低分子肝素结合替罗非班治疗老年急性下肢深静脉血栓对PAC-1、P 选择素的影响

Therapeutic effect of low molecular heparin plus Tirofiban in acute deep venous thrombosis

摘要:

目的 研究低分子肝素结合替罗非班治疗老年急性下肢深静脉血栓的疗效以及对血小板激活复合物-1（PAC-1）、P 选择素的影响。方法 选取2013 年2 月-2016 年2 月广西柳州市人民医院收治的老年急性下肢深静脉血栓（ADVT）患者138 例为研究对象，采用随机数字表法分为观察组和对照组，每组69 例。对照组患者给予低分子肝素皮下注射2 周，观察组在对照组基础上联合替罗非班静脉泵注。比较两组患者治疗前后的下肢肢围差、血小板计数、凝血四项、PAC-1 和P 选择素阳性率。结果 治疗前，两组患者的各项指标差异无统计学意义（P >0.05）；治疗后两组患者的膝上15 cm 和膝下10 cm 处下肢肢围差均降低，观察组肢围差低于对照组；两组患者的纤维蛋白原浓度均下降，观察组低于对照组，差异有统计学意义（P <0.05）。治疗前后，两组患者的凝血酶原时间、活化部分凝血酶原时间、凝血酶时间和血小板计数无变化，组间比较差异无统计学意义（P >0.05）。治疗后两组患者的PAC-1 及P 选择素阳性率差异均有统计学意义（P <0.05）。结论 低分子肝素结合替罗非班可以有效治疗老年ADVT，减小下肢肢围差，降低PAC-1 和P 选择素的阳性表达，抑制血栓形成，不影响患者凝血功能，疗效良好，值得临床推广。

Abstract:

Objective To investigate the therapeutic effect of low molecular heparin plus Tirofiban in acute Deep venous thrombosis (ADVT) and potential underlying mechanisms. Methods Totally 138 cases of ADVT admitted into our hospital from February 2013 to February 2016 were included and randomly divided into control group and observation group (n = 69). Patients from control group received standard treatment of low molecular heparin, while patients from observation group was treated with Tirofiban in addition to low molecular heparin. Limb circumference difference, platelet count, PT, APTT, TT, FIB pre- and post- treatments, PAC-1 and CD62P positive rate were recorded. Results All patients recovered in both groups (P > 0.05). Decrease of limb circumference and FIB concentration in observation group were significant when compared with control group (P < 0.05). Platelet count,PT, APTT and TT were decreased in the two groups while no dramatic difference were founded between the groups(P > 0.05). Positive rate of PAC-1 was decreased significantly with treatment of tirofiban in both observation group and control group when compared with groups receiving low molecular heparin only [(11.45 ± 1.63) % vs (7.68 ±1.03) %, (11.79 ± 1.67) %, (3.92 ± 0.94) %, separately, (P < 0.05)]. Reduction of positive rate of CD62P was more significant with treatment of Tirofiban in both observation group and control group when compared with groups receiving low molecular heparin only [(13.30 ± 1.52) % vs (4.83 ± 1.05) %, (12.89 ± 1.47) % vs (9.01 ± 1.26)%, separately, (P < 0.05)]. Conclusion Low molecular heparin combined with Tirofiban is a promising therapeutic option for ADVT, and inhibition of thrombosis is achieved potentially through decreased expression of PAC-1 and CD62P.