| 230 | 4 | 53 |
| 下载次数 | 被引频次 | 阅读次数 |
目的 分析影响急性肺血栓栓塞症(PTE)患者初始胃肠外低分子肝素(LMWH)抗凝治疗中抗Xa因子活性的相关因素，以提高抗凝治疗的有效性和安全性。方法 收集2018年1月至2022年12月收治的急性PTE病例158例，检测LMWH使用第3剂后血药浓度达到稳态时的抗Xa因子活性，分析影响抗Xa因子活性的相关因素。结果 158例病例中，抗凝不足的有56例(占35.4%)，抗凝达标的有93例(占58.9%)，抗凝过度的有9例(占5.7%)。相关分析显示肌酐清除率、活化部分凝血活酶时间基线活性，抗β2糖蛋白抗体、抗凝血酶Ⅲ活性和给药剂量与抗Xa因子活性具有相关性。进一步行多元线性回归分析得到回归方程：■。回归分析显示，不合并使肝素结合蛋白增加的疾病患者抗Xa因子活性水平高于合并使肝素结合蛋白增加的疾病患者(P<0.05)。结论 影响急性PTE患者LMWH抗凝疗效的因素有肌酐清除率、活化部分凝血活酶时间基线、抗β2糖蛋白抗体、抗凝血酶Ⅲ活性和给药剂量。PTE患者使用LMWH抗凝治疗前需要对上述指标进行检测，同时用药时需监测抗Xa因子活性，以随时调整LMWH的剂量，保证抗凝治疗的安全和有效。
Abstract：AIM To analyze the related factors affecting the activity of anti-factor Xa in initial gastrointestinal low molecular weight heparin (LMWH) anticoagulant therapy in patients with acute pulmonary thromboembolism (PTE),so as to improve the efficacy and safety of anticoagulant therapy.METHODS A total of 158 patients diagnosed with acute PTEfrom January 2018 to December 2022 were collected to detect activity of anti-factor Xa after the third dose of LMWH,and the related factors affecting the anti-factor Xa were analyzed.RESULTS Among 158 patients included,56 patients (35.4%)of activity of anti-factor Xa were not up to standard,93 patients (58.9%) were up to standard,and 9 patients (5.7%) were over anticoagulant activity.Correlation analysis indicated that creatinine clearance and activated partial thromboplastin time baseline were negatively correlated with anti-factor Xa,while anti-β2 glycoprotein antibody,antithrombinⅢactivity and anticoagulant medication dosage were positively correlated with anti-factor Xa.Further multiple linear regression was used to obtain the regression equation:■.Regression analysis indicated that patients without diseases that increase the binding of heparin-binding proteins had higher levels of activity of anti-factor Xa compared to those with such diseases(P<0.05).CONCLUSION The factors affecting the anticoagulant activity of LMWH in patients with acute PTE are creatinine clearance rate,APTT baseline,anti-β2 glycoprotein antibody,antithrombinⅢactivity and medication dosage.Before anticoagulation of LMWH in PTE patients,anti-thrombinⅢactivity,anti-β2 glycoprotein antibody and renal function should be detected,anti-factor Xa should be monitored to adjust the dosage of LMWH to ensure the safety and effectiveness during anticoagulation.
[1] LIM W, DENTALI F, EIKELBOOM J W, et al. Meta-analysis:lowmolecular-weight heparin and bleeding in patients with severe renal insufficiency[J]. Ann Intern Med, 2006, 144(9):673.
[2]中华医学会呼吸病学分会肺栓塞与肺血管病学组,中国医师协会呼吸医师分会肺栓塞与肺血管病工作委员会,全国肺栓塞与肺血管病防治协作组.肺血栓栓塞症诊治与预防指南[J].中华医学杂志, 2018, 98(14):1060.
[3] MONAGLE P, CHAN A K C, GOLDENBERG N A, et al.Antithrombotic therapy in neonates and children:Antithrombotic Therapy and Prevention of Thrombosis, 9th Ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J]. Chest, 2012, 141(2 Suppl):e737S.
[4] LIMONE B L, HERNANDEZ A V, MICHALAK D, et al. Timing of recurrent venous thromboembolism early after the index event:a meta-analysis of randomized controlled trials[J]. Thromb Res,2013, 132(4):420.
[5] VAN ES J, DOUMA R A, KAMPHUISEN P W, et al. Clot resolution after 3weeks of anticoagulant treatment for pulmonary embolism:comparison of computed tomography and perfusion scintigraphy[J]. J Thromb Haemost, 2013, 11(4):679.
[6] BOOKSTAVER D A, SPARKS K, PYBUS B S, et al. Comparison of anti-xa activity in patients receiving apixaban or rivaroxaban[J].Ann Pharmacother, 2018, 52(3):251.
[7]王振兴,徐冷楠,付沛颉,等.抗Xa因子活性检测在血液透析患者低分子肝素抗凝中的应用进展[J].中国血液净化, 2022,21(5):365.
[8] BARA L, LEIZOROVICZ A, PICOLET H, et al. Correlation between anti-Xa and occurrence of thrombosis and haemorrhage in post-surgical patients treated with either Logiparin(LMWH)or unfractionated heparin. Post-surgery Logiparin Study Group[J].Thromb Res, 1992, 65(4-5):641.
[9] HAKEAM H A, DUHAILIB Z A, ALSEMARI M, et al. Anti-factor xa levels in low-weight surgical patients receiving enoxaparin for venous thromboembolism prophylaxis:a prospective cohort study[J]. Clin Appl Thromb Hemost, 2020, 26:1076029620931194.
[10] LEVY J H, CONNORS J M. Heparin resistance-clinical perspectives and management strategies[J]. N Engl J Med,2021, 385(9):826.
[11] CROLES F N, LUKENS M V, MULDER R, et al. Monitoring of heparins in antithrombin-deficient patients[J]. Thromb Res,2019, 175:8.
[12]王诗雨,李莉娟,黄梅,等. β2-糖蛋白Ⅰ的多重作用及其抗体在血液系统疾病中的研究进展[J].临床检验杂志, 2021, 39(10):787.
[13]何媛,周小娟,蒋钦.抗心磷脂抗体、抗β2糖蛋白Ⅰ抗体在系统性红斑狼疮血栓患者中的临床意义[J].吉林医学, 2021, 42(8):1803.
[14]秦韬,杨峻,全裔,等.抗心磷脂抗体及抗β2糖蛋白I抗体对系统性红斑狼疮患者发生血栓并发症的预测价值[J].血栓与止血学, 2019, 25(5):738.
[15]杨苏乔,杨媛华,翟振国,等.影响急性肺血栓栓塞症预后的因素[J].中华结核和呼吸杂志, 2013, 36(12):977.
[16]陈淑霞,齐晓勇,谷剑,等.冠状动脉介入治疗中血小板计数、抗凝血酶-Ⅲ对激活凝固时间的影响[J].临床荟萃, 2007, 22(15):1068.
[17]尹述洲,邓硕曾,卢光奎,等.心脏手术病人血小板、抗凝血酶Ⅲ与肝素相对耐药的相关性[J].临床麻醉学杂志, 2004, 20(2):73.
[18] XU H M, CAI H W, QIAN Z S, et al. Dosing practice of low molecular weight heparins and its efficacy and safety in cardiovascular inpatients:a retrospective study in a Chinese teaching hospital[J]. BMC Cardiovasc Disord, 2012, 12:118.
[19] HAN Z C, BELLUCCI S, SHEN Z X, et al. Glycosaminoglycans enhance megakaryocytopoiesis by modifying the activities of hematopoietic growth regulators[J]. J Cell Physiol, 1996,168(1):97.
[20]彭理,何阳,樊志强,等.低分子肝素致血小板增多症的临床特点分析[J].中南药学, 2024, 22(2):514.
基本信息:
DOI：10.19577/j.1007-4406.2024.05.003
中图分类号:R563.5
引用信息:
[1]姚莉,姜倩,崔梦茹,等.急性肺血栓栓塞症患者低分子肝素抗凝治疗中抗Xa因子活性的影响因素分析[J].中国临床药学杂志,2024,33(05):339-344.DOI:10.19577/j.1007-4406.2024.05.003.
基金信息:
新疆维吾尔自治区药学会科研基金资助项目（编号YXH201804）
2024-05-25
2024-05-25