慢性阻塞性肺疾病患者急性加重期血浆D-二聚体与纤维蛋白原浓度变化的临床意义

目的 探讨慢性阻塞性肺疾病患者急性加重期(AECOPD)血浆D-二聚体、纤维蛋白原浓度变化的临床意义.方法 选择符合标准的AECOPD患者60例,其中30例AECOPD患者(治疗组)在常规治疗同时加用低分子肝素,另30例行常规治疗(对照组).在治疗期间采集2组静脉血检测 D-二聚体、纤维蛋白原浓度及肺功能相关指标监测.结果 AECOPD患者血浆D-二聚体浓度为(2.48±1.35) mg/L,纤维蛋白原浓度为(6.4±3.0)g/L,稳定期血浆D-二聚体浓度和纤维蛋白原浓度分别为(0.50±0.25) mg/L、(2.7±2.4)g/L.急性加重期患者血浆D-二聚体浓度和纤维蛋白原浓度明显高于稳定期(t=3.377,5.647,P =0.003,0.017).COPD急性加重期患者和稳定期患者用力肺活量(FVC)、一秒钟用力呼气量(FEV1)、FEV1/FVC比较差异均有统计学意义(P＜0.01或P＜0.05).治疗组与对照组比较,病程明显缩短,住院费用降低(8±6)d比(22±5)d,t=2.274; (7100±1300)元比(8800±3500)元,t=3.727;P＜0.05或P＜0.01].结论 检测D-二聚体、纤维蛋白原浓度可评估AECOPD患者静脉血栓栓塞症的发生率,为临床应用肝素治疗提供可靠依据.

Clinical significance of the concentration changes of plasma D dimer and fibrinogen of patients with chronic obstructive pulmonary disease during acute exaecebation

Objective To explore clinical significance of the concentration changes of plasma D dimer and fibrinogen of patients with chronic obstructive pulmonary disease （COPD） during the acute and stable phase. Methods Sixty patients with acute exacerbation of chronic obstructive pulmonary disease who underwent conventional treatment plus low molecular weight heparin were enrolled. The level of plasma D dimer and fibrinogen were detected and pul- monary function was monitored during treatment. 30 cases among these 60 patients with AECOPD were treated with routine therapy plus low molecular weight heparin（ treatment group） and 30 cases without low molecular weight hepa- rin （ control group）. Results The level of D dimer and fibrinogen of the patients with COPD in acute exaecebation were significant]y higher than those in stable phase D dimer： （ 2. 48 ±1.35 ） mg/L vs （ 0. 5±0. 25 ） mg/L, t = 3. 337, P = 0. 003 ; fibrinogen ： （6.45±3.02） g/L vs （2. 70± 2.41 ） g/L, t = 5. 647, P = 0. 017 ]. There were significant difference on FVC, FEV1 , FEVI/FVC% between patients with COPD in acute exaecebation and in stable phase（P 〈 0.01 or P 〈 0. 05 ）. The course of the disease and the hospitalization expenses of treatment group were significantly decreased than those of control group （ t = 2. 274, P 〈 0. 05, t = 3.727, P 〈 0.01, respectivly）. Conclusion The incidence of venous thromboembolism in patients with AECOPD can be evaluated by detecting the level of D dimer and fibrinogen, and it can also provide reliable basis for application of the haparin in clinical treatment.