心房颤动患者血栓形成与腺苷、血小板P选择素表达的关系

［李为民,韩薇,王岚峰.中华心血管病杂志,2000,28(5)：367］ 目的研究慢性心房颤动(房颤)患者血栓形成与血浆腺苷水平、血小板活化的关系。方法应用反相高效液相色谱及流式细胞仪,分析窦性心律及房颤患者血浆腺苷水平、血小板P选择素、GPⅡb/Ⅲa表达量,同时放免法测定血浆TXB2、6-keto-PGF1α含量,计算TXB2/6-keto-PGF1α。并应用不同浓度的8-苯基茶碱阻断腺苷受体,流式细胞仪分析其对血小板P选择素表达量的影响。结果房颤组血浆腺苷水平明显低于窦性心律组,分别为(55.6±27.3)μg/L与(77.5±30.2)μg/L,(P<0.01)。血小板P选择素表达量明显高于窦性心律组,分别为(6.53±3.37)%与(4.72±1.97)%,P<0.05。血小板GPⅡb/Ⅲa有增高趋势,但无统计学意义(18.7±8.6)%与(15.6±8.3)%,P>0.05。血浆TXB2及TXB2/6-keto-PGF1α含量均显著增高［(150.3±58.0)ng/L与(102.4±36.5)ng/L,P<0.01;1.43±0.59与0.74±0.29,P<0.001］;而血浆6-keto-PGF1α的含量无显著变化(P>0.05)。血小板P选择素表达量房颤血栓形成组明显高于窦性心律无血栓组［(7.34±2.74)%与(4.72±1.97)%,P<0.01］;房颤血栓形成组与房颤无血栓组无显著差异［(7.34±2.74)%与(6.17±2.76)%,P>0.05］。应用8-苯基茶碱阻断腺苷受体后,血小板P选择素表达量增加,并在一定范围内呈浓度依赖性。超过一定范围,血小板P选择素表达量反而下降。结论血浆腺苷水平降低可能是房颤患者血小板活化、血栓形成的原因之一。腺苷及腺苷调节替代治疗,有可能预防房颤患者的血栓形成。     

心房颤动对风湿性心脏病患者血小板活化和内皮功能异常的影响

目的:观察风湿性心脏病伴心房颤动(房颤)的血小板活化和内皮功能的变化.方法:测量20例风湿性心脏病(风心病)伴窦性心律患者(窦律组)、23例风心病伴房颤患者(房颤组)和20例对照组的外周血浆因子Ⅷ相关抗原(VWFAG)、血小板α颗粒膜蛋白-140(GMP-140)和血浆平均血小板体积(MPV)的水平变化.结果:与对照相比,窦律组血浆VWFAG水平均显著升高(P＜0.05),而血浆GMP-140及MPV水平无显著性改变(P＞0.05),房颤组与窦律组相比血浆GMP-140、MPV和VWFAG水平更高(P＞0.05),结论:心房颤动使风湿性二尖瓣狭窄患者血小板活化和内皮受损.     

老年急性心肌梗死患者血小板参数的临床意义

目的探讨老年急性心肌梗死(AMI)患者血小板参数的临床意义。方法 对2007年3月—2010年11月收治的老年AMI患者84例(AMI组)与同期健康查体者90例(健康对照组)应用血细胞分析仪测定血小板(PLT)计数、血小板平均体积(MPV)和血小板分布宽度(PDW)值,并进行比较。结果 AMI组PLT低于健康对照组[(221±62)×10~9/L vs(280±32)×10~9/L],MPV和PDW高于健康对照组[分别为(10.30±1.08)fl vs(9.80±0.50)fl和(13.01±2.07)%vs(11.48±0.40)%],差异均有统计学意义(P<0.05);并且AMI组PLT与MPV、PDW呈负相关(r=-0.34l,r=-0.462,P均<0.05)。结论急性心肌梗死患者PLT计数下降,MPV、PDW升高,血小板活化是AMI的独立危险因素。     

血小板参数与脑梗死、下肢静脉血栓相关性的探讨

目的:探讨血小板计数(PLT)、血小板压积(PCT)、平均血小板体积(MPV)、血小板分布宽度(PDW)及大血小板比率(P-LCR)与脑梗死、下肢静脉血栓的相关性。方法:测定脑梗死组40例、下肢静脉血栓组28例及健康体检者(正常对照组)40例的PLT、PCT、MPV、PDW及P-LCR值,并进行统计分析。结果:(1)脑梗死组MPV、PDW、P-LCR检测结果分别为:11.3±1.1fl、15.1±2.8fl、(34.9±7.9)%,对照组分别为:10.3±0.8fl、12.6±1.6 fl、(27.8±5.4)%,两组比较差异有统计学意义(P<0.01)。(2)下肢静脉血栓组MPV、PDW、P-LCR检测结果分别为11.0±1.1fl、14.6±3.3fl、(33.5±8.2)%,与正常对照组比较差异有统计学意义(P<0.05)。结论:MPV、PDW、P-LCR是脑梗死发生的重要危险因子,也可以作为下肢静脉血栓形成的一个危险因素。     

血小板指标与冠心病关系的临床研究

目的:研究血小板指标在稳定型心绞痛(SAP),不稳定型心绞痛(UAP)和急性心肌梗死(AMI)发病中的临床意义。方法:随机选择对照组30例、SAP组28例、UAP组19例、AMI组21例,共98例病人测定血小板计数(PLT)、血小板平均体积(MPV)。统计结果由SAS软件分析。结果:UAP组和AMI组患者的PLT分别为161.84±35.67(×109/L)和137.55±28.19(×109/L),明显低于对照组(P<0.01)。SAP组、UAP组和AMI组患者的MPV分别为8.79±1.86(fl)、9.81±1.47(fl)、10.94±1.73(fl)均不同程度的高于对照组。其中UAP组和AMI组增人更显著(P<0.01)。结论:血小板指标检测对判断SAP、UAP和AMI的发生及预后有一定的临床价值。UAP、AMI的PLT和MPV变化与其病变程度有关。     

血小板环氧化酶及P-选择素的检测及其在冠心病患者中的表达

目的:建立用流式细胞术测定富血小板血浆(platelet-rich plasma,PRP)中血小板环氧化酶-1(cyclooxygenase-1,COX-1)和环氧化酶-2(cyclooxygenase-2,COX-2)及P-选择素表达的方法;检测在无抗血小板药物干预的状况下中国汉族冠心病患者血小板COX-1?COX-2及P-选择素的表达情况?方法:入选拟行冠状动脉搭桥术?停用阿司匹林及氯吡格雷7 d以上的冠心病患者20例,采集空腹静脉血,经预处理及荧光标记抗体孵育后用流式细胞仪检测血小板COX-1?COX-2及P-选择素的表达情况?结果:在无抗血小板药物干预的状况下,中国汉族冠心病患者血小板COX-1?COX-2阳性表达比例分别为(39.67 ± 9.20)%和(4.11 ± 2.74)%;生理盐水刺激后血小板膜表面P-选择素的阳性表达率为(13.56 ± 8.07)%,花生四烯酸刺激后的阳性表达率为(24.08 ± 13.49)%,血小板膜表面P-选择素的实际阳性表达率为(10.27 ± 7.40)%?结论:流式细胞术可有效测定血小板COX-1?COX-2和P-选择素的表达,冠心病患者血小板COX-1?COX-2和P-选择素的表达在中国汉族人种与高加索人种间可能存在差异?     

恶性肿瘤化疗患者血小板参数的实验观察

目的:探讨恶性肿瘤化疗患者血小板参数的变化及临床意义。方法:使用血细胞分析仪测定115例术后恶性肿瘤化疗患者和46例术后非化疗患者的血小板参数,并与正常对照组比较。结果:恶性肿瘤化疗患者的平均血小板体积MPV、血小板体积分布宽度PDW和大血小板比值P-LCR均明显低于正常对照组MPV:8.37±0.77fl对8.70±0.67fl,P<0.05;PDW:9.622±1.47fl对10.27±1.29fl,P<0.01;P-LCR:0.157±0.05对0.176±0.04,P<0.05,血小板(Plt)明显高于正常对照组,249.86±92.23×109/L对219.95.00±52.62×109/L,P<0.05,与非化疗患者比较明显降低(P<0.05),血小板无差异(P>0.05);非化疗患者MPV、PDW和P-LCR较正常对照组均无显著性差异P>0.05;Plt明显高于正常对照组(P<0.05);血小板数>300×109/L的化疗患者的MPV、PDW和P-LCR与血小板数<300×109/L的化疗患者比较均明显降低(P<0.01)。结论:恶性肿瘤化疗患者血小板参数的测定对观察其骨髓抑制状况和病情估计有一定的临床意义。     

妊娠期高血压综合征孕妇骨代谢变化的临床意义

目的:探讨妊娠期高血压综合征(简称妊高症)孕妇骨代谢变化的临床意义.方法:回顾性分析于我院妇产科建档的62例妊高症孕妇(妊高症组,n=62)和62例正常妊娠孕妇(正常妊娠组,n=62)临床资料.对比两组孕妇骨代谢指标[血清钙(Ca)、磷(P)、降钙素(CT)、骨钙素(BGP)]、血小板参数[血小板计数(PLT)、血小板平均体积(MPV)、血小板分布宽度(PDW)]及血液流变学指标(全血黏度、血浆黏度)差异.结果:正常妊娠组孕妇血清Ca[(2.41±0.23)mmol/L]、CT[(62.34±15.34)ng/L]、BGP[(5.23±0.78)μg/L]等骨代谢指标检测结果及PLT[(172.96±33.63)×109/L]水平均显著高于妊高症组孕妇[(2.19±0.25)mmol/L、(43.52±12.55)ng/L、(3.63±0.91)μg/L和(147.92±26.35)×109/L],MPV[(9.23±1.20)fl]、PDW[(19.25±1.02)%]等血小板参数检测结果,全血粘度[(8.82±1.29)η/mPa·s、(5.20±0.51)η/mPa·s、(4.23±0.59)η/mPa·s]、血浆粘度[(1.62±0.28)η/mPa·s]等血液流变学指标检测结果及血清P[(1.21±0.08)mmol/L]水平则显著低于妊高症组,差异均有统计学意义.结论:妊高症孕妇相较于正常孕妇存在骨代谢、血小板参数及血液流变学状态异常情况,需引起临床重视.     

生物学变异对正常人血小板数影响的研究

目的探讨生物学变异对正常人血小板数的影响。方法对成都、苏州和哈尔滨三地区707名正常人的血小板数进行测定,对地域、季节及个体因累包括出血时间(BT)、血小板相关抗体(PA-IgG)、网织血小板(Ret-PLT)、甘油三脂(TG)、胆固醇(Ch)和高密度脂蛋白(HDL)的含量等引起正常人血小板数的变化进行了测定。结果成都和苏州地区正常人血小板数的范围分别为52～202×109/L和60～259×109/L,显著低于哈尔滨的154～358×109/L(P< 0.0001);平均血小板体积(MPV)在成都(11.8～15.6fl)和苏州(10.9～15.8fl)显著高于哈尔滨(9.5～12.9fl)(P< 0.0001);成都与苏州地区正常人冬季的血小板数显著低于夏季(P<0.0001),而MPV高于夏季(P<0.05)。成都地区正常人低血小板组(<150×109/L)的PA-IgG(13.5±7.1 ng/107PLT)明显高于正常血小板组(>150～109/L)的PA-IgG (8.3±2.7 ng/107PLT)(P<0.0001);苏州地区正常人低血小板组的Ret-PLT(19.5±7.1%)明显高于正常血小板组(11.6±2.7%)(P<0.01):成都地区正常人低血小板组的BT(8.6±2.3 min)明显高于正常血小板组(6.0±1.2 min) (P<0.01)。同时,结果表明成都地区正常血小板组的HDL(1.60±7.6 mmol/L)显著高于低血小板组(1.23±0.31 mol/L)(P<0.01);冬季的Ch含量(4.58±0.86 mmoL/L)显著高于     

支气管哮喘BALB/c小鼠血小板P-选择素表达的变化

目的观察支气管哮喘小鼠的血小板表面抗原P-选择素表达的变化。方法随机将雌性BALB/c小鼠20只分为：正常对照组、哮喘模型组；用流式细胞仪测定血小板膜上P-选择素的阳性率。结果正常对照组和哮喘组P-选择素表达的阳性率分别为（1．23±1.02）%、（4.52±1.45）%，哮喘模型组P-选择素较正常对照组增高，差异有统计学意义（P<0.01）；凝血酶诱导P-选择素数值正常对照组和哮喘模型组分别为（45.12±4.03）%、（44.68±5.34）%，差异无统计学意义（P>0.05）；正常对照组和哮喘组肺泡灌洗液中性粒细胞分别为（6.64±1.86）%、（25.60±2.66）%，差异有统计学意义（P<0.01）。结论支气管哮喘小鼠中存在血小板的活化，活化后的血小板可能参与哮喘的炎症反应。     

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.     

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.     

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…     

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.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.