【摘要】：目的研究低分子肝素治療急性冠狀動脈綜合征(ACS)對抗Xa活性的影響。方法選取ACS患者59例。以內生肌酸酐清除率(Ccr)30 mL·min~(-1)22例患者為試驗組,其余37例患者(Ccr)30 mL·min~(-1)為對照組。2組患者均皮下注射達肝素5000 U,每12 h注射1次;均口服阿司匹林100 mg·d~(-1),1次/天,療程15 d。治療第3天、第10天,用發(fā)色底物法監(jiān)測抗Xa活性,用光電比濁法檢測部分活化凝血酶原時間(APTT)和國際標準化比值(INR),用血細胞分析儀檢測血小板計數(shù)。結果治療第3天、第10天,試驗組的抗Xa活性分別為(0.66±0.21),(0.39±0.17)U·mL~(-1),明顯高于對照組的(0.40±0.22),(0.34±0.1)U·mL~(-1);試驗組的APTT分別為(35.23±6.12),(28.14±5.37)s,INR分別為(1.23±0.25),(1.07±0.21),明顯低于對照組的APTT(38.97±5.64),(33.76±5.12)s和INR(1.37±0.27),(1.19±0.23);試驗組血小板計數(shù)分別為(196.52±56.41),(181.25±46.31)×10~9/L,明顯高于對照組(183.47±57.38),(167.17±45.66)×10~9/L,差異均有統(tǒng)計學意義(均P0.05)。結論對于內生肌酸酐清除率較低的ACS患者進行低分子量肝素治療時,需監(jiān)測患者的抗Xa活性,并密切關注患者出血風險。
[Abstract]:Objective to study the effect of low molecular weight heparin (LMWH) on Xa activity in patients with acute coronary syndrome (ACS). Methods 59 patients with ACS were selected. The clearance rate of endogenous creatinine (Ccr) was 30 mL min~ (-1) in 22 patients in the trial group and (Ccr) 30 mL min~ (-1) in the other 37 patients as control group. All patients in both groups were subcutaneously injected with heparin 5000 U once every 12 hours. Aspirin 100 mg D1 was taken orally once a day for 15 days. On the 3rd and 10th day of treatment, the activity of anti Xa was detected by chromogenic substrate method, the partial activated prothrombin time (APTT) was detected by photoelectricity turbidimetry, and the platelet count was detected by hematology analyzer with (INR),. Results on the 3rd and 10th day of treatment, the anti- Xa activity of the experimental group was (0.66 鹵0.21), (鹵0.39 鹵0.17) U mL~ (-1), which was significantly higher than that of the control group (0.40 鹵0.22), (, 0.34 鹵0.1) U mL~ (-1). The APTT of the experimental group was (35.23 鹵6.12), (28.14 鹵5.37) SINR (1.23 鹵0.25), (1.07 鹵0.21), which was significantly lower than that of the control group (38.97 鹵5.64). (33.76 鹵5.12) s and INR (1.37 鹵0.27), (, 1.19 鹵0.23); The platelet count in the test group was (196.52 鹵56.41), (鹵46.31) 脳 10 9 / L, which was significantly higher than that in the control group (183.47 鹵57.38), (167.17 鹵45.66) 脳 10 9 / L (P 0.05). Conclusion low molecular weight heparin therapy for ACS patients with low creatinine clearance should monitor the anti Xa activity and pay close attention to the bleeding risk.
【作者單位】： 溫州市人民醫(yī)院心內科;溫州市人民醫(yī)院婦產科實驗室;
【基金】：浙江省公益性技術應用研究計劃基金資助項目(2014C33158) 溫州市科技計劃基金資助項目(Y20140094) 溫州市醫(yī)藥衛(wèi)生科學研究基金資助項目(2013A04)
【分類號】：R541.4

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