摘要
目的:观察达比加群酯联合阿司匹林和氯吡格雷对非瓣膜性房颤(NVAF)患者凝血功能及踝肱指数(ABI)的影响.方法:选择2018年1月～2020年10月于黄石市第四医院有限公司行经皮冠状动脉介入术(PCI)治疗的NVAF患者108例,按随机数字表法分为联合治疗组(达比加群酯+阿司匹林+氯吡格雷)与对照组(阿司匹林+氯吡格雷),各54例.治疗6个月后,比较两组凝血功能、趾肱指数(TBI)、ABI、血栓弹力图、血清基质金属蛋白酶9(MMP-9)水平、栓塞事件、出血事件和不良反应发生情况.结果:治疗后,与对照组比较,联合治疗组活化部分凝血活酶时间(APTT)[(45.46±4.27)s比(52.38±5.03)s]、凝血酶原时间(PT)[(13.14±1.33)s 比(15.32±1.57)s]、凝血酶时间(TT)[(22.67±2.21)s 比(27.05±3.15)s]、TBI[(0.78±0.13)比(0.84±0.15)]、ABI[(1.11±0.14)比(1.18±0.13)]、R值[(11.43±3.42)s 比(14.48±4.51)s]、K 值[(8.54±2.18)s 比(10.78±3.26)s]、MA 值[(46.06±15.11)mm 比(55.49±18.26)mm]均显著增加,血清MMP-9 水平[(182.47±18.84)μg/ml 比(165.52±14.17)μg/ml]显著降低(P＜0.05 或＜0.01).联合治疗组栓塞事件总发生率(5.56％)、出血事件总发生率(1.85％)均显著低于对照组(18.52％,14.81％)(P均＜0.05).两组不良反应发生率无统计学意义(P=0.687).结论:达比加群酯联合阿司匹林和氯吡格雷可显著改善NVAF患者凝血功能,减少栓塞事件和出血事件发生,降低血清MMP-9水平,且不增加不良反应.
Abstract
Objective:To observe the influence of dabigatran etexilate combined with aspirin+clopidogrel on coagulation function and ankle-brachial index(ABI)in patients with non-valvular atrial fibrillation(NVAF).Methods:A total of 108 NVAF patients who underwent percutaneous coronary intervention(PCI)in Huangshi Fourth Hospital Co.,Ltd be-tween January 2018 and October 2020 were selected,and divided into combined treatment group(n=54,dabigatran etexi-late+aspirin+clopidogrel)and control group(n=54,aspirin+clopidogrel)according to random number table meth-od.After 6-month treatment,coagulation function,toe-brachial index(TBI),ABI,thromboelastography,serum level of matrix metalloproteinase-9(MMP-9),incidence of embolic events,bleeding events and adverse reactions were com-pared between two groups.Results:After treatment,compared with control group,patients in combined treatment group had significant higher activated partial thromboplastin time(APTT)[(45.46±4.27)s vs.(52.38±5.03)s],prothrom-bin time(PT)[(13.14±1.33)svs.(15.32±1.57)s],thrombin time(TT)[(22.67±2.21)s vs.(27.05±3.15)s],TBI[(0.78±0.13)vs.(0.84±0.15)],ABI[(1.11±0.14)vs.(1.18±0.13)],R value[(11.43±3.42)s vs.(14.48±4.51)s],K value[(8.54±2.18)s vs.(10.78±3.26)s]and MA value[(46.06±15.11)mm vs.(55.49±18.26)mm],and significant lower serum MMP-9 level[(182.47±18.84)μg/mlvs.(165.52±14.17)μg/ml](P＜0.05 or＜0.01).Total incidence rates of embolic events(5.56％)and bleeding events(1.85％)in combined treatment group were significantly lower than those of control group(18.52％,14.81％)(P＜0.05 both).There was no significant difference in incidence rate of adverse reactions between two groups(P=0.687).Conclusion:Dabigatran etexilate combined with aspi-rin+clopidogrel can significantly improve coagulation function,reduce embolic events and bleeding events,and reduce ser-um MMP-9 level in NVAF patients without increasing adverse reactions.
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