摘要
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:Y_(抗Xa因子活性)=0.107-0.003X_(肌酐清除率)+0.594X_(给药剂量)+0.287X_(抗凝血酶Ⅲ活性)+0.001X_(抗β2糖蛋白抗体)。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β_(2)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。
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 PTE from 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-β_(2)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:Y_(activity of anti-factor Xa)=0.107-0.003X_(creatinine clearance)+0.594X_(anticoagulant medication dosage)+0.287X_(antithrombinⅢactivity)+0.001X_(anti-β2 glycoprotein antibody).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-β_(2)glycoprotein antibody,antithrombinⅢactivity and medication dosage.Before anticoagulation of LMWH in PTE patients,anti-thrombinⅢactivity,anti-β_(2) 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.
作者
姚莉
姜倩
崔梦茹
黄渲棋
赵生俊
YAO Li;JIANG Qian;CUI Mengru;HUANG Xuanqi;ZHAO Shengjun(Department of Pharmacy,Traditional Chinese Medical Hospital Affiliated to Xinjiang Medical University,Urumqi 830000,China;College of Pharmacy,Xinjiang Medical University,Urumqi 830054,China)
出处
《中国临床药学杂志》
CAS
2024年第5期339-344,共6页
Chinese Journal of Clinical Pharmacy
基金
新疆维吾尔自治区药学会科研基金资助项目(编号YXH201804)。
关键词
低分子肝素
抗凝
肺血栓栓塞症
抗XA因子
多元线性回归
low molecular weight heparin
anticoagulant
pulmonary thromboembolism
anti-factor Xa
multiple linear regression
