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目的:观察低分子量肝素(LMWH)对川崎病(KD)患儿血液高凝状态的影响及意义。方法:确诊为KD的住院患儿38例,分为阿司匹林组20例和LMWH组18例,LMWH组予LMWH 50～100IU·kg~(-1),ih,qd,连用10 d。于急性期、恢复期测定患儿血小板、肌酸磷酸激酶同功酶、C-反应蛋白、血沉、心肌肌钙蛋白Ⅰ、内皮素、D-二聚体、纤维蛋白原、凝血酶原时间、活化部分凝血活酶时间。结果:与急性期相比,恢复期Plt、CPK-MB、CRP、ESR、CTnI、ET、D—dimer、Fib显著降低(P<0.01),PT、APTT延长(P<0.01)。与阿司匹林组恢复期相比,LMWH组恢复期Plt、CPK-MB、CTnI显著降低(P<0.01),CRP、ESR无明显变化(P>0.05);ET、D-dimer、Fib降低(P<0.05或P<0.01),PT、APTT延长(P<0.05)。结论:LMWH能有效改善急性期KD患儿血液高凝状态,且可降低CPK-MB、CTnI,对防止微血栓形成及心肌损害有保护作用。
Objective: To observe the effect and significance of low molecular weight heparin (LMWH) on hypercoagulability in children with Kawasaki disease (KD). Methods: Thirty-eight inpatients diagnosed as KD were divided into 20 cases of aspirin group and 18 cases of LMWH group. LMWH group was given LMWH of 50-100 IU · kg -1, ih and qd for 10 days. In acute and convalescent phase, the platelet, creatine phosphokinase isoenzyme, C-reactive protein, erythrocyte sedimentation rate, cardiac troponin I, endothelin, D-dimer, fibrinogen, prothrombin time, Activated partial thromboplastin time. Results: The recovery of Plt, CPK-MB, CRP, ESR, CTnI, ET, D-dimer and Fib were significantly decreased (P <0.01) and PT and APTT were prolonged (P <0.01). The levels of Plt, CPK-MB and CTnI in recovery group were significantly lower than those in aspirin group (P <0.01), while the levels of CRP and ESR in LMWH group were not significantly different (P> 0.05 or P <0.01), PT and APTT prolonged (P <0.05). Conclusion: LMWH can effectively improve the blood hypercoagulability in children with acute KD, and can reduce the CPK-MB and CTnI, and has a protective effect on preventing microthrombus formation and myocardial damage.