目的 探究阿加曲班注射液聯(lián)合貝前列素鈉治療下肢動(dòng)脈硬化閉塞癥的臨床療效。方法 選取2019年7月—2021年7月于河北北方學(xué)院附屬第一醫(yī)院就診的120例下肢動(dòng)脈硬化閉塞癥患者為研究對(duì)象，隨機(jī)分為對(duì)照組和治療組，每組各60例。對(duì)照組飯后口服貝前列素鈉片，2片/次，3次/d。治療組在對(duì)照組基礎(chǔ)上靜脈滴注阿加曲班注射液，10 mg加入250 mL生理鹽水，2次/d。兩組患者連續(xù)治療4周。觀察兩組患者臨床療效，比較治療前后兩組患者下肢動(dòng)脈血管血流速度、血液流變學(xué)、踝肱指數(shù)（ABI）、Rutherford評(píng)分、血清超敏C反應(yīng)蛋白（hs-CRP）、單核細(xì)胞趨化因子-1（MCP-1）、細(xì)胞間黏附分子-1（ICAM-1）、同型半胱氨酸（Hcy）、抗凝血酶Ⅲ（AT-III）和D-二聚體（D-D）水平。結(jié)果 治療后，治療組總有率效為95.00%，顯著高于對(duì)照組的83.33%，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。治療后，兩組患者股淺動(dòng)脈、脛后動(dòng)脈、足背動(dòng)脈的血管內(nèi)徑、血流量均顯著增加，而峰值流速顯著降低（P＜0.05），且治療組下肢動(dòng)脈血管血流速度改善情況明顯好于對(duì)照組（P＜0.05）。治療后，兩組全血高切黏度、全血低切黏度、血漿黏度及細(xì)胞沉降率均顯著降低（P＜0.05），且治療組顯著低于對(duì)照組（P＜0.05）。治療后，兩組患者ABI顯著升高，而Rutherford評(píng)分顯著降低（P＜0.05），且治療組下肢運(yùn)動(dòng)功能顯著好于對(duì)照組（P＜0.05）。治療后，兩組患者血清hs-CRP、MCP-1、ICAM-1、Hcy、AT-Ⅲ水平顯著降低，而D-D水平顯著升高（P＜0.05），且治療組血生化指標(biāo)顯著好于對(duì)照組（P＜0.05）。結(jié)論 阿加曲班注射液聯(lián)合貝前列素鈉治療下肢動(dòng)脈硬化閉塞癥療效顯著，對(duì)下肢動(dòng)脈硬化、血管狹窄及血清炎癥改善明顯。

Objective To explore the clinical efficacy of Argatroban Injection combined with beraprost sodium in treatment of arteriosclerosis obliterans of lower limbs. Methods Patients (96 cases) with arteriosclerosis obliterans of lower limbs in the First Affiliated Hospital of Hebei North University from July 2019 to July 2021 were randomly divided into control and treatment group, and each group had 60 cases. Patients in the control group were po administered with Beraprost Sodium Tablets after meals, 2 tablets/time, three times daily. Patients in the treatment group were iv administered with Argatroban Injection on the basis of the control group, 10 mg added into normal saline 250 mL, twice daily. Patients in two groups were treated for 4 weeks. After treatment, the clinical evaluation was evaluated, the blood flow velocities of lower extremity arteries, hemorheology, lower extremity motor function, ABI, Rutherford scores, the levels of hs-CRP, MCP-1, ICAM-1, Hcy, AT-Ⅲ, and D-D in two groups before and after treatment were compared. Results After treatment, the clinical effective rate in the treatment group was 95.00%, significantly higher than 83.33% in the control group, and there was significant difference between two groups (P < 0.05). After treatment, the internal diameter and blood flow of superficial femoral artery, posterior tibial artery and dorsalis pedis artery were significantly increased, while the peak velocity were significantly decreased (P < 0.05), and the improvement of arterial blood flow velocity of lower extremities in the treatment group was significantly better than that in the control group (P < 0.05). After treatment, the whole blood high shear viscosity, whole blood low shear viscosity, plasma viscosity, and cell sedimentation rate were significantly decreased in two groups (P < 0.05), and which in the treatment group were significantly lower than those in the control group (P < 0.05). After treatment, the ABI of the two groups were significantly increased, while the Rutherford score were significantly decreased (P < 0.05), and the motor function of the lower extremities in the treatment group was significantly better than that in the control group (P < 0.05). After treatment, the serum levels of hs-CRP, MCP-1, ICAM-1, Hcy, and AT-Ⅲ in two groups were significantly decreased, while the level of D-D were significantly increased (P < 0.05), and the blood biochemical indexes in the treatment group were significantly better than those in the control group (P < 0.05). Conclusion Argatroban Injection combined with beraprost sodium is effective in the treatment of arteriosclerosis obliterans of lower extremities, and can significantly improve arteriosclerosis, vascular stenosis and serum inflammation of lower extremities.

R971

河北省衛(wèi)健委項(xiàng)目(20220601)