慢性心功能不全患者凝血指标的变化

目的:探讨慢性心功能不全(CHF)患者体内凝血指标的变化,观察阿司匹林对CHF患者凝血状态的影响。 方法:60例CHF患者为试验组,随机分为阿司匹林治疗组(A组)30例,非阿司匹林治疗组(B组)30例,健康对照组(C组)15例。A组在常规抗心衰治疗基础上加用阿司匹林75mg/d,B组仅用常规抗心衰治疗。试验第1天和治疗2周后检测血浆P-选择素、D-二聚体、血管性血友病因子(v-WF)水平。 结果:CHF患者血浆P-选择素、D-二聚体、v-WF水平明显高于正常对照组(P<0.05),且心功能越差,这些指标升高越明显。A、B两组患者治疗2周后血浆P-选择素、D-二聚体、v-WF水平均有所下降,与治疗前比较有显著差异(P<0.05);但A组与B组之间凝血指标治疗前后变化值相比较无差异(P>0.05)。 结论:CHF患者体内存在着高凝状态,阿司匹林并未在改善心衰高凝状态上有优势,提示其应用于CHF患者应当慎重。

Changes of the coagulative state in patient with chronic heart failure

Objective:To investigate the changes of the coagulative state in CHF . The study was to assess whether aspirin can improve the coagulative state in CHF. Methods: 60 patients were randomly divided into two groups,group A (n= 30) was treated with aspirin 75mg/d plus conventional therapy for 14 days, and group B (n = 30) was trated only with conventional therapy for 14 days. Meanwhile 15 healthy persons were also chosen as normal controls (group C). All blood samples were obtained at baseline (before aspirin therapy) , and 2 weeks after the start of treatment. P-selectin, v-WF and D-dimmer were measured by ELISA, respectively. Results: The levels of plasma P-selectin, v-WF and D-dimmer in CHF group were higher than those in normal controls and there was significant difference(P<0. 05). The levels of plasma P-selectin, v-WF and D-dimmer increased in proportion to the severity of heart failure. The levels of plasma P-selectin, v-WF and D-dimmer in both group A and group B reduced significantly after treatment (P<0. 05) ,but there were no significant difference between group A and group B(P>0. 05). Conclusions: A hypercoagulable state exists in the patients with chronic heart failure, which may be associated with an increasing risk of thromboembolism. This study suggests aspirin has no good effect on changes of coagulation. We should pay more attentions to it in clinical practice.