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目的探讨调整剂量华法林[国际标准化比值(INR)2~3]对高危持续性心房颤动(AF)患者血栓前状态和心功能的影响。方法99例高危持续性AF患者随机给予阿司匹林(100mg/d,阿司匹林组)或调整剂量华法林(华法林组)治疗1年。于治疗前、治疗后6个月和12个月分别检测血栓前状态(PTS)各分子标志物,采用免疫比浊法测定D-二聚体水平,采用ELISA双抗体夹心法测定血小板α-颗粒膜蛋白(GMP)-140、血浆血栓调节蛋白(TM)和血浆凝血酶-抗凝血酶Ⅲ复合物(TAT)水平;超声测定心排出量(CO)和左室射血分数(LVEF),进行前后比较分析。随访中观察有无血栓栓塞和出血并发症发生。结果①与阿司匹林组比较,华法林组治疗6个月、12个月后D-二聚体、GMP-140、TAT、TM水平均显著降低,CO、LVEF均显著增加(P<0.05);②随访期间两组均无血栓栓塞事件发生,华法林组有1例出现上消化道大出血,经治疗痊愈。结论调整剂量华法林能不同程度地改善高危AF患者的血栓前状态和心功能,疗效优于阿司匹林,治疗是安全的。
Objective To investigate the effect of adjusted dose of warfarin (INR) 2 ~ 3 on the prothrombotic state and cardiac function in patients with high-risk persistent atrial fibrillation (AF). Methods Ninety-nine patients with high-risk persistent AF were randomized to receive either aspirin (100 mg / day, aspirin) or warfarin (warfarin) for 1 year. The prethrombotic state (PTS) markers were detected before treatment, 6 months and 12 months after treatment. The level of D-dimer was measured by immunoturbidimetry. The platelet α-particle Membrane protein (GMP) -140, plasma thrombomodulin (TM) and plasma thrombin-antithrombin Ⅲ complex (TAT) were measured. Cardiac output (CO) and left ventricular ejection fraction (LVEF) Before and after comparative analysis. During follow-up, observe the occurrence of thromboembolism and bleeding complications. Results ① Compared with aspirin group, the levels of D-dimer, GMP-140, TAT and TM were significantly decreased and the levels of CO and LVEF were significantly increased in warfarin group after 6 months and 12 months (P <0.05); During the follow-up period, no thromboembolism occurred in both groups. One case of warfarin group had upper gastrointestinal bleeding and recovered after treatment. Conclusion Adjusted-dose warfarin can improve the pre-thrombotic state and cardiac function in patients with high-risk AF to some extent, and its efficacy is better than that of aspirin. The treatment is safe.