammatory factors in patients,improve vascular endothelial function and coagulation function,promote immune regulation,and obtain more satisfactory curative effect,with less adverse reactions and high safety.