目的 探索血漿D-二聚體及纖維蛋白原在慢性阻塞性肺疾病急性加重期（AECOPD）患者中的變化以及利伐沙班對其干預的療效評價。方法 選擇2016年1月-2018年4月在徐州醫(yī)科大學第二附屬醫(yī)院呼吸內科就診的確診慢性阻塞性肺疾?。–OPD）患者120例，AECOPD組與COPD穩(wěn)定期對照組各60例，選擇同期在此院健康體檢者62例作為對照，均于早晨空腹靜脈采血，比較3組研究對象的D-二聚體及纖維蛋白原水平；將AECOPD患者隨機分為兩組，即利伐沙班組和低分子肝素組，每組30例，分別在常規(guī)治療的基礎上口服利伐沙班藥物及皮下注射低分子肝素，比較兩組的療效。結果 AECOPD組患者的血漿D-二聚體及纖維蛋白原水平高于穩(wěn)定期對照組及健康體檢組，差異具有統(tǒng)計學意義（P<0.05）。穩(wěn)定期對照組患者D-二聚體濃度及纖維蛋白原水平高于健康體檢組，但差異無統(tǒng)計學意義。患者經利伐沙班或低分子肝素治療后血漿D-二聚體、纖維蛋白原水平均較治療前降低，差異具有統(tǒng)計學意義（P<0.05）；利伐沙班組患者經治療后D-二聚體水平低于低分子肝素組（P<0.05），纖維蛋白原水平組間差異無統(tǒng)計學意義；pO₂均較治療前有所上升，pCO₂均治療前有所降低，血氣分析指標明顯改善（P<0.05），但兩組間差異均無統(tǒng)計學意義；低分子肝素組治療AECOPD患者總有效率（73.33%）略低于利伐沙班組（80.00%），但差異無統(tǒng)計學意義。結論 AECOPD患者的血漿D-二聚體及纖維蛋白原水平高于穩(wěn)定期患者及健康者，血液處于高凝狀態(tài)。利伐沙班與低分子肝素兩種藥物的療效接近，但利伐沙班克服了低分子肝素與傳統(tǒng)口服抗凝藥的局限，在臨床治療AECOPD患者中具有更好的應用價值。

Objective To explore the changes of plasma D-dimer and fibrinogen in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and evaluate the efficacy of rivaroxaban for its intervention. Methods Selected 120 cases with COPD diagnosed in Department of Respiratory Medicine, Second Affiliated Hospital of Xuzhou Medical University from January 2016 to April 2018, we divided the cases into two group:the group in AECOPD and the group in stable phase of Chronic Obstructive Pulmonary Disease, 60 cases in each group. At the same time, we select 62 adults with health examination as normal control group in the hospital physical examination center. The above three groups of subjects all collected blood in the morning with a fasting vein, comparison among the three groups of differences in the levels of plasma D-dimer and fibrinogen. We randomly divided AECOPD patients into two groups of 30 patients in each group. Patients in the two groups received oral rivaroxaban and subcutaneous injections of low molecular weight heparin on the basis of routine treatment respectively, compare the efficacy of the two groups. Results The plasma D-dimer and fibrinogen levels in the AECOPD group were higher than those in the stable control group and the healthy examination group (P<0.05).The D-dimer and fibrinogen levels in the stable control group were higher than those in the healthy group, but the difference was not statistically significant. The plasma levels of D-dimer and fibrinogen in patients after treatment with rivaroxaban or low-molecular-weight heparin were lower than those before treatment, and the difference was statistically significant (P<0.05). In the rivaroxaban group, D-dimer levels were lower than those in the low-molecular-weight heparin group (P<0.05), and there was no significant difference in fibrinogen levels between the two groups. pO₂ increased compared with before treatment, pCO₂ decreased before treatment, blood gas analysis index improved significantly (P<0.05), but there was no significant difference between the two groups. The total effective rate of patients with AECOPD in the low-molecular-weight heparin group (73.33%) was slightly lower than that in the rivaroxaban group (80.00%), but the difference was not statistically significant. Conclusion The plasma D-dimer and fibrinogen levels in patients with AECOPD were higher than those in stable patients and healthy individuals, and the blood was hypercoagulated. The efficacy of rivaroxaban and low molecular weight heparin is similar, but rivaroxaban overcomes the limitations of low molecular weight heparin and traditional oral anticoagulants, and has a better application value in clinical treatment of AECOPD patients.