Effect of rivaroxaban on hemorheology, inflammatory factors and coagulation function in patients with spinal trauma after spinal fusion
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摘要:
目的 分析利伐沙班对脊柱创伤患者脊柱融合术后血液流变学、炎性因子及凝血功能的影响。 方法 选择2019年1月~ 2020年1月我院外科接受脊柱融合术治疗的脊柱创伤102例患者，按照随机数字表排布法分为观察组（n=51）和对照组（n=51），对照组行术后常规处理，观察组在此基础上给予利伐沙班治疗，1次/d，1次1片，连续治疗14 d。比较两组患者术后1~14 d血液流变学（全血低切黏度、全血中切黏度、全血高切黏度、红细胞压积、血浆黏度及血小板黏附率），炎性因子（白细胞介素8、白细胞介素10、肿瘤坏死因子-α及C反应蛋白），凝血功能指标（凝血酶时间、凝血酶原时间、活化部分凝血酶时间、纤维蛋白原及D-二聚体）。 结果 经过治疗，两组患者全血低切黏度、全血中切黏度、全血高切黏度、红细胞压积、血浆黏度及血小板黏附率等血液流变学均有一定程度降低，且观察组与对照组差异有统计学意义（P < 0.05）；观察组炎症因子白细胞介素8、白细胞介素10、肿瘤坏死因子-α及C反应蛋白水平均显著低于对照组（P < 0.05）；观察组凝血酶时间、凝血酶原时间、活化部分凝血酶时间、纤维蛋白原及D-二聚体等凝血功能指标均低于对照组（P < 0.05）。 结论 利伐沙班可以有效改善脊柱融合术后脊柱创伤患者的血液流变学，降低相关炎性因子水平，且未明显改变相关凝血功能，具有一定的安全性和临床效果。 Abstract:Objective To investigate the effect of rivaroxaban on hemorheology, inflammatory factors and coagulation function in patients with spinal trauma after spinal fusion. Methods A total of 102 patients with spinal trauma who underwent spinal fusion in our hospital from January 2019 to January 2020 were selected. The patients were randomly divided into observation group (n=51) and control group (n=51) according to the random number table arrangement method. The control group was given routine postoperative treatment, and the observation group was given rivaroxaban treatment, once a day, one tablet once a day for 14 days. The hemorheology (whole blood low shear viscosity, whole blood medium shear viscosity, whole blood high shear viscosity, hematocrit, plasma viscosity and platelet adhesion rate), inflammatory factors (IL-8, IL-10, TNF-α and CRP), coagulation function indexes (TT, Pt, APTT, FIB and D-D) were compared between the two groups at 1 and 14 days after operation. Results After treatment, the hemorheology of whole blood low shear viscosity, whole blood medium shear viscosity, whole blood high shear viscosity, hematocrit, plasma viscosity and platelet adhesion rate of the two groups were reduced to a certain extent(P < 0.05). The inflammatory factors IL-8 and IL-10 in the observation group were significantly lower than those in the control group (P < 0.05). The levels of TNF-α and CRP in the observation group were significantly lower than those in the control group (P < 0.05). The coagulation indexes such as TT, Pt, APTT, FIB and D-D in the observation group were lower than those in the control group (P < 0.05). Conclusion Rivaroxaban can effectively improve the hemorheology of patients with spinal trauma after spinal fusion, reduce the level of related inflammatory factors, and do not significantly change the coagulation function, which has a certain safety and clinical effect. -
Key words:
- rivaroxaban /
- spinal trauma /
- spinal fusion /
- hemorheology /
- inflammatory factors /
- coagulation function
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图 1 脊柱融合术后影像学检查结果
A~B：术后腰椎X线正侧位所示侧方内螺丝固定位置良好；C~D：术后腰椎三维CT所示L3/4椎间隙高度恢复明显，椎管容积扩大显著.
Figure 1. Imaging results after fusion.
表 1 两组患者治疗前后血液流变学对比
Table 1. Comparison of hemorheology between the two groups of patients before and after treatment (n= 51, Mean±SD)
组别 观察组 对照组 治疗前 治疗后 治疗前 治疗后 全血低切黏度(mPa/s) 7.09±2.41 2.11±0.91*# 7.11±2.40 4.39±1.37* 全血中切黏度(mPa/s) 4.85±1.15 1.03±0.33*# 4.86±1.14 2.51±0.69* 全血高切黏度(mPa/s) 4.37±1.32 2.03±0.61*# 4.41±1.31 3.02±1.04* 红细胞压积(%) 52.47±5.27 27.48±2.89*# 52.51±5.31 35.75±3.27* 血浆黏度(mPa/s) 1.81±0.27 1.29±0.21*# 1.79±0.26 1.53±0.29* 血小板黏附率(%) 38.74±3.72 24.89±2.68*# 38.69±3.71 32.89±3.08* *P < 0.05 vs治疗前；#P < 0.05 vs对照组. 
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表 2 两组患者治疗前后炎症因子对比
Table 2. Comparison of inflammatory factors between the two groups of patients before and after treatment (n=51, Mean±SD)
组别 观察组 对照组 治疗前 治疗后 治疗前 治疗后 IL-8(ng/L) 0.59±0.09 0.15±0.02*# 0.58±0.10 0.37±0.06* IL-10(pg/L) 2.61±0.79 0.91±0.37*# 2.59±0.78 1.51±0.59* TNF-α(ng/L) 1.87±0.24 1.01±0.12*# 1.89±0.25 1.47±0.19* CRP(mg/L) 7.21±0.83 2.73±0.29*# 7.19±0.82 4.01±0.42* *P < 0.05 vs治疗前；#P < 0.05 vs对照组；IL-8：白细胞介素8；IL-10：白细胞介素10；TNF-α：肿瘤坏死因子-α；CRP：C反应蛋白.
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表 3 两组患者治疗前后凝血功能指标对比
Table 3. Comparison of coagulation function indexes of the two groups of patients before and after treatment (n=51, Mean±SD)
组别 观察组 对照组 治疗前 治疗后 治疗前 治疗后 TT(s) 13.63±1.43 44.17±4.79*# 13.59±1.44 26.74±2.53* PT(s) 10.91±3.51 16.12±2.95*# 10.89±3.52 12.37±3.09* APTT(s) 49.35±5.03 76.58±7.38*# 49.29±4.99 60.31±5.31* FIB(mg/dL) 479.34±43.78 302.42±29.87*# 481.65±43.97 351.76±33.97* D-D(μg/L) 894.58±79.86 341.07±32.79*# 895.14±80.03 459.79±46.91* *P < 0.05 vs治疗前；#P < 0.05 vs对照组；TT：凝血酶时间；PT：凝血酶原时间；APTT：活化部分凝血酶时间；FIB：纤维蛋白原；D-D：D-二聚体.
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