摘要
目的:了解慢性心力衰竭患者体内凝血状态的变化,并观察短期使用小剂量阿司匹林对其凝血状态的干预作用。方法:选择2004-01/2005-07安徽医科大学第一附属医院收治的60例慢性心力衰竭患者(心功能Ⅱ～Ⅳ级),随机分为标准抗心力衰竭组30例及阿司匹林组30例。标准抗心力衰竭组接受标准抗心衰治疗,包括血管紧张素转化酶抑制剂单用或加用利尿剂,合用地高辛0.125～0.25mg/d,心功能Ⅱ～Ⅲ级患者加用β-受体阻滞剂;阿司匹林组在标准抗心衰治疗基础上,加阿司匹林75～100mg/d。在进入试验第1天和治疗2周后采集血标本,分别测定血浆P-选择素、血浆血管性假性血友病因子、D-二聚体水平。以30例同期健康体检者为正常对照组。结果:90例受试者全部进入结果分析。①慢性心力衰竭患者血P-选择素、血管性假性血友病因子和D-二聚体水平明显高于正常对照组眼(21.17±4.05),(16.78±3.26)g/L;(175.63±28.16)%,(125.78±24.95)%;(0.86±0.24),(0.51±0.15)mg/L,P均<0.05演。②标准抗心力衰竭组治疗后P-选择素、血管性假性血友病因子和D-二聚体水平较治疗前均下降眼(18.02±2.65),(21.45±3.97)g/L;(156.23±20.13)%,(175.23±25.6)%;(0.62±0.19),(0.87±0.21)mg/L;P均<0.05演。③阿司匹林组治疗后P-选择素、血管性假性血友病因子和D-二聚体水平较治疗前也显著下降眼(16.39±3.05),(20.87±4.06)g/L;(149.21±23.56)%,(176.01±28.12)%;(0.56±0.20)mg/L,(0.84±0.19)mg/L;P均<0.05演。④标准抗心力衰竭组和阿司匹林组患者治疗前血P-选择素、血管性假性血友病因子和D-二聚体水平差异无显著性(P>0.05);治疗后阿司匹林组组各指标均低于标准抗心力衰竭组,但无统计学意义(P>0.05)。结论:慢性心力衰竭患者体内存在高凝状态,有血栓形成的倾向,短期使用小剂量阿司匹林对心衰的凝血状态影响小,慢性心力衰竭患者阿司匹林使用的剂量及疗程有待于进一步研究。
AIM： To investigate the changes of the eoagulative state in patients with chronic heart failure （CHF）, and observe the interventional effect of smalldose aspirin on coagulative state, METHODS： A total of 60 patients with CHF （cardiac function of Ⅱ -Ⅳ grade）, who were treated at the First Affiliated Hospital of Anhui Medical University from January 2004 to July 2005, were selected and randomly assigned into standard anti-CHF group with 30 cases and aspirin group with 30 cases. Standard anti-CHF therapy was performed in the standard anti-CHF group, including single angiotensin-eonverting enzyme inhibitor agent or adding diuretic, combing eedoxin 0.125-0.25 mg per day, adding beta-receptor blocker in patients with Ⅱ-Ⅲ cardiac function. Based on the standard anti-CHF therapy, the patients in the aspirin group were also treated with aspirin 75-100 mg per day. Blood sample was collected at the 1^st day entering trial and 2^rd week after treatment, and then plasma P-selectin, plasma yon Willebrand＇s disease and D-dimer level were detected, respectively. Thirty healthy testees were enrolled as normal control group in the same period. RESULTS： Totally 90 testees were involved in the result analysis. ①P-selectin, plasma yon Willebrand＇s disease and D-dimer level in the CHF patients were higher significantly than those in the normal control group [（21.17±4.05）, （16.78±3.26）g/L;（175.63±28.16）%, （125.78±24.95）%; （0.86±0.24）, （0.51±0.15） mg/L,P 〈 0.05].②The P-selectin, plasma yon Willebrand＇s disease and D-dimer level decreased in the standard CHF group as compared with that before treatment [（18.02±2.65）,（21.45±3.97） g/L; （ 156.23±20.13）%, （ 175.23±25.6）% ; （0.62±0.19）, （0.87±0.21） mg/L ; P 〈 0.05].③The P-selectin, plasma yon Willebrand＇s disease and D-dimer level decreased obviously in the aspirin treatment group as compared with that before treatment [（16.39±3.05）,（20.87±4.06） g/L;（149.2±23.56）%, （176.01±28.12）%;（0.56±0.20） mg/L,（0.84±0.19） mg/L;P〈 0.05].④ There was insignificant difference in P-selectin, plasma von Willebrand＇s disease and D-dimer level between the standard CHF group and the aspirin group before treatment （P 〉 0.05）; Each index in the aspirin group after treatment was lower that those in the standard CHF group, but had no statistical significance （P 〉 0.05）. CONCLUSION： A hypereoagulable state exists in the patients with chronic heart failure, which may be associated with an increasing risk of thromboembolism. Small dose of aspirin has few effects on changes of coagulation in short period, and the further research is also needed about the dose and course of aspirin in CHF patients.
出处
《中国临床康复》
CSCD
北大核心
2006年第12期1-3,共3页
Chinese Journal of Clinical Rehabilitation
基金
安徽省教育厅自然科学基金资助项目(2005KJ352ZC)~~
