症状性下肢动脉疾病抗栓治疗分析

doi:10.3969/j.issn.1004-583X.2021.10.014

摘要/Abstract

摘要：

目的探讨小剂量利伐沙班联合抗血小板药对症状性下肢动脉疾病患者的治疗效果。结论回顾性分析167例下肢动脉粥样硬化病变患者,分为观察组和对照组,观察组为利伐沙班(2.5 mg, 2次/d)联合抗血小板药物西洛他唑(100 mg, 2次/d),对照组单联抗血小板西洛他唑(100 mg, 2次/d)。2组治疗并随访18个月,观察主要肢体不良事件、主要心脑血管事件以及主要出血事件。结果观察组主要心脑血管事件、肢体主要不良事件较对照组明显下降(P<0.05),主要出血事件在两组比较差异无统计学意义(P>0.05)。方法小剂量利伐沙班联合抗血小板药物西洛他唑可明显减少症状性下肢动脉疾病的心脑血管和肢体主要不良事件,改善预后,且具有安全性。

关键词: 动脉粥样硬化, 下肢, 栓塞,胆固醇, 血小板聚集抑制剂

Abstract:

Objective To explore the curative effects of low-dose rivaroxaban combined with ant-platelet drugs for symptomatic lower extremity atherosclerosis disease(LEASD).Methods The data of 167 LEASD patients were retrospectively analyzed and divided into observation group and control group. Patients in observation group were treated with antithrombotic therapy using rivaroxaban (2.5 mg, bid) combined with anti-platelet drug namely cilostazol (100 mg, bid), and those in control group with the same dose of cilostazol alone (100 mg, bid). A 18-month follow-up was performed. The key observation was major adverse limb events(MALEs), major adverse cardiovascular events(MACEs) and adverse bleeding events(MBEs).Results MACEs and MALEs were significantly lower in observation group than in control group (P<0.05). No differences were statistically significant in MBEs between groups (P>0.05).Conclusion For LEASD patient, low-dose rivaroxaban combined with anti-platelet drug namely cilostazol can significantly reduce MACEs and MALEs, and improve prognosis with safety.

Key words: atherosclerosis, lower extremity, embolism,cholesterol, platelet aggregation inhibitors

中图分类号:

R543.5

陈隽, 周一薇, 李秀娟. 症状性下肢动脉疾病抗栓治疗分析[J]. 临床荟萃, 2021, 36(10): 937-941.

Chen Jun, Zhou Yiwei, Li Xiujuan. Analysis of antithrombotic therapy for symptomatic lower extremity atherosclerosis disease[J]. Clinical Focus, 2021, 36(10): 937-941.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.10.014

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I10/937

图/表 2

表1 两组一般资料比较

临床特征	观察组(n=89)	对照组(n=78)	统计值	P值
性别(男/女,例)	65/24	58/20	χ²=0.036	0.850
年龄( $x -$ ±s,岁)	69.3±6.8	68.5±7.2	t=0.738	0.462
BMI(kg/m²)	25.8±5.6	26.1±6.1	t=0.331	0.741
吸烟史(例)	41	33	χ²=0.110	0.740
D-二聚体(mg/L)	2.3±0.3	0.8±0.4	t=20.249	<0.01
ABI	0.6±0.3	0.5±0.4	t=1.841	0.067
高血压病(例)	75	65	χ²=0.002	0.963
SBP(mmHg)	139.31±15.61	143.57±12.91	t=-1.744	0.083
DBP(mmHg)	82.31±7.30	83.06±8.09	t=-0.580	0.563
糖尿病(例)	72	65	χ²=0.043	0.836
空腹血糖(mmol/L)	9.18±1.66	9.41±1.72	t=-0.766	0.445
餐后2小时血糖(mmol/L)	15.10±2.58	15.28±2.71	t=-0.411	0.681
糖化血红蛋白(%)	9.58±2.05	9.48±1.44	t=0.329	0.743
高脂血症(例)	53	51	χ²=0.380	0.538
甘油三酯(mmol/L)	1.91±0.66	2.00±0.57	t=-0.699	0.486
LDL-C(mmol/L)	3.75±1.00	3.67±1.07	t=0.349	0.728
冠心病(例)	35	29	χ²=0.016	0.900
心绞痛发作次数(次/周)	6.26±1.67	5.45±1.55	t=1.994	0.051
心绞痛持续时长(min/次)	2.20±0.96	2.48±1.12	t=-1.085	0.282
慢性心功能衰竭(例)	21	16	χ²=0.085	0.770
NT-proBNP(pg/ml)	2580.13±295.85	2644.21±491.17	t=-0.493	0.625
LVEF(%)	48.62±4.24	50.44±3.08	t=-1.449	0.156
心房颤动(例)	18	12	χ²=0.373	0.541
左心房内径(cm)	4.16±0.37	4.12±0.48	t=0.284	0.779
合并用药
他汀类(例)	49	48	χ²=0.476	0.490
ACEI(例)	73	64	χ²=0.039	0.847
贝前列素(例)	35	28	χ²=0.088	0.767

表1 两组一般资料比较

临床特征	观察组(n=89)	对照组(n=78)	统计值	P值
性别(男/女,例)	65/24	58/20	χ²=0.036	0.850
年龄( $x -$ ±s,岁)	69.3±6.8	68.5±7.2	t=0.738	0.462
BMI(kg/m²)	25.8±5.6	26.1±6.1	t=0.331	0.741
吸烟史(例)	41	33	χ²=0.110	0.740
D-二聚体(mg/L)	2.3±0.3	0.8±0.4	t=20.249	<0.01
ABI	0.6±0.3	0.5±0.4	t=1.841	0.067
高血压病(例)	75	65	χ²=0.002	0.963
SBP(mmHg)	139.31±15.61	143.57±12.91	t=-1.744	0.083
DBP(mmHg)	82.31±7.30	83.06±8.09	t=-0.580	0.563
糖尿病(例)	72	65	χ²=0.043	0.836
空腹血糖(mmol/L)	9.18±1.66	9.41±1.72	t=-0.766	0.445
餐后2小时血糖(mmol/L)	15.10±2.58	15.28±2.71	t=-0.411	0.681
糖化血红蛋白(%)	9.58±2.05	9.48±1.44	t=0.329	0.743
高脂血症(例)	53	51	χ²=0.380	0.538
甘油三酯(mmol/L)	1.91±0.66	2.00±0.57	t=-0.699	0.486
LDL-C(mmol/L)	3.75±1.00	3.67±1.07	t=0.349	0.728
冠心病(例)	35	29	χ²=0.016	0.900
心绞痛发作次数(次/周)	6.26±1.67	5.45±1.55	t=1.994	0.051
心绞痛持续时长(min/次)	2.20±0.96	2.48±1.12	t=-1.085	0.282
慢性心功能衰竭(例)	21	16	χ²=0.085	0.770
NT-proBNP(pg/ml)	2580.13±295.85	2644.21±491.17	t=-0.493	0.625
LVEF(%)	48.62±4.24	50.44±3.08	t=-1.449	0.156
心房颤动(例)	18	12	χ²=0.373	0.541
左心房内径(cm)	4.16±0.37	4.12±0.48	t=0.284	0.779
合并用药
他汀类(例)	49	48	χ²=0.476	0.490
ACEI(例)	73	64	χ²=0.039	0.847
贝前列素(例)	35	28	χ²=0.088	0.767

表2 两组患者治疗症状性下肢动脉疾病的疗效及安全性评估(例)

事件	观察组 (n=89)	对照组 (n=78)	χ²值	P值
心血管死亡	3	6	0.793	0.373
心肌梗死	2	6	1.640	0.200
卒中	2	5	0.907	0.341
主要心血管事件	5	9	4.190	0.041
主要心脑血管事件	6	14	4.953	0.026
血管性截肢	1	7	4.028	0.045
肢体主要不良事件	2	9	4.420	0.036
致死性出血	1	1	0.383	0.536
症状性涉及关键器官的出血	1	1	0.383	0.536
导致住院的出血	2	1	0.013	0.908
主要出血	5	4	0.041	0.839

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