目的 探究阿加曲班注射液联合贝前列素钠治疗下肢动脉硬化闭塞症的临床疗效。方法 选取2019年7月—2021年7月于河北北方学院附属第一医院就诊的120例下肢动脉硬化闭塞症患者为研究对象，随机分为对照组和治疗组，每组各60例。对照组饭后口服贝前列素钠片，2片/次，3次/d。治疗组在对照组基础上静脉滴注阿加曲班注射液，10 mg加入250 mL生理盐水，2次/d。两组患者连续治疗4周。观察两组患者临床疗效，比较治疗前后两组患者下肢动脉血管血流速度、血液流变学、踝肱指数（ABI）、Rutherford评分、血清超敏C反应蛋白（hs-CRP）、单核细胞趋化因子-1（MCP-1）、细胞间黏附分子-1（ICAM-1）、同型半胱氨酸（Hcy）、抗凝血酶Ⅲ（AT-III）和D-二聚体（D-D）水平。结果 治疗后，治疗组总有率效为95.00%，显著高于对照组的83.33%，两组比较差异有统计学意义（P＜0.05）。治疗后，两组患者股浅动脉、胫后动脉、足背动脉的血管内径、血流量均显著增加，而峰值流速显著降低（P＜0.05），且治疗组下肢动脉血管血流速度改善情况明显好于对照组（P＜0.05）。治疗后，两组全血高切黏度、全血低切黏度、血浆黏度及细胞沉降率均显著降低（P＜0.05），且治疗组显著低于对照组（P＜0.05）。治疗后，两组患者ABI显著升高，而Rutherford评分显著降低（P＜0.05），且治疗组下肢运动功能显著好于对照组（P＜0.05）。治疗后，两组患者血清hs-CRP、MCP-1、ICAM-1、Hcy、AT-Ⅲ水平显著降低，而D-D水平显著升高（P＜0.05），且治疗组血生化指标显著好于对照组（P＜0.05）。结论 阿加曲班注射液联合贝前列素钠治疗下肢动脉硬化闭塞症疗效显著，对下肢动脉硬化、血管狭窄及血清炎症改善明显。

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

河北省卫健委项目(20220601)