血浆D-二聚体、红细胞比容及纤维蛋白原检测在AECOPD患者中的临床意义及肝素干预特点

Clinical significance of plasma D-dimer and red cell hematocrit and fibrinogen detection and heparin intervention characteristics in patients with AECOPD

目的探讨血浆D-二聚体、红细胞比容及纤维蛋白原检测在AECOPD患者中的临床意义及肝素干预特点。方法选取2012年7月至2016年7月在我院呼吸内科确诊AECOPD患者118例,随机分为对照组46例和AECOPD组72例,同时选择我院52例非AECOPD患者作为健康对照组。对照组给予常规治疗的基础上,AECOPD组给予低分子肝素5000U注射,健康对照组无任何治疗措施。对照组、健康对照组出院前1周空腹静脉抽血,AECOPD组入院次日、治疗1周及出院前1周都空腹静脉抽血,6m L静脉血置于枸椽酸钠抗凝管中,西施美康i-2000测量红细胞比容,随后离心收血浆,D-二聚体、纤维蛋白原由PUN-2048系列半自动凝血分析仪测定。患者出院时,记录其临床症状控制情况,分为临床控制、显效、有效、无效4级,同时记录总控制率。结果对照组D-二聚体、红细胞比容和纤维蛋白原水平均高于健康对照组,差异有统计学意义(t=18.87、21.45、23.47,P<0.05);AECOPD组D-二聚体、红细胞比容和纤维蛋白原水平略高于健康对照组,差异无统计学意义(t=2.34、1.78、0.99,P>0.05),D-二聚体、红细胞比容和纤维蛋白原水平均低于对照组,差异有统计学意义(t=22.06、17.94、21.63,P<0.05);对照组治疗后D-二聚体、红细胞比容和纤维蛋白原水平均低于对照组治疗前,差异有统计学意义(t=19.45、16.88、21.54,P<0.05);AECOPD治疗一周后D-二聚体、红细胞比容和纤维蛋白原水平下降,差异有统计学意义(t=7.34、6.26、8.99,P<0.05);至出院前一周D-二聚体、红细胞比容和纤维蛋白原水平降至最低水平,差异有统计学意义(t=20.43、2.76、18.00,P<0.05);AECOPD组治疗咳嗽、咳痰、喘息、啰音症状的控制率均高于对照组,差异有统计学意义(χ~2=10.60、8.84、8.25、19.5,P<0.05);AECOPD组治疗总有效率高于对照组,差异有统计学意义(χ~2=4.27,P<0.05)。结论肝素能降低AECOPD患者血液高凝状态,其疗效好,能显著改善患者临床症状;同时监测血浆D-二聚体、红细胞比容和纤维蛋白原水平的变化对该类疾病的诊断、程度判断、抗凝治疗效果判定具有重要的意义。

Objective To investigate the clinical significance of plasma D-dimer and red cell hematocrit and fibrinogen detection and heparin intervention characteristics in patients with AECOPD. Methods 118 patients with AECOPD from July 2012 to July 2016 were selected and randomly divided into the control group( n = 46) and the AECOPD group( n = 72). At the same time,52 non AECOPD patients in our hospital were selected as the healthy control group. The control group was given conventional treatment,and the AECOPD group were given subcutaneous injection of 5000 U low molecular weight heparin. There was no treatment measures in the healthy control group. The healthy control group and the control group were given fasting venous blood 1 week before discharge,and the AECOPD group was given fasting venous blood at day of admitted to hospital,1 week of treatment and 1 week before discharge. The level of red cell hematocrit was detected by XN-2000 i and the levels of D-dimer and fibrinogen by PUN-2048 series semi automatic coagulation analyzer. At the time of discharge,the clinical symptoms of the patients were recorded,which were divided into 4 levels: clinical control,effective,effective and ineffective. Results The levels of D-dimer,hematocrit and fibrinogen were higher in the control group than in the healthy control group( t = 18. 87,21. 45,23. 47,P < 0. 05),and they were slightly higher in the AECOPD group than in the control group( t = 2. 34,1. 78,0. 99,two P > 0. 05). After treatment,the levels of D-dimer and fibrin specific red cell were lower than before( t = 19. 45,16. 88,21. 54,P < 0. 05). A week before discharge,the levels of plasma D-dimer,hematocrit and fibrinogen in patients with AECOPD decreased significantly to the lowest levels and the difference were statistically significant( t = 20. 43,2. 76,18. 00,P < 0. 05). The scores of cough,expectoration,wheezing,and crackles symptoms were higher in the AECOPD group than in the control group( χ~2= 10. 60,8. 84,8. 25,19. 5,P < 0. 05). The total effective rate was higher in the AECOPD group than in the control group( χ~2= 4. 27,P < 0. 05). Conclusion Heparin can reduce hypercoagulable state in AECOPD patients,and significantly improve the clinical symptoms. The changes of plasma D-dimer and fiber protein of red cells has important significance.