尿激酶溶栓治疗对下肢深静脉血栓合并急性肺栓塞患者凝血功能、D-二聚体、N-末端脑钠肽前体的影响
doi: 10.16766/j.cnki.issn.1674-4152.2017.12.019
Effect of urokinase thrombolysis on coagulation function,D-dimer and NT-pro BNP in deep vein thrombosis patients with acute pulmonary embolism
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摘要: 目的 探讨尿激酶溶栓治疗对下肢深静脉血栓合并急性肺栓塞患者凝血功能、D-二聚体(D-Dimer,D-D)、N-末端脑钠肽前体(N-terminal pro-brain nitric peptide,NT-proBNP)的影响。 方法 选取2014年7月—2016年10月于杭州医学院附属人民医院进行治疗的下肢深静脉血栓合并急性肺栓塞患者86例,随机对照表法分为观察组和对照组,各43例。对照组患者采用低分子肝素序贯华法林进行治疗,观察组在对照组的基础上给予小剂量尿激酶溶栓治疗,2组均治疗14 d。观察2组患者临床疗效、凝血功能、D-D、NT-proBNP变化情况。 结果 观察组患者下肢深静脉血栓、肺栓塞治疗有效率明显高于对照组(P<0.05);与治疗前相比,2组患者治疗后血小板(platelet,PLT)、纤维蛋白原(fibrinogen,FIB)水平与治疗前差异无统计学意义(P>0.05),国际标准化比值(international normalized ratio,INR)水平明显升高(P<0.05),与对照组相比,观察组患者治疗后INR、PLT、FIB水平差异无统计学意义(P>0.05);与治疗前相比,2组患者治疗后D-D、NT-proBNP水平明显降低(P<0.05);与对照组相比,观察组患者治疗后D-D、NT-proBNP水平降低更显著(P<0.05);与治疗前相比,2组患者治疗后膝上20 cm周径差、膝下15 cm周径差明显降低(P<0.05);与对照组相比,观察组患者治疗后膝上20 cm周径差、膝下15 cm周径差降低更显著(P<0.05)。 结论 尿激酶溶栓治疗对下肢深静脉血栓合并急性肺栓塞患者疗效显著,凝血功能指标均在正常范围内,无出血现象,且可改善下肢深静脉血栓合并急性肺栓塞患者D-D、NT-proBNP水平。Abstract: Objective To investigate the effect of urokinase thrombolysis on coagulation function,D-Dimer(D-D) and N-terminal pro-brain nitric peptide(NT-proBNP) in deep vein thrombosis patients with acute pulmonary embolism. Methods A total of 86 deep vein thrombosis patients with acute pulmonary embolism were randomly divided into observation group(43 cases) and control group(43 cases) from July,2014 to October,2016.The patients of the control group received initial low-molecular-weight heparin(LMWH) administration followed by warfarin therapy,while the patients of the observation group received additional low dose urokinase thrombolysis based on the control group.The course in both groups was 14 d.The clinical effect,coagulation function,D-D and NT-proBNP in both groups were observed. Results The effective rate of the observation group was significantly higher than that in control group(P<0.05).After the treatment,the levels of Platelet(PLT) and Fibrinogen(FIB) were not improved in both groups(P>0.05).The level of international normalized ratio (INR) increased significantly after treatment (P<0.05),however,there was no significant difference in the levels of INR,PLT and FIB between the two groups (P>0.05).After the treatment,the levels of D-D and NT-proBNP decreased significantly(P<0.05),and more significantly in the observation group(P<0.05).After the treatment,the circumference difference of knee above 20 cm and below 15 cm of the two groups decreased significantly(P<0.05),especially in the observation group (P<0.05). Conclusion Urokinase thrombolysis is effective in deep vein thrombosis patients with acute pulmonary embolism,maintaining coagulation function indexes within the normal range,and no bleeding.It can also improve the levels of D-D and NT-proBNP.
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