【摘要】目的 以13 u/(h·kg)作为肺栓塞患者肝素抗凝起始量，分别研究该起始量下肝素剂量及血浆肝素浓度与活化部分凝血酶时间(APTT)的线性量化关系，利用线性方程预测维持量、达标浓度与APTT区间，以方便临床控制抗凝快速而稳定达标。方法 记录25例PTE患者治疗前及使用肝素后每6 h一次的APTT和血浆肝素浓度值;运用相关性与单因素线性回归的统计学方法探讨血浆肝素浓度与APTT值的线性关系、肝素剂量与APTT值的线性关系。结果 (1)肝素浓度与APTT的线性关系(均P<0.05)：个体内相关系数为0.618～0.914(线性)与0.640～0.873(lg),决定系数为0.382～0.836(线性)与0.409～0.762(lg);个体间相关系数为0.779(线性)与0.707(lg),决定系数为0.607(线性)与0.500(lg)，回归方程为APTT=132.99×肝素浓度+35.11、lgAPTT=0.599×肝素浓度+1.671及肝素浓度=0.0045×APTT-0.055、肝素浓度=0.834×lgAPTT-1.260。(2)肝素剂量与浓度的线性关系：所求个体内相关系数、决定系数与个体间相关系数、决定系数几乎均P>0.05，未能求出具有统计学显著意义的单因素线性回归方程。(3)肝素剂量与APTT的线性关系：个体内相关系数为0.548～0.883(线性),决定系数为0.300～0.780(线性);个体间相关系数为0.164～0.609(线性),决定系数为0.027～0.371(线性)，回归方程为APTT=2.72×肝素剂量+35.265(P=0.003),肝素剂量=0.0144× APTT+10.356(P=0.003)。结论 (1)肝素浓度(抗Ⅱ因子法)与APTT之间具有良好的正相关性与线性关系，提供了APTT代替肝素浓度检测的依据。回归方程预测抗Ⅱ因子法肝素达标浓度为0.152～0.260 u/ml(线性)与0.130～0.300 u/ml(lg)。(2)肝素剂量、浓度与APTT的相互关系受多重因素影响，单因素线性相关与回归模型不足以正确揭示肝素剂量与浓度的关系。
【关键词】 肝素 活化部分凝血酶原时间 肺栓塞 抗凝治疗
Study of relationship among heparin dosage,concentration and APTT in pulmonary thromboembolism
LUO Hua，LIANG Ying.ICU of Shenzhen Hospital of Peking University，Shenzhen 518036，China
[Abstract] Objective By using 13u/h/kg of heparin as initial dosage to treat PTE and study linear relationship among heparin dosage,concentration and APTT respectively.To predict maintenance dosage,concentration of heparin and APTT range within the therapeutic area depending on regression formula.Methods In 25 PTE cases,the numerus of APTT and heparin concentration before therapy and every 6 h after therapy were recorded sequently.The linear relationship between heparin concentration and APTT,between heparin dosage and APTT were analyzed separately with correlation and univariate linear regression.Results ①Linear relationship between heparin concentration and APTT was showed as follow(P<0.05):correlation coefficient within individual were 0.618～0.914(linear)and 0.640～0.873(lg).Coefficients of determination were
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