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目的:探讨阿司匹林(150mg/d)、调整剂量华法林[国际标准化比值(INR)1.5～2.5]治疗对中老年非瓣膜病持续性心房颤动(Af)患者凝血-纤溶功能的作用。方法:106例非瓣膜病持续性Af患者随机给予阿司匹林(150mg/d)或调整剂量华法林治疗1年。于治疗前、治疗后6个月和12个月,采用免疫比浊法测定D-二聚体(D-Dimer)水平,采用酶联免疫吸附双抗体夹心法(ELISA法)测定组织型纤溶酶原激活物(t-PA)和纤溶酶原激活剂抑制物(PAI-1)水平,进行前后比较分析。对可能影响D-Dimer、t-PA和PAI-1变化的因素,包括年龄、性别、体质指数、血小板数、肌酐、尿酸、血糖、TC、TG、凝血-纤溶指标治疗前水平和抗凝药物等因素进行Pearson相关分析和多元线性回归分析。随访中观察有无血栓栓塞和出血并发症发生。结果:①阿司匹林(150mg/d)治疗12个月后PAI-1水平显著降低,与治疗前比较,差异有统计学意义[(77.92±12.99)∶(84.86±18.97)μg/L],P<0.05),但对D-Dimer、t-PA无影响。华法林治疗6个月、12个月后D-Dimer均显著降低[分别为(0.10±0.08)、(0.11±0.08)mg/L]与治疗前[(0.17±0.09)mg/L]比较,均P<0.05;治疗12个月后PAI-1水平较治疗前亦显著降低[(77.13±18.53)∶(87.58±19.94)μg/L,P<0.05],但对t-PA无影响。②Pearson相关分析发现,治疗前后D-Dimer、t-PA和PAI-1的变化幅度均与其各自治疗前水平呈正相关,D-Dimer的变化幅度还与体质指数呈正相关,PAI-1的变化幅度还与TG呈正相关。多元线性回归分析也发现,治疗前D-Dimer、t-PA和PAI-1的水平是影响药物治疗后各指标变化幅度的主要因素。③随访期间无血栓栓塞和严重出血并发症发生。结论:阿司匹林(150mg/d)或调整剂量华法林均能不同程度地改善非瓣膜病Af患者的高凝低纤溶状态,治疗是安全的。
Objective: To investigate the effects of aspirin (150mg / d) and adjusted-dose warfarin (INR) 1.5 ~ 2.5 on coagulation-fibrinolysis in patients with non-valvular persistent atrial fibrillation (Af). Methods: One hundred and six patients with non-valvular persistent Af were randomized to aspirin (150 mg / d) or adjusted-dose warfarin for 1 year. Before treatment, 6 and 12 months after treatment, the level of D-dimer was determined by immunoturbidimetry, and the tissue fibrinolysis was determined by enzyme-linked immunosorbent assay (ELISA) (T-PA) and plasminogen activator inhibitor (PAI-1) levels were compared before and after comparative analysis. Factors that may affect changes in D-Dimer, t-PA and PAI-1 include age, sex, body mass index, platelet count, creatinine, uric acid, blood glucose, TC, TG, Drug and other factors Pearson correlation analysis and multiple linear regression analysis. During follow-up, observe the occurrence of thromboembolism and bleeding complications. Results: (1) The level of PAI-1 in aspirin (150mg / d) group after 12 months treatment was significantly lower than that before treatment (77.92 ± 12.99 vs 84.86 ± 18.97 μg / L, P < 0.05), but no effect on D-Dimer, t-PA. D-Dimer significantly decreased at 6 and 12 months after warfarin treatment (0.10 ± 0.08 and 0.11 ± 0.08 mg / L, respectively, respectively) compared with those before treatment (0.17 ± 0.09 and mg / L) , Both P <0.05. After 12 months of treatment, PAI-1 level was significantly lower than that before treatment [(77.13 ± 18.53) vs (87.58 ± 19.94) μg / L, P <0.05], but had no effect on t-PA. (2) Pearson correlation analysis showed that the changes of D-Dimer, t-PA and PAI-1 before and after treatment were positively correlated with their respective pre-treatment levels, and the changes of D-Dimer were positively correlated with body mass index. And TG was positively correlated. Multivariate linear regression analysis also found that pretreatment D-Dimer, t-PA and PAI-1 levels are the main factors that influence the change of each index after drug treatment. ③ no thromboembolism during follow-up and severe bleeding complications. CONCLUSIONS: Aspirin (150 mg / d) or adjusted-dose warfarin can both improve the hypercoagulability and fibrinolytic status of patients with non-valvular disease Af to varying degrees, and the treatment is safe.