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投稿时间：2022-03-21 网络发布日期：2023-04-20
投稿时间：2022-03-21 网络发布日期：2023-04-20
中文摘要: 目的 探讨急性肺栓塞患者应用利伐沙班治疗对其凝血功能的影响及安全性。
方法 收集南京医科大学第一附属医院2018年1月至2021年1月确诊为急性肺栓塞的108例患者作为肺栓塞组,并进行危险分层（高危组18例、中危组52例、低危组38例）。选取同期健康体检者110例作为对照组,观察肺栓塞组治疗前，治疗1周、3周、3个月的凝血功能、肝肾功能及血常规指标的变化,以及不良反应发生情况。
结果 与对照组相比,肺栓塞组凝血酶原时间（PT）、纤维蛋白原（FIB）、D-二聚体（D-D）升高,红细胞压积（HCT）、血红蛋白（Hb）降低,丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）水平升高（P＜0.05）;急性肺栓塞治疗前高危组D-D水平高于中危、低危患者（P＜0.05）。D-D水平随着治疗时间的增加显著降低（P＜0.05）,其他指标差异无统计学意义（P＞0.05）。时间因素对肺栓塞患者凝血功能、肝肾功能的作用不随危险分层的不同而不同（P＞0.05）;不同时间点D-D、ALT水平呈下降趋势（P＜0.05）,其他凝血功能、肝肾功能指标、Hb及HCT差异无统计学意义（P＞0.05）。治疗过程中观察到黑便1例,粪便隐血阳性1例,血尿1例,出血事件发生率为2.8%（3/108）,1例复发肺栓塞。
结论 急性肺栓塞患者应用利伐沙班治疗对PLT无影响,凝血功能无明显延长,对肝肾功能无影响,安全性较高。
Abstract:Objective To explore the effect of rivaroxaban on coagulation function in the treatment of patients with acute pulmonary embolism(APE) and its safety.
Methods A total of 108 patients with APE in the First Affiliated Hospital with Nanjing Medical University from January 2018 to January 2021 were enrolled as pulmonary embolism (PE)group, and risk stratification was performed (18 in the high-risk group, 52 in the medium risk group, and 38 in the low risk group). At the same time, 110 healthy subjects were served as control group. The changes of coagulation function, liver and kidney function, blood routine indexes and adverse reactions were observed before and 1-, 3-week and 3 months after treatment,and the occurrence of adverse reactions was recorded in PE group and control group.
Results Compared with those in control group,the levels of prothrombin time（PT）, fibrinogen（FIB）, D-dimer（D-D）, alanine aminotransferase（ALT） and aspartate aminotransferase（AST） significantly increased, and the levels of hematocrit（HCT） and hemoglobin（Hb） decreased in PE group（P＜0.01）.The level of D-D in high-risk group was statistically higher than that in medium-risk group and low-risk group before treatment （P＜0.05）, The effects of time factors on coagulation function, liver and kidney function in patients with PE didnt vary with different risk stratification (P＞0.05); and decreased significantly with the increase of treatment time（P＜0.05）.With the prolongation of treatment time, the levels of D-D and ALT showed a statistically downward trend（P＜0.05）,however, there were no significant differences in coagulation function, liver and kidney function indexes, Hb and HCT levels（P＞0.05）. The incidence of bleeding events was 2.8%（3/108）, including 1 case of black stool, 〖JP2〗1 case of fecal occult blood positive and 1 case of hematuria, and the recurrent PE occurred in 1 case during the treatment.
Conclusion Rivaroxaban has no obvious impacts on PT, coagulation function and liver and kidney function in the treatment of APE patients and with higher safety.
keywords: Rivaroxaban Acute pulmonary embolism Risk stratification Coagulation function Liver and kidney function
文章编号： 中图分类号：R563.5 文献标志码：A
基金项目:国家自然科学基金项目（81871544）;江苏省科技基础研究计划（自然科学基金）（BK20181493）
附件
| Author Name | Affiliation |
| SHI Yangyang, XU Jie, SHI Xinwei, SUN Kai | Department of Emergency Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210000, China |
引用文本：
史阳阳, 徐杰, 史薪炜, 孙凯.利伐沙班治疗急性肺栓塞对患者凝血功能的影响及安全性评估[J].中国临床研究,2023,36(4):500-504.
史阳阳, 徐杰, 史薪炜, 孙凯.利伐沙班治疗急性肺栓塞对患者凝血功能的影响及安全性评估[J].中国临床研究,2023,36(4):500-504.