抗血小板治疗对脓毒症炎症反应和血小板功能及治疗效果的影响

吴淑璐; 牛凯旋; 徐阳; 刘成; 邓晰明

doi:10.16766/j.cnki.issn.1674-4152.002584

抗血小板治疗对脓毒症炎症反应和血小板功能及治疗效果的影响

doi: 10.16766/j.cnki.issn.1674-4152.002584

蚌埠医学院第一附属医院重症医学科，安徽蚌埠 233004

基金项目:

安徽省高校自然科学基金项目 KJ2019A0351

详细信息

通讯作者:
邓晰明, E-mail: bbdxm@163.com

中图分类号: R631R446
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出版历程
- 收稿日期: 2021-10-16
- 网络出版日期: 2022-09-26

Effects of antiplatelet therapy on inflammatory response, platelet function and therapeutic effect of sepsis

Department of Intensive Care, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨抗血小板药物阿司匹林对脓毒症患者的炎症控制效果及其安全性。方法选取2020年10月—2021年6月蚌埠医学院第一附属医院重症医学科收治的61例脓毒症患者，按照随机数字表法分为对照组(31例)及实验组(30例)。对照组予以常规脓毒症治疗，实验组予以常规治疗+阿司匹林100 mg，经胃管注入，1次/d，连用7 d。对比2组患者治疗前后PCT、CRP、IL-6水平变化，凝血功能(凝血酶原时间、凝血酶时间、活化部分凝血活酶时间)变化，血小板计数与功能(血栓弹力图中的MA值)，并观察阿司匹林常见不良反应(消化道出血)的发生率及患者治疗有效率。结果经过治疗，2组患者的PCT、CRP、IL-6水平均降低，且实验组降低水平明显大于对照组，差异有统计学意义(P值分别为0.012、0.006、0.043)。实验组的凝血功能变化(凝血酶原时间、凝血酶时间、活化部分凝血活酶时间)和血小板计数变化与对照组相比差异无统计学意义(均P>0.05)；实验组的血小板功能指标MA变化与对照组相比差异有统计学意义(P=0.023)。实验组的阿司匹林副反应发生率与对照组相比差异无统计学意义(P=0.694)；治疗后实验组患者的急性生理与慢性健康评分Ⅱ及序贯器官衰竭评分比对照组降低明显，差异有统计学意义(P值分别为0.048、0.028)；实验组的治疗效果与对照组相比差异无统计学意义(P=0.344)。结论抗血小板药物阿司匹林能控制脓毒症患者的炎症反应和血小板功能，且对凝血功能与血小板计数没有明显抑制，并且不增加患者出血的发生率，但没有改善患者的最终治疗效果。
- 脓毒症 /
- 抗血小板 /
- 广义估计方程 /
- 降钙素原 /
- 白介素-6 /
- C反应蛋白
Abstract: Objective To investigate the anti-inflammatory effect and safety of antiplatelet drug aspirin in patients with sepsis. Methods A total of 61 sepsis patients admitted to the Department of Intensive Care Medicine of the First Affiliated Hospital of Bengbu Medical College from October 2020 to June 2021 were selected, including 31 patients in the control group and 30 patients in the experimental group. The control group received conventional sepsis treatment, and the experimental group received conventional treatment + aspirin 100 mg, one time a day, by gastric tube injection, once a day, for 7 days. Changes in the levels of procalcitonin, C-reactive protein and interleukin-6, coagulation function (prothrombin time, thrombin time and activated partial thrombin time), and platelet count and function (MA value in thromboelastic diagram) were compared between the two groups before and after treatment. The incidence of common adverse reactions (gastrointestinal bleeding) and treatment efficiency of aspirin were observed. Results After treatment, the levels of PCT, CRP and IL-6 in the two groups decreased, and the decreased levels in the experimental group were significantly higher than those in the control group (P=0.012, 0.006 and 0.043, respectively). There were no significant differences in coagulation function (prothrombin time, thrombin time and activated partial thromboplastin time) and platelet count PLT between the two groups (all P>0.05). The change in platelet function index MA in the experimental group was statistically different from that in the control group (P=0.023). There was no statistical difference in the incidence of aspirin side effects between the two groups (P=0.694). After treatment, acute physiology and chronic health evaluation Ⅱ and sequential organ failure assessment scores in the experimental group were significantly lower than those in the control group, with statistical differences (P=0.048, 0.028). There was no statistical difference in the therapeutic effect between the two groups (P=0.344). Conclusion The antiplatelet drug aspirin can control the inflammatory response in patients with sepsis, and it has no obvious inhibition on coagulation function, platelet count and function. It does not increase the incidence of bleeding in patients, but it does not improve the patients' final treatment outcome.
- Sepsis /
- Antiplatelet /
- Generalised estimation equation /
- Procalcitonin /
- Interleukin-6 /
- C-reactive protein

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表 1 2组患者性别、年龄、治疗前APACHEⅡ及SOFA评分比较

Table 1. Gender, age, APACHE Ⅱ and SOFA scores before treatment were compared between the two groups

组别	例数	性别(例)		年龄(x ±s，岁)	APACHEⅡ[M(P₂₅, P₇₅)，分]	SOFA[M(P₂₅, P₇₅)，分]
组别	例数	男性	女性	年龄(x ±s，岁)	APACHEⅡ[M(P₂₅, P₇₅)，分]	SOFA[M(P₂₅, P₇₅)，分]
对照组	31	23	8	60.35±15.46	19(15, 21)	7.00(5.00, 10.00)
观察组	30	22	8	61.83±12.01	19(13, 25)	7.00(5.75, 10.00)
统计量		0.006^a		0.173^b	-0.065^c	-0.109^c
P值		0.939		0.679	0.948	0.913
注：^a为χ²值，^b为t值，^c为Z值。

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表 2 2组患者不同时间点的炎症指标统计[M(P₂₅, P₇₅)]

Table 2. The inflammatory indicators of the two groups at different time points were statistically analyzed [M(P₂₅, P₇₅)]

组别	指标	D1	D3	D5	D7
对照组	PCT(μg/L)	3.92(0.37, 59.83)	2.48(0.39, 20.83)	1.49(0.36, 7.05)	1.41(0.32, 7.61)
	CRP(mg/L)	199.20(60.01, 218.40)	161.90(96.30, 210.80)	81.70(46.80, 175.50)	75.40(34.80, 128.38)
	IL-6(pg/ml)	140.7(41.46, 385.75)	45.64(18.52, 160.70)	36.31(19.67, 175.50)	41.23(26.67, 176.00)
观察组	PCT(μg/L)	2.44(0.54, 7.71)	1.68(0.37, 6.43)	1.23(0.44, 4.36)	0.86(0.44, 2.51)
	CRP(mg/L)	57.50(8.00, 139.15)	103.40(31.58, 172.55)	77.00(37.13, 96.50)	61.95(35.53, 96.75)
	IL-6(pg/ml)	47.85(30.39, 90.24)	49.40(30.71, 142.13)	41.56(26.73, 146.28)	40.39(21.03, 106.17)

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表 3 2组炎症指标比较的广义估计方程分析

Table 3. Generalized estimating equation analysis of inflammation index comparison between two groups

变量		B	SE	95% CI		Wald χ²	P值
变量		B	SE	下限	上限	Wald χ²	P值
PCT	组别	-21.555	7.677	-36.600	-6.509	7.884	0.005
	时间	-2.868	0.907	-4.646	-1.090	9.998	0.002
	组别与时间交互	2.390	0.946	0.536	4.245	6.380	0.012
CRP	组别	-72.730	21.809	-115.475	-29.984	11.121	0.001
	时间	-10.427	2.255	-14.847	-6.006	21.373	< 0.001
	组别与时间交互	9.536	3.445	2.783	16.289	7.660	0.006
IL-6	组别	-162.522	64.921	-35.280	6.267	6.267	0.012
	时间	-25.469	10.545	-4.802	5.834	5.834	0.016
	组别与时间交互	21.968	10.880	43.292	4.077	4.077	0.043
注：以对照组为参照。

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表 4 2组患者各时间点的凝血功能、血小板计数及功能指标统计[M(P₂₅, P₇₅)]

Table 4. The blood coagulation function, platelet count and functional indexes of the two groups at each time point were statistically analyzed [M(P₂₅, P₇₅)]

组别	指标	D1	D3	D5	D7
对照组	PT(s)	14.20(13.00, 15.50)	13.50(12.40, 14.30)	12.60(11.90, 14.60)	13.30(12.50, 15.00)
	TT(s)	32.30(26.70, 36.80)	29.30(25.10, 37.50)	28.90(25.00, 32.70)	28.10(26.30, 35.00)
	APTT(s)	32.30(26.70, 36.80)	29.30(25.10, 34.00)	28.40(24.90, 31.70)	27.80(26.10, 32.40)
	PLT(×10⁹/L)	116.00(67.00, 225.00)	113.00(54.00, 245.00)	123.00(69.00, 245.00)	166.00(52.00, 285.00)
	MA(mm)	50.10(41.40, 57.00)	55.20(41.30, 59.10)	57.90(46.00, 60.50)	59.30(49.20, 66.00)
观察组	PT(s)	12.55(11.75, 13.60)	13.05(11.80, 14.00)	12.55(12.08, 13.83)	12.65(11.90, 13.53)
	TT(s)	27.20(24.60, 35.53)	28.25(24.68, 34.93)	29.65(24.70, 34.33)	26.70(24.68, 32.40)
	APTT(s)	27.65(25.05, 36.63)	29.70(24.78, 34.13)	28.35(24.35, 33.25)	25.60(22.28, 28.03)
	PLT(×10⁹/L)	123.00(79.50, 222.25)	160.50(86.25, 252.00)	221.00(107.00, 267.75)	237.50(126.75, 303.75)
	MA(mm)	54.35(47.83, 61.70)	58.70(55.40, 64.93)	64.30(60.50, 70.28)	71.20(63.10, 74.35)

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表 5 2组凝血功能、血小板计数及功能比较的广义估计方程分析

Table 5. Analysis of the comparison of coagulation function, platelet count and function between the two groups by generalized estimating equation

变量		B	SE	95% CI		Wald χ²	P值
变量		B	SE	下限	上限	Wald χ²	P值
PT	组别	-1.064	1.071	-5.790	3.173	0.986	0.321
	时间	-0.239	0.097	-0.774	0.290	6.098	0.014
	组别与时间交互	0.082	0.135	-0.848	0.523	0.368	0.544
TT	组别	-1.308	2.287	-3.163	1.036	0.327	0.567
	时间	-0.242	0.271	-0.429	-0.049	0.796	0.372
	组别与时间交互	-0.162	0.350	-0.182	0.346	0.216	0.642
APTT	组别	-0.360	2.365	-5.564	3.522	0.023	0.879
	时间	-0.484	0.246	-0.799	0.258	3.875	0.049
	组别与时间交互	-0.374	0.383	-1.153	0.332	0.954	0.329
PLT	组别	-4.645	30.331	-64.091	54.802	0.023	0.878
	时间	6.672	3.294	0.216	13.127	4.102	0.043
	组别与时间交互	7.551	4.560	-1.387	16.489	2.742	0.098
MA	组别	5.795	2.742	0.421	11.168	4.467	0.035
	时间	1.735	0.172	1.398	2.072	101.710	< 0.001
	组别与时间交互	0.756	0.333	0.103	1.410	5.142	0.023
注：以对照组为参照。

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表 6 2组患者治疗效果及副作用的比较

Table 6. Comparison of treatment effects and side effects between the two groups

组别	例数	APACHEⅡ[M(P₂₅, P₇₅)，分]		SOFA[M(P₂₅, P₇₅)，分]		消化道出血(例)	治疗效果(例)
组别	例数	治疗前	治疗后	治疗前	治疗后	消化道出血(例)	有效	无效
对照组	31	19.00(15.00, 21.00)	14.00(10.00, 20.00)	7.00(5.00, 10.00)	5.00(3.00, 8.00)	5	17	14
观察组	30	19.00(13.00, 25.00)	10.00(7.75, 16.75)	7.00(5.75, 10.00)	4.00(2.00, 6.00)	6	20	10
统计量		-0.065^a	-2.088^a	-0.109^a	-2.192^a	0.155^b	0.894^b
P值		0.948	0.037	0.913	0.028	0.694	0.344
注：^a为Z值，^b为χ²值。

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