低分子肝素对慢性病贫血患者Hb和C反应蛋白水平影响的初步研究
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摘要
目的初步研究低分子肝素(LMWH)在治疗慢性病贫血(ACD)患者中的临床意义。方法对90例伴有血栓形成或血浆D-二聚体很高而有血栓形成倾向的ACD患者应用LMWH(4 000U/天,7～15天)治疗,并测定治疗前后Hb和C-反应蛋白(CRP)水平以观察它们的变化情况,同时分析其临床意义。结果①贫血组治疗前Hb水平为93.51±15.55g/L,明显低于治疗后的100.95±12.97g/L,差异有统计学意义(t=2.527 8,P<0.05)。②无贫血组治疗前Hb水平为133.09±10.69g/L,与治疗后的135.57±13.09g/L比较差异无统计学意义(t=0.7417,P>0.05)。③治疗前贫血组CRP为49.31±39.07mg/L,明显高于治疗后的29.73±39.07mg/L,差异有统计学意义(t=2.483 4,P<0.05)。④无贫血组治疗前CRP水平为18.08±16.77mg/L,与治疗后的18.24±12.31mg/L比较差异无统计学意义(t=0.023 7,P>0.05)。⑤治疗前后CRP水平与Hb水平均呈负相关(分别为r=-0.425 9,P<0.01和r=-0.234 7,P<0.05)。结论LMWH上调ACD患者的Hb水平,可以改善患者的贫血,可能机制是下调CRP水平。
Objective To preliminary study the significance of low molecular weight heparin(LMWH)in the treatment the patients of anemia of chronic diseases(ACD).Methods Used LMWH(4 000 U/day,7～15 days)to therapy the patients with thrombus formation or plasma D-two dimer(D-D)which was high and had a tendency to thrombosis,to observe change of the levels of CRP and Hb in patients in pretherapy and post-therapy,and to analysis of its clinical significance.Results ①In anemia group the Hb levels in pretherapy were 93.51±15.55 g/L,which were lower than 100.95±12.97 g/L in posttherapy(t=2.527 8,P<0.05).②In non-anemia group,the level of Hb were not difference between the pretherapy and posttherapy(rspectively were 133.09±10.69 g/L and 135.57±13.09 g/L,t=0.741 7,P>0.05).③In anemia group,the levels of CRP were 49.31±39.07 mg/L in pretherapy,which were higher than 29.73±39.07 mg/L in post-therapy(t=2.483 4,P<0.05).④In non-anemia group,the level of CRP were not differnce between the pretherapy and post-therapy(respectively were 18.08±16.77 mg/L and 18.24±12.31 mg/L,t=0.023 7,P>0.05).⑤There were all negtive correlation between the CRP and Hb in pretherapy and post-therapy(respectively were r=-0.425 9,P<0.01 and r=-0.234 7,P<0.05).Conclusion LMWH could up-regulate the levels of Hb,and better for the degree of anemia in patients with ACD.The possible mechanism is to down regulate the level of CRP.
Objective To preliminary study the significance of low molecular weight heparin(LMWH)in the treatment the patients of anemia of chronic diseases(ACD).Methods Used LMWH(4 000 U/day,7～15 days)to therapy the patients with thrombus formation or plasma D-two dimer(D-D)which was high and had a tendency to thrombosis,to observe change of the levels of CRP and Hb in patients in pretherapy and post-therapy,and to analysis of its clinical significance.Results ①In anemia group the Hb levels in pretherapy were 93.51±15.55 g/L,which were lower than 100.95±12.97 g/L in posttherapy(t=2.527 8,P<0.05).②In non-anemia group,the level of Hb were not difference between the pretherapy and posttherapy(rspectively were 133.09±10.69 g/L and 135.57±13.09 g/L,t=0.741 7,P>0.05).③In anemia group,the levels of CRP were 49.31±39.07 mg/L in pretherapy,which were higher than 29.73±39.07 mg/L in post-therapy(t=2.483 4,P<0.05).④In non-anemia group,the level of CRP were not differnce between the pretherapy and post-therapy(respectively were 18.08±16.77 mg/L and 18.24±12.31 mg/L,t=0.023 7,P>0.05).⑤There were all negtive correlation between the CRP and Hb in pretherapy and post-therapy(respectively were r=-0.425 9,P<0.01 and r=-0.234 7,P<0.05).Conclusion LMWH could up-regulate the levels of Hb,and better for the degree of anemia in patients with ACD.The possible mechanism is to down regulate the level of CRP.
引文
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[2]ZHANG A S,YANG F,WANG J H,et al.Hemojuvelin-neogenin interaction is required for bone morphogenic protein-4-induced hepcidin expression[J].JBiol Chem,2009,284(34):22580-22589.
[3]NEMETH E,TUTTLE M S,POWELSON J,et al.Hepcidin regulates cellular iron efflux by binding to ferroportin and inducing its internalization[J].Science,2004,306(5704):2090-2093.
[4]程旭,潘湘涛,张媛,等.C反应蛋白及血清铁调素在肿瘤患者中的表达及其与贫血的关系[J].中国继续医学教育,2017,9(7)44-45.CHEN Xu,PAN Xiangtao,ZHANG Yuan,et al.The expression of C-reactive protein and serum hepcidin in tumor patients and its relationship with anemia[J].China Continuing Medical Education,2017,9(7)44-45.
[5]POLI M,ASPERTI M,RUZZENENTI P,et al.Hepcidin antagonists for potential treatments of disorders with hepcidin excess[J].Front Pharmacolgy,2014,5:86.
[6]POLI M,GIRELLI D,CAMPOSTRINI N,et al.Heparin:A potent inhibitor of hepcidin expression in vitro and in vivo[J].Blood,2011,117(3):997-1004.