严重急性呼吸综合征后骨坏死的血液学改变及相关基因检测

目的探讨严重急性呼吸综合征(SARS)后骨坏死的病因学,以便用于非创伤性骨坏死的早期诊断和易感人群的筛选。方法取61例SARS后骨坏死患者空腹肘静脉血。另取健康人群52名为对照,应用酶联免疫吸附法等试验定凝血、纤溶指标,应用实时聚合酶链反应(PCR)仪测定因子V G1691A(FV Le iden)变、凝血酶原G20210A突变。结果SARS后骨坏死患者血液学因素改变明显,其中蛋白C(PC)、活化蛋白C抵抗(APC-R)、抗凝血酶Ⅲ(AT-Ⅲ)、纤溶酶原激活抑制物(PAI)、纤溶酶原(PLG)。两组比较,差异有统计学意义(109%±20%vs 85%±34%、8.0 U/m l±4.3U/m l、16 U/m l±14 U/m l、197 s±46 s vs 192 s±63 s、104%±14%vs 84%±29%、94%±15%vs69μ/m l±23μ/m l,P<0.01)。骨坏死组和对照组均未发现因子V Le iden突变和凝血酶原G20210A的突变。结论SARS后骨坏死患者存在高凝低纤溶倾向,对骨坏死易感人群可以进行高凝和低纤溶指标的筛选,PC、AT-Ⅲ、PAI、APC-R、PLG可作为骨坏死易感因素的筛选指标。SARS后骨坏死与因子V Le iden和凝血酶原G20210A突变无关。     

凝血、纤溶系统功能与脑卒中关系的研究

目的:研究机体凝血和纤溶系统功能的改变与脑卒中发生的相关性,探讨凝血酶激活的纤溶抑制物的水平和活性在缺血性脑卒中及出血性脑卒中的临床意义。方法:选取57例脑卒中患者,同时选择30例健康者为对照组,测定血浆组织型纤溶酶原激活物(tPA)、纤溶酶原激活抑制物(PAI)的含量、纤溶酶原(PLG)的活性、凝血酶激活的纤溶抑制物(TAFI)的含量及活性。结果:脑卒中患者tPA为(12.5±6.3)μg/ml,PLG为(89.6±14.3)%,都明显低于对照组(18.2±6.1)μg/ml,(110.2±10.5)%(P<0.05);而PAI为(36.7±9.6)μg/ml,TAFI为(120±37.6)μg/ml及TAFIa(186.6±77.2)ng/ml,显著高于对照组,分别是(26.5±7.10)μg/ml、(95.1±28.3)μg/ml、(132.42±30.67)ng/ml,差异有统计学意义。结论:机体凝血纤溶功能的异常与脑卒中的发生关系密切,TAFI具有抑制纤溶的作用,提示在脑卒中的发病中是个独立的危险因子。     

重症感染并发多脏器功能衰竭时凝血和纤溶系统变化的研究

据《中华内科杂志》1886年35卷第10期报道 为观察感染性多系统脏器功能衰竭(MSOF)时凝血纤溶系统变化的特点及意义,北京友谊医院血液科刘贵健等对68例不同程度的感染病人测定观察了凝血酶原时间(PT),活化的部分凝血活酶时间(APTT),纤维蛋白原(Fg)、纤维结合蛋白(Fn)和D-二聚体(D-Dimer)含量,凝血因子Ⅱ、Ⅶ、Ⅹ、Ⅻ(F Ⅰ、F Ⅶ、F Ⅹ、FⅫ)活性,抗凝血酶-Ⅲ(AT-Ⅲ)、纤溶酶原(PLG)、α_2-抗纤溶酶(α_2-AP)、组织纤溶酶原活化物(π-PA)和纤溶酶原活化物抑制物(PAI)活性、血小板(Plπ)数量。 结果表明,重症感染合并MSOF时,PT、APTT异常率明显增高,FⅡ、FⅦ、FⅩ、FⅫ活性明显减低,Plπ明显减少,Fn含量显著降低,AT-Ⅲ、PLG活性均明显减低,Fg、D-Dimer明显增高,     

凝血系统及纤维蛋白溶解系统测定在肾病综合征中的意义

目的：测定凝血、纤溶系统的部分项目以期探讨在肾病综合征（NS）病人中的结果及意义。方法：采用发色底物法测定纤溶酶原（PLG）的活性、凝血酶原（FⅡ）、凝血酶（FⅡa)、组织型纤溶酶原激活剂（t-PA)、组织型纤溶酶原激活剂抑制物（PAI-1）;采用ELISA法测定血小板a-颗粒膜蛋白-140（GMP-140）、纤维蛋白原降解产物（FDP）;采用免疫浊度法测定PLG含量、抗凝血酶Ⅲ（AT-Ⅲ）等项目;结果：肾病综合征病人的PLG活性、t-PA较正常组低,有显著性差异（P＜0.01),FⅡ、FDP、PLG含量、PAI-1正常组高,有显著差异（P＜0.01),而GMP-140与正常组相比无差异（P＞0.05),同期观察了肾病综合征病人治疗好转前后的结果,显示治疗好转后PLG活性上升,FDP上升,PLG含量及AT-Ⅲ下降。结论：肾病综合重病人存在凝血亢进的同时纤溶也亢进,测定凝血和纤溶系统的一些项目可了解病情并利于治疗。     

血管内皮细胞损害与急性冠脉综合征患者凝血-纤溶状态改变的关系

目的研究血管内皮细胞损害与急性冠脉综合征(acute coronary syndrome, ACS)患者凝血-纤溶状态改变的关系,为临床治疗提供依据.方法以健康体检者35例,稳定型心绞痛患者35例为对照,回顾性分析了2003年1月至2005年7月,我院收治的35例ACS患者的循环内皮细胞(CEC)、血管性假血友病因子(vWF)、血浆纤溶酶原(PLG)、血浆组织型纤溶酶原激活物(tPA)活性、血浆纤溶酶原激活物抑制物(PAI),D-二聚体(D-D)及抗凝血酶Ⅲ(AT-Ⅲ)的测定值.结果 ACS患者的tPA、PLG及AT-Ⅲ活性明显低于正常对照及稳定型心绞痛组(P《0.01),但CEC、vWF及PAI、D-D水平明显高于后者(P《0.01).CEC与vWF、D-D水平呈显著正相关(rvWF=0.68, rD-D=0.68,P《0.05).结论血管内皮细胞损害是ACS患者凝血-纤溶病理改变的重要原因,CEC、vWF及D-D可作为疾病严重程度的判断指标.     

骨折患者凝血指标检测及其临床意义

目的:探讨骨折患者凝血指标改变及其临床意义。方法:用凝固法检测34例骨折患者的凝血酶原时间测定(PT)、活化部分凝血活酶时间测定(APTT)、纤维蛋白原含量测定(FIB)、凝血酶时间测定(TT);免疫比浊法检测D-二聚体;发色底物法检测抗凝血酶-Ⅲ(AT-Ⅲ)、蛋白C(PC)、纤溶酶原(PLG)。结果:骨折患者组除TT以外各项指标均高于正常对照组。结论:骨折患者凝血系统改变,纤溶亢进,自身抗凝能力增强,血液处于低凝状态,临床上应考虑在术前增加抗凝指标(AT-Ⅲ、PC)的检测。     

流行性出血热并发弥散性血管内凝血42例分析

对95例流行性出血热(EHF)患者的出、凝血。抗凝血、纤溶指标进行动态检测,结果确诊并发弥散性血管内凝血(DIC)者42例(44.2%)。DIC 患者各项实验室诊断指标异常率依次为:血小板数(BPC)100%>纤溶酶原(PLG)95.2%>抗凝血酶Ⅲ(AT-Ⅲ)90.5%>凝血酶时间(TT)78.6%>纤维蛋白(原)降解产物     

血栓前状态与糖尿病肾病相关因素的研究

目的:观察2型糖尿病(DM)患者血栓前状态(PTS)指标在糖尿病肾病(DN)各期的水平,探讨其在DN发生、发展中的作用.方法:检测30例正常人和90例2型DM患者血栓前状态指标:Von willebrand因子(VWF)、血栓调节蛋白(TM)、血小板γ-颗粒膜蛋白(GMP-140),蛋白C活性(PC)、抗凝血酶Ⅲ(AT-Ⅲ)、凝血酶-抗凝血酶复合物(TAT),组织纤溶酶原激活物(t-PA),纤溶酶原激活物抑制物(PAI).结果:①DM各组血浆PC、TAT、VWF水平高于正常对照组,t-PA水平、AT-Ⅲ活性低于正常对照组,在DM无并发症时即出现上述改变(P＜0.01);②血浆PAI、TM、GMP-140水平在正常白蛋白尿组出现有统计学意义的升高(P均＜0.05).结论:①DM在无并发症时,即存在PTS;②PC、TAT、VWF、t-PA、AT-Ⅲ活性检测有助于PTS诊断;③PAI、TM、GMP-140是早期诊断DN较敏感的指标,并能反映DN的发生和发展,与尿白蛋白排泄量(UAE)联合检测有助于早期诊断DN.     

妇科恶性肿瘤患者术后血液血栓前状态的检测

目的探讨妇科恶性肿瘤患者血栓前状态生物指标的变化。方法检测38例妇科恶性肿瘤患者手术前后及20例正常非孕妇女的血管性血友病因子(vWF)、血小板ɑ-颗粒膜蛋白(GMP-140)、抗凝血酶(AT-Ⅲ)、蛋白C依赖的活化部分凝血酶原时间(PCAT)、纤溶酶原(PLG)、纤溶酶原激活物抑制物(PAI)、D-二聚体和组织纤溶酶原激活物(t-PA)等指标。结果妇科恶性肿瘤患者术前vWF含量、GMP-140、AT-Ⅲ、PLG、PAI、D-二聚体均比对照组高(P<0.01),而术后升高更明显;PCAT手术前、后均明显低于正常非孕妇女;而组织纤溶酶原激活物(t-PA)则无显著性改变(P>0.05)。结论提示妇科恶性肿瘤患者术前血液呈血栓前状态,术后呈更明显的血栓前状态。     

养血安胎颗粒对复发性流产血栓前状态的中西结合干预模式的建立

目的通过对复发性流产患者血栓前状态的相关血栓标志物进行筛查,验证中医瘀血型辨证与其相关性,建立养血安胎颗粒对其规范化的治疗模式。方法将1497例自然流产患者按流产次数分为1次、2次、3次及以上,分别检测抗凝血酶Ⅲ(AT-Ⅲ)、纤溶酶原(PLG)、交联纤维蛋白降解产物(DD)、纤溶酶原降解产物(FDP)、纤溶酶原活化物抑制因子-1(PAI-1)、组织型纤溶酶原激活物(t-PA)、蛋白C(PC)、蛋白S(PS)等血栓标志物。对入选289例复发性流产患者按照随机、对照原则分为中药治疗组(127例)和西药治疗组(162例),观察养血安胎颗粒和阿司匹林对复发性流产血栓前状态的疗效。结果 AT-Ⅲ、PAI-1对不良妊娠结局的影响具有统计学差异(P0.05),随着流产次数的增加特征性明显(P0.05);阿司匹林对AT-Ⅲ的影响具有统计学意义(P0.05);养血安胎颗粒对PAI-1的影响具有统计学意义(P0.01);各指标两组间治疗前后效果比较差异均无统计学意义(P0.05)。结论养血安胎颗粒通过养血活血、健脾补肾,调节止血—凝血—抗凝系统,改善复发性流产血栓前状态。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.