IPF Patients With Low-molecular-weight Heparin On Serum HGF Expression And Clinical Efficacy Study

Objective: Randomized controlled trials through clinical research, to observation the effect of low molecular weight heparin anticoagulant therapy on arterial blood analysis, the clinical symptoms,and levels of plasma D-dimer and serum HGF expression of patients with IPF. Preliminary study the effect of anticoagulant therapy in patients with IPF and its mechanism of effect.Method: Seventeen patients with idiopathic pulmonary fibrosis admitted to the First Hospital of Shanxi Medical University from January 2008 to December 2008. Patients were randomly divided into two groups Patients were assigned to receive prednisolone alone or prednisolone plus anticoagulant therapy. (eight cases of anticoagulant therapy group, nine cases of nonanticoagulant therapy group). There was no significant difference in baseline characteristics. Detecting the two groups of patients admitted to hospital 1 and 14 days of blood gas analysis (including PO₂, PCO₂, P (A-a) O₂, SO₂%), plasma D-dimer level, the degree of dyspnea score, serum HGF levels. Statistical software( SPSS13.0 statistical package),values are reported as mean±SD, with Rank sum test, significance was accepted at P <0.05.Result: The serum HGF levels in the anticoagulant group was significantly reduced by IH administration of low molecular heparin sodium (388.68±114.39pg/ml on day 1, vs 601.46±170.90 pg/ml on day 14, P = 0.012), Conversely, no significant difference between the serum HGF levels on day 1 and day 14 in the nonanticoagulant group. There are significant difference between the serum HGF levels in the anticoagulant group and the nonanticoagulant group, P <0.05.The plasma D-dimer levels in the anticoagulant group was significantly decreased by IH administration of low molecular heparin sodium (600.82ng/ml±392.5vs 370.9±259.4ng/ml, P = 0.04), instead of no significant difference between the plasma D-dimer levels on day 1 and day 14 in the nonanticoagulant group. There are significant difference between the plasma D-dimer levels in the anticoagulant group and the nonanticoagulant group, P <0.05.PaO₂, SO₂% in the anticoagulant group was significantly higher than before treatment, there are statistically significant, PaO₂ (54.39±12.21mmHg vs 72.45±12.41 mmHg, P = 0.16), SO₂% (83.90±6.59 vs 93.03±2.72, P = 0.012), Conversely, no significant difference between before and after treatment in the nonanticoagulation group. There are significant difference between PaO₂, SO₂% in the anticoagulant group and the nonanticoagulant group, P <0.05.P (A-a) O₂ decreased than that before treatment,after anticoagulant treatment with low molecular weight heparin sodium,there are statistically significant (26.31±7.98 mmHg vs 18.06±6.56 mmHg, P = 0.04), Conversely, no significant difference between P (A-a) O₂ on day 1 and day 14 in the nonanticoagulation group. There are significant difference between P (A-a) O₂ in the anticoagulant group and the nonanticoagulant group, P <0.05.Changes in the two groups before and after treatment there was no significant difference in PaCO₂, anticoagulant group (42.06 mmHg±11.35 vs 37.68±9.87 mmHg, P = 0.43), non-anticoagulant group (45.36±14.23 mmHg vs 44.33±12.94 mmHg, P = 0.51) . There are no significant difference between PaCO₂ in the anticoagulant group and the nonanticoagulant group, P >0.05.The degree of dyspnea score in the anticoagulant group was significantly reduced by IH administration of low molecular heparin sodium (3.6±0.5 vs 3.0±0.5, P = 0.04), rather than no significant difference between the degree of dyspnea score on day 1 and day 14 in the nonanticoagulation group. There are significant difference between the degree of dyspnea score in the anticoagulant group and the nonanticoagulant group, P <0.05.APTT and PLT in the anticoagulant group after treatment compared with before treatment, no statistically significant difference, P> 0.05.Conclusion: The results of this study show that Hormone treatment combined with low molecular weight heparin can improve clinical symptoms and indicator of blood gas analysis , lowering blood hypercoagulability in patients with IPF. It prompted that it is effective treatment of hormone antiinflammatory combined with anticoagulant in patients with IPF . The results of this study show that subcutaneous injection of low molecular weight heparin in patients with IPF can significantly increased HGF serum levels suggesting that anticoagulant therapy may be some way to stimulate expression of HGF, then HGF may play a certain way to the role of anti-pulmonary fibrosis.