| 雷智贤,周莉蓉,王 琪,麦碧薇,朱乃云.阿加曲班抗凝对连续血液净化患儿凝血功能及单核细胞TLR2rMnX、TLR4rMnX表达水平的影响[J].,2020,(17):3349-3353 |
| 阿加曲班抗凝对连续血液净化患儿凝血功能及单核细胞TLR2rMnX、TLR4rMnX表达水平的影响 |
| The Effect of Argatroban Anticoagulation on Coagulation Function and Expression Levels of TLR2rMnX and TLR4rMnX in Monocytes |
| 投稿时间：2019-12-28 修订日期：2020-01-23 |
| DOI：10.13241/j.cnki.pmb.2020.17.034 |
| 中文关键词: 连续血液净化 阿加曲班 肝素 凝血功能 TLR2rMnX TLR4rMnX |
| 英文关键词: Continuous blood purification Argatroban Heparin Coagulation function TLR2rMnX TLR4rMnX |
| 基金项目:海南省自然科学基金项目（813245） |
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| 中文摘要: |
| 摘要 目的：探讨阿加曲班抗凝治疗连续血液净化患儿的疗效及对凝血功能及单核细胞TLR2rMnX、TLR4rMnX表达水平的影响。方法：选取从2017年3月至2018年10月于我院儿童重症医学科接受连续血液净化治疗的患儿86例进行研究，将其按照随机抽签法分成研究组与对照组。对照组予以普通肝素抗凝治疗，研究组予以阿加曲班抗凝治疗。分别比较两组的28 d死亡率、治疗前后凝血功能血小板计数（PLT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）和单核细胞TLR2rMnX、TLR4rMnX表达水平、治疗过程中滤器与管路凝血程度、使用寿命以及穿刺部位出血情况的差异。结果：研究组28d死亡率（2.33%）比对照组（9.30%）低，但差异无统计学意义（x2 =0.849，P=0.357）。治疗后研究组APTT（31.61±1.26）s、FIB水平（6.61±1.80）g/L较对照组的（27.92±1.44）s、（5.58±1.72）g/L明显更高（t=12.646、2.713，P=0.000、0.008）。研究组治疗过程中滤器与管路凝血程度0级人数占比（93.02%）相比对照组（76.74%）较高，而Ⅱ级人数占比（0.00%）相比对照组（9.30%）较低（x2=4.440、4.195，P=0.035，0.041）。研究组穿刺部位出血等级为0级人数占比（93.02%）高于对照组（74.42%），而Ⅱ级人数占比（0.00%）低于对照组（9.30%）（x2=5.460，4.195；P=0.019，0.041）。研究组管路、滤器使用寿命（18.73±7.74）h、（20.84±8.01）h相比对照组的（14.57±6.88）h、（16.20±7.15）h均较长（t=2.634、2.834，P=0.010，0.006）。治疗后研究组单核细胞TLR2rMnX、TLR4rMnX表达水平为（4.72±1.39）、（3.22±0.82），均低于对照组的（8.30±1.44）、（5.11±0.94）（t=11.729、9.936，P=0.000、0.000）。结论：阿加曲班抗凝应用于连续血液净化患儿中的疗效相比普通肝素抗凝更佳，且有利于改善凝血功能和单核细胞TLR2rMnX、TLR4rMnX表达水平，能够降低滤器或管路凝血发生风险，同时有效降低穿刺部位出血风险，增加管路、滤器使用寿命。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the therapeutic effect of argatroban anticoagulant therapy on continuous blood purification in children and its effect on coagulation function and expression levels of TLR2rMnX and TLR4rMnX in monocytes. Methods: 86 children who received continuous blood purification from March 2017 to October 2018 in the Department of pediatric critical care medicine of our hospital were selected for the study, they were divided into study group and control group according to the random lottery method. The control group was given ordinary heparin anticoagulant treatment, the study group was given argatroban anticoagulant treatment. The 28d mortality rate, platelet count(PLT), activated partial thromboplastin time(APTT), fibrinogen(FIB) and TLR2rMnX, TLR4rMnX levels in monocytes before and after treatment, the degree of coagulation, service life between filters and pipelines and differences in bleeding conditions at puncture sites during treatment were compared between the two groups. Results: The 28d mortality rate（2.33%） in the study group was lower than that in the control group（9.30%）, but there was no significant difference (x2=0.849, P=0.357). After treatment, APTT（31.61±1.26）s, FIB levels（6.61±1.80）g/L in the study group were obvious higher than the control group（27.92±1.44）s，（5.58±1.72）g/L (t=12.646，2.713, P=0.000, 0.008). The number of level 0 degree of blood coagulation in filters and pipelines in the process of coagulation treatment in the study group（93.02%） higher than in the control group（76.74%）, while level Ⅱ （0%） was lower than the control group（9.30%）（x2=4.440, 4.195, P=0.035, 0.041）. The number of level 0 puncture bleeding in study group（93.02%） was much higher than the control group（74.42%）, while level Ⅱ number （0.00%） was lower than the control group （9.30%）（x2=5.460, 4.195, P=0.019, 0.041）. The service life of pipeline and filter in the study group （18.73±7.74）h,（20.84±8.01）h was longer than those in the control group（14.57±6.88）h,（16.20±7.15）h （t=2.634, 2.834, P=0.010, 0.006）. The expression levels of TLR2rMnX and TLR4rMnX in monocytes of the study group were (4.72±1.39), (3.22 ±0.82), which were lower than those of the control group (8.30±1.44), (5.11±0.94) （t=11.729, 9.936，P=0.000, 0.000）. Conclusion: Argatroban anticoagulation in children with continuous blood purification is more effective than heparin anticoagulation and it is conducive to improving coagulation function and TLR2rMnX, TLR4rMnX levels in monocytes, it can reduce the risk of coagulation in filters or pipelines and it can effectively reduce the risk of bleeding at the puncture site, increase the service life of pipelines and filters. |
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