利伐沙班联合阿替普酶治疗急性肺栓塞对患者凝血功能及GRP78 GRP94表达的影响

doi:10.3969/j.issn.1006-6233.2024.02.031

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摘要 目的: 观察利伐沙班联合阿替普酶对急性肺栓塞患者凝血功能及葡萄糖调节蛋白78(GRP78)、葡萄糖调节蛋白94(GRP94)表达的影响。方法: 选取2021年1月至2022年12月我院收治的104例急性肺栓塞患者为对象,采用简单随机法分为两组。所有患者均给予绝对卧床、止痛、抗感染、吸氧等常规治疗,常规组(n=52)加用阿替普酶治疗,联合组(n=52)加用利伐沙班联合阿替普酶治疗。统计两组出血事件发生率。检测两组凝血功能、血栓弹力图及GRP78、GRP94、肺动脉压、血气指标的差异。结果: 两组活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)及血栓弹力图中α角、反应时间(R)治疗后较治疗前升高,联合组治疗前后APTT、PT及血栓弹力图中R、α角差值大于常规组(P<0.05)。两组纤维蛋白原(Fib)、D-二聚体(D-D)治疗后较治疗前降低,联合组治疗前后Fib、D-D差值大于常规组(P<0.05);两组血栓弹力图中凝血时间(K)治疗前后比较,差异无统计学意义(P>0.05)。两组GRP78、GRP94治疗后较治疗前降低,联合组治疗前后GRP78、GRP94差值大于常规组(P<0.05)。两组动脉血氧分压(PaO₂)治疗后较治疗前升高,联合组治疗前后PaO₂差值大于常规组(P<0.05);两组动脉血二氧化碳分压(PaCO₂)治疗后较治疗前降低,联合组治疗前后PaCO₂差值大于常规组(P<0.05)。两组出血事件发生率比较,差异无统计学意义(P>0.05)。结论: 利伐沙班联合阿替普酶治疗急性肺栓塞可降低GRP78、GRP94的表达,改善凝血功能和血气指标。

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关键词 ：急性肺栓塞, 利伐沙班, 阿替普酶, 凝血功能, 葡萄糖调节蛋白

Abstract：Objective: To observe the effects of rivaroxaban combined with alteplase on coagulation function and the expression of glucose regulatory protein 78 (GRP78) and glucose regulatory protein 94 (GRP94) in patients with acute pulmonary embolism. Methods: A total of 104 patients with acute pulmonary embolism admitted to our hospital from January 2021 to December 2022 were selected as subjects and divided into two groups by simple random method. All patients were given absolute bed rest, analgesia, anti-infection, oxygen inhalation and other conventional treatment, conventional group (n=52) plus alteplase treatment, combined group (n=52) plus rivaroxaban plus alteplase treatment. The incidence of bleeding events in the two groups was analyzed. The differences of coagulation function, thrombus elasmogram, GRP78, GRP94, pulmonary artery pressure and blood gas indexes between the two groups were detected. Results: The activated partial thromboplastin time (APTT), prothrombin time (PT) and α Angle and reaction time in the thromboxelasticity chart of the two groups were higher after treatment than before treatment, and the difference of R and α Angle in the APTT, PT and thromboxelasticity chart before and after treatment in the combined group was greater than that in the conventional group (P<0.05). Fibrinogen (Fib) and D-dimer (D-D) in the two groups were lower after treatment than before treatment, and the difference of Fib and D-D in the combined group was greater than that in the conventional group (P<0.05). There was no significant difference in coagulation time (K) between the two groups before and after treatment (P>0.05). GRP78 and GRP94 in the two groups were lower after treatment than before treatment, and the difference of GRP78 and GRP94 before and after treatment in the combined group was greater than that in the conventional group (P<0.05). The partial pressure of arterial oxygen (PaO₂) in the two groups was higher after treatment than before treatment, and the difference of PaO₂ in the combined group was greater than that in the conventional group (P<0.05). The partial blood pressure of carbon dioxide (PaCO₂) of the two groups was lower after treatment than before treatment, and the difference of PaCO₂ before and after treatment in the combined group was greater than that in the conventional group (P<0.05). There was no significant difference in the incidence of bleeding events between the two groups (P>0.05). Conclusion: Rivaroxaban combined with alteplase in the treatment of acute pulmonary embolism can improve the coagulation function, reduce the expression of GRP78 and GRP94, and increase the blood gas index.

Key words： Acute pulmonary embolism Rivaroxaban Alteplase Coagulation function Glucose-regulatory protein

基金资助:陕西省重点研发计划项目,(编号:2022SF-402)

引用本文:

孙静岚, 周红艳, 王颖, 张艳峰, 崔梅英. 利伐沙班联合阿替普酶治疗急性肺栓塞对患者凝血功能及GRP78 GRP94表达的影响[J]. 河北医学, 2024, 30(2): 330-335.
SUN Jinglan, ZHOU Hongyan, WANG Ying, et al. Effect of Rivaroxaban Combined with Alteplase on Coagulation Function and Expression of GRP78 and GRP94 in Patients with Acute Pulmonary Embolism. HeBei Med, 2024, 30(2): 330-335.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2024.02.031 或 http://www.hbyxzzs.cn/CN/Y2024/V30/I2/330

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