慢性肺源性心脏病患者血浆纤维蛋白原（FB）及血气分析的相关性研究

目的探讨慢性肺心病患者血浆纤维蛋白原（FB）水平及与血气分析相关性。方法对126例慢性肺心病患者治疗前后血气分析、血浆纤维蛋白原及30例对照组的血浆纤维蛋白原分别进行测定。结果血浆纤维白原水平在慢性肺心病加重期患者明显升高，与对照组相比有鼎著性差异；治疗后血浆纤维蛋白原明显下降，与对照组相比均有显著性差异；血浆纤维蛋白原与动脉血氧分压（PaO2）呈负相关。血浆纤维蛋白原与动脉血二氧化碳分压（PaCO2）呈正相关。结论慢性肺心病患者血浆纤维蛋白原增高，易导致肺小动脉血栓形成、低氧血症和高碳酸血症。临床应改善缺氧、通气及适当的抗凝治疗对控制病情有益。     

AECOPD血浆D-二聚体与纤维蛋白原水平变化及临床意义

目的 探讨AECOPD血浆D-二聚体与纤维蛋白原的水平变化与临床意义.方法 选取本院收治的64例AECOPD患者作为观察组,同时以同期进行健康体检的健康者64例作为对照组.对比观察组治疗前后与对照组的血浆D-二聚体与纤维蛋白原水平.结果 观察组患者治疗前后D-二聚体与纤维蛋白原水平较对照组相比,均有显著增高,差异有显著性意义（P〈0.05）.同时,观察组治疗后较治疗前相比,D-二聚体与纤维蛋白原水平有显著性降低（P〈0.05）.结论 COPD患者血浆中D-二聚体与纤维蛋白原水平与其病情严重程度密切相关,联合检测两者在患者血清中的水平可反映COPD患者的治疗效果,对该病的临床检测与治疗有较好的指导意义.     

慢性呼吸衰竭患者血浆纤维蛋白降解产物、凝血因子Ⅱ测定的临床意义

目的探讨慢性呼吸衰竭患者凝血指标临床意义。方法对28例慢性呼吸衰竭患者治疗前后血气分析、凝血指标及28例对照组的凝血指标分别进行测定。结果血浆纤维蛋白降解产物（FDP）在呼衰期明显升高；血浆凝血因子Ⅱ水平明显降低。血浆纤维蛋白降解产物与血氧分压呈负相关，与血二氧化碳分压呈正相关。结论慢性呼吸衰竭患者存在高凝状态，并容易导致肺小动脉血栓形成。低氧血症、高碳酸血症与血浆FDP水平增高有关。血浆纤维蛋白降解产物、凝血因子Ⅱ测定对反映慢性呼吸衰竭患者的高凝状态有一定价值。     

慢性呼吸衰竭患者血气分析与凝血三项检测的相关性研究

目的探讨慢性呼吸衰竭患者凝血三项及与血气分析相关性。方法对28例慢性呼吸衰竭患者治疗前后血气分析、凝血三项及28例对照组的凝血三项分别进行测定。结果血浆纤维蛋白原、部分活化凝血活酶时间、凝血酶原时间水平在慢性呼吸衰竭患者明显升高,治疗后明显下降;血浆纤维蛋白原与血氧分压呈负相关,与血二氧化碳分压呈正相关。结论慢性呼吸衰竭患者存在高凝状态,临床治疗中适当的抗凝治疗对控制慢性呼吸衰竭患者的病情可能有益。     

肺癌患者凝血常规指标检测的临床意义

目的探讨肺癌患者凝血功能相关指标与临床病理特征及预后的相关性。方法对60例肺癌患者及20例健康人的血浆凝血酶原时间（PT）、纤维蛋白原（FIB）、部分活化凝血活酶时间（APTT）分别进行测定。结果肺癌患者血浆纤维蛋白原水平显著高于健康对照组（P〈0.01）,血浆PT、APTT值与对照组相比无显著性差异。肺癌组中除PT值在性别上有显著性差异外（P〈0.05）,其余各指标与患者的年龄、性别、病理类型、肿瘤大小、TNM分期、有无远处转移等临床病理特征之间无明显关系。血浆纤维蛋白原与生存期之间有显著的负相关（r=-0.32,P〈0.01）。结论肺癌患者存在血浆纤维蛋白原水平增高,血浆纤维蛋白原水平与患者的生存期呈负相关,抗凝治疗对改善肺癌的预后可能有益。     

COPD患者D-二聚体和纤维蛋白原检测的临床价值

目的 探讨COPD患者血浆D-二聚体和纤维蛋白原检测的临床意义.方法 分别检测122例按病情严重程度分期、分度的COPD患者和30例健康对照组血浆D-二聚体和纤维蛋白原含量,分析比较各组间血浆D-二聚体和纤维蛋白原含量的差异.结果 COPD患者血浆D-二聚体和纤维蛋白原含量明显高于健康对照组(P＜0.05),且急性加重期明显高于稳定期(P＜0.05).在75例急性加重期COPD患者中,轻、中、重、极重度患者其血浆D-二聚体和纤维蛋白原含量间相互比较(P＜0.05).结论 COPD患者存在血液高凝状态,且随着病情的加重而加重,对其监测和预防性使用抗凝、溶栓剂是非常必要的.     

肝肺综合征患者降钙素基因相关肽及内皮素含量检测

目的　肝肺综合征 (HPS)的发生与血循环或肺内扩张 /收缩血管物质失衡密切相关。检测HPS患者血浆中降钙素基因相关肽 (CGRP)和内皮素 (ET)含量 ,以探讨它们在HPS发病中的作用。方法　选择经肺灌注扫描及血气分析诊断的HPS患者 16例 ,无HPS的肝硬化患者 30例 ,用放射免疫分析法测定其血浆CGRP、ET含量 ,同时以 15名健康献血员作为对照。结果　HPS组血浆CGRP[(6 5± 15 )pg/ml]、ET[(78± 2 1) pg/ml]显著高于肝硬化组 [(5 1± 15 ) pg/ml,(6 0± 14 ) pg/ml,P <0 .0 1],也显著高于对照组 [(32± 12 ) pg/ml,(36± 11)pg/ml,P <0 .0 1];肝硬化组与正常对照组比较差异也有显著性(P <0 .0 1)。线性相关分析显示 ,HPS组患者血浆CGRP及ET含量与动脉血氧分压呈显著负相关 ,与肺内分流率大小无关。结论　HPS患者血浆CGRP、ET含量增高 ,其增高可能与HPS肺内血管扩张和动脉血氧分压下降有关。     

血浆纤维蛋白原在社区获得性肺炎临床治疗中的应用价值

目的 :探讨血浆纤维蛋白原在社区获得性肺炎临床治疗中的应用价值。方法选取我院2015年4月-2017年9月收治的102例社区获得性肺炎患者作为研究对象,分别根据CURB-65评分和治疗结局将患者按病情严重程度和转归进行分组,比较各组间患者血浆纤维蛋白原(Fib)、C反应蛋白(CRP)以及降钙素原(PCT)水平特点,并对Fib与CRP、PCT的相关性进行分析。结果经CURB-65评分分组后,三组患者Fib、CRP及PCT水平差异均具有统计学意义(P 0. 05);两两比较显示,与低危组相比,中危组、高危组Fib、CRP以及PCT水平明显增高(P 0. 05),与中危组相比,高危组Fib、CRP以及PCT水平明显增高(P 0. 05)。根据不同疾病转归分组后,存活组Fib、CRP以及PCT水平均明显低于死亡组(P 0. 05)。经Spearman相关性分析,Fib水平与CRP呈正相关(r=0. 697,P 0. 01),与PCT无明显相关性(r=0. 257,P=0. 05)。结论 CAP患者存在高凝和继发性纤溶亢进状态,且其程度与炎症反应程度具有一定的相关性,因此及时予以相关治疗可能对于临床治疗效果具有一定的辅助作用。而Fib作为CAP病情严重程度及预后判断的价值则需进一步观察研究。     

结核性胸膜炎患者血浆纤维蛋白原和D-二聚体的变化和意义

目的 观察结核性渗出性胸膜炎患者治疗前后血浆纤维蛋白原(FIB)和D-二聚体(D-D)水平的变化.方法 检测124例结核性胸膜炎(治疗前组)患者、30例治疗后吸收好转期(治疗后组)患者和30例健康体检者(对照组)的血浆FIB和D-D水平,对结果进行分析.结果 结核性胸膜炎(治疗前组)患者血浆FIB和D-D水平升高,与治疗后组和对照组比较有显著性差异(P<0.01);结核性胸膜炎患者治疗后组血浆FIB与对照组比较无显著性差异(P>0.05);而血浆D-D仍较对照组升高(P<0.01).结论 结核性胸膜炎患者血浆FIB和D-D水平变化与病情相关,可作为结核性胸膜炎诊断、监测疗效和预后的辅助指标.     

肺栓塞再发与血浆纤维蛋白原升高相关性研究

目的 观察并评价不同血浆纤维蛋白原水平与肺栓塞再发的关系.方法 回顾性分析77例初次肺栓塞患者治疗缓解后及24例肺栓塞再发患者的血浆纤维蛋白原水平,比较再发肺栓塞患者及未再发肺栓塞患者血浆纤维蛋白原水平是否存在显著差异,比较肺栓塞再发患者初次发病治疗缓解后及肺栓塞再发治疗前血浆纤维蛋白原水平之间的差异,同时分析肺栓塞再发患者栓塞灶分布与血浆纤维蛋白原升高之间的相关性.结果 再次发作肺栓塞患者血浆纤维蛋白原水平高于未再次发作肺栓塞患者(P＜0.05),肺栓塞再发组冶疗前血浆纤维蛋白原水平高于初次肺栓塞患者治疗缓解后血浆纤维蛋白原水平(P＜0.05),再次肺栓塞组血浆纤维蛋白原升高水平与患者的肺栓塞病灶分布无明显相关性(P＞0.05).结论 血浆纤维蛋白原升高与肺栓塞再发相关,纤维蛋白原升高是肺栓塞再发事件的重要危险因素,对肺栓塞再发有预测意义.     

慢性肺心病急性加重期纤溶状态的研究

目的　探讨慢性肺心病患者血浆Ｄ二聚体等纤溶指标变化。方法　对４２ 例肺心病患者治疗前后及２０ 例对照组的血浆纤溶活性分别进行测定。结果　血浆Ｄ二聚体水平在肺心病加重期患者明显升高（与对照组和缓解期比较Ｐ＜ ０－００１）;血浆纤溶酶活性在肺心病加重期明显下降;血浆纤溶酶活性与二氧化碳分压（ＰａＣＯ２） 呈负相关（ｒ＝ －０－４３,Ｐ＜０－０１）,与氧分压（ＰａＯ２）呈正相关（ｒ＝０－３９ ,Ｐ＜０－０１） 。结论　血浆纤溶活性降低与肺心病高凝状态有关,并容易导致肺小动脉血栓形成,Ｄ二聚体可作为慢性肺心病肺小动脉血栓形成的实验室指标。慢性肺心病患者临床上可应用溶栓药物。     

慢性肺心病降钙素基因相关肽内皮素心钠素的表达及其临床意义

目的 :探讨降钙素基因相关肽 (CGRP)内皮素 (ET)心钠素 (ANP)在慢性阻塞性肺疾病肺心病病理生理过程所起的作用、临床意义及其相互关系。方法 :应用放射免疫方法测定单纯慢性支气管炎(A组 ) 2 1例 ,慢性支气管炎并阻塞性肺气肿 (B组 ) 2 7例 ,慢性支气管炎、阻塞性肺气肿并肺心病 (PHD)(C组 ) 3 2例及健康对照组 (D组 ) 2 4例CGRP、ET及ANP水平 ,同步测定动脉血气及第一秒用力呼气容积占预计值的百分比数 (FEV1 %P)。结果 :1 各指标变化 ( 1)CGRPB、C组急性期、稳定期均低于对照组 ,且急性期均低于稳定期 ;C组各期相应的低于B组 ,A组急性期、稳定期与对照组无明显差异 ;( 2 )ETA组急性期及B、C组急性期、稳定期均高于对照组 ,各自组急性期均高于稳定期 ,除A组稳定期降至正常外 ,B、C组稳定期均高于对照组 ,且C组各期相应的高于B组 ;( 3 )ANPB组急性期及C组急性期、稳定期均高于对照组 ,C组急性期明显高于B组急性期 ,B、C组急性期明显高于各自稳定期。 2 直线相关分析结果 :CGRP与PaO2 呈非常显著正相关 (P <0 0 1) ,与PaCO2 、ANP呈显著负相关 (P <0 0 5 ) ,与ET呈非常显著负相关 (P <0 0 1) ;ET与ANP非常显著正相关 (P <0 0 1) ,与PaCO2 正相关 (P <0 0 5 ) ,与PaO2 、FEV1 %P非常显著负相关 (P     

慢性阻塞性肺疾病缓解期患者血浆内皮素变化及其与心肺功能的关系

目的探讨内皮素（ＥＴ）－１在慢性阻塞性肺疾病（ＣＯＰＤ）发展中的临床意义。方法采用ＥＴ－１放射免疫直接法，血气分析仪和肺功能仪等测定３４例ＣＯＰＤ缓解期患者血浆不同部位ＥＴ－１浓度及其血流动力、心肺功能参数。结果肺动脉高压患者血浆ＥＴ－１明显高于肺动脉压正常者和健康人。肺动脉高压患者血浆ＥＴ－１与全肺阻力指数（ＴＰＲＩ）、体循环阻力指数（ＳＶＲＩ）、肺动脉平均压（ｍＰＡＰ）、体循环平均压（ＭＳＡＰ）和肺毛细血管楔压（ＰＣＷＰ）呈正相关，与ｐＨ值、混合静脉血氧分压（ＰｖＯ２）、混合静脉血氧含量（ＣｖＯ２）、小气道功能［５０％肺活量最大呼气流量（Ｖ５０）／２５％肺活量最大呼气流量（Ｖ２５）、（Ｖ２５／ＨＴ）％］呈负相关。肺动脉压正常者血浆ＥＴ－１与ＴＰＲＩ、ｍＰＡＰ、右心每搏功指数（ＲＶＳＷＩ）、左心每搏功指数（ＬＶＳＷＩ）呈正相关，与ｐＨ值、肺活量（ＶＣ）、最大通气量（ＭＶＶ）、Ｖ５０／Ｖ２５、（Ｖ２５／ＨＴ）％呈负相关。结论ＣＯＰＤ缓解期患者血浆ＥＴ－１增高可能仍是肺动脉高压形成的重要因素之一。血浆ＥＴ－１水平与心肺功能互相影响，ＥＴ－１的异常表达和释放可加速病情发展     

慢性支气管炎、COPD及肺心病患者BNP、肺功能和血气变化的研究

目的探讨慢性支气管炎(慢支)、COPD、慢性肺源性心脏病(肺心病)患者不同时期BNP(B型钠尿肽)、肺功能、动脉血气的变化。方法慢支、COPD、肺心病患者均空腹抽静脉血检测BNP;另抽动脉血检测血气;并行肺功能检测。三组间对比,并与正常组对照。结果由慢支发展到COPD、肺心病时BNP逐渐升高(P<0.05);慢支、COPD及肺心病各组FEV1/FVC、MMEF逐渐降低(P均<0.05),动脉血氧分压(PaO2)、PH值逐渐降低,二氧化碳分压(PaCO2)逐渐增高(P均<0.05)。BNP与PaO2、PH呈显著负相关(r=-0.69,-0.58,P均<0.01),而与PaCO2呈正相关(r=0.55,P<0.01)。BNP与FEV1/FVC、MMEF均呈显著负相关,P均<0.01)。结论血浆BNP水平与血气分析及肺功能变化关系密切,血浆BNP水平可以作为判断COPD病情严重程度的一个指标。     

Association between activation of the renin-angiotensin system and secondary erythrocytosis in patients with chronic obstructive pulmonary disease

PURPOSE: An association between activation of the renin-angiotensin system and enhanced erythropoiesis has been observed in patients with several diseases, including congestive heart failure and hypertension. Our goal was to examine whether the renin-angiotensin system is associated with secondary erythrocytosis in patients with chronic obstructive pulmonary disease (COPD). SUBJECTS AND METHODS: Plasma renin activity, plasma aldosterone concentration, serum erythropoietin level, and serum angiotensin converting enzyme (ACE) activity were measured in 12 patients with COPD and secondary erythrocytosis [mean (+/-SD) hematocrit of 53% +/- 3%] and in 12 matched controls with COPD who did not have erythrocytosis (hematocrit 45% +/- 5%). All patients had chronic hypoxemia (PaO2 <60 mm Hg). RESULTS: Both plasma renin and aldosterone levels were threefold greater in patients with secondary erythrocytosis compared to controls. No difference in erythropoietin levels was observed between patients with or without secondary erythrocytosis. Renin levels (r = 0.45; P = 0.02) but not erythropoietin levels (r = 0.15; P = 0.47) were correlated with hematocrit in the entire sample. Renin levels and PaO2 were the only variables independently and significantly associated with hematocrit values in a multiple linear regression model. CONCLUSION: Activation of the renin-angiotensin system is associated with the development of secondary erythrocytosis in chronically hypoxemic patients with COPD. The exact mechanism is not yet fully understood, but angiotensin II may be responsible for inappropriately sustained erythropoietin secretion or direct stimulation of erythroid progenitors.     

Elevated plasma ghrelin level in underweight patients with chronic obstructive pulmonary disease

Ghrelin, a novel growth hormone-releasing peptide, has been shown to cause a positive energy balance by reducing fat use and stimulating food intake. This study investigated whether plasma ghrelin is associated with clinical parameters in patients with chronic obstructive pulmonary disease. Plasma ghrelin was measured in 50 patients and 13 control subjects, together with anabolic and catabolic factors. Patients were divided into two groups based on body mass index: underweight patients (n = 26) or normal weight patients (n = 24). Plasma ghrelin was significantly higher in underweight patients than in normal weight patients and healthy control subjects. Circulating tumor necrosis factor-alpha, interleukin-6, and norepinephrine were significantly higher in underweight patients than in normal weight patients. Plasma ghrelin correlated negatively with body mass index and correlated positively with catabolic factors such as tumor necrosis factor-alpha and norepinephrine. In addition, plasma ghrelin correlated positively with percent predicted residual volume and residual volume-to-total lung capacity ratio. In conclusion, plasma ghrelin was elevated in underweight patients with chronic obstructive pulmonary disease, and the level was associated with a cachectic state and abnormality of pulmonary function.     

Evidence of local exercise-induced systemic oxidative stress in chronic obstructive pulmonary disease patients.

Chronic inactivity may not be the sole factor involved in the myopathy of chronic obstructive pulmonary disease (COPD) patients. One hypothesis is that exercise-induced oxidative stress that leads to muscle alterations may also be involved. This study investigated whether exercise localised to a peripheral muscle group would induce oxidative stress in COPD patients. Eleven COPD patients (FEV1 1.15+/-0.4 L (mean+/-SD)) and 12 healthy age-matched subjects with a similar low quantity of physical activity performed endurance exercise localised to a peripheral muscle group, the quadriceps of the dominant leg. The authors measured plasma levels of thiobarbituric reactive substances (TBARs) as an index of oxidative stress, the release in superoxide anion (O2*-) by stimulated phagocytes as an oxidant, and blood vitamin E as one antioxidant. Quadriceps endurance was significantly lower in the COPD patients compared with healthy subjects (136+/-16 s versus 385+/-69 s (mean+/-SEM), respectively). A significant increase in TBARs 6 h after quadriceps exercise was only found in the COPD patients. In addition, significantly higher O2*- release and lower blood vitamin E levels were found in COPD patients than in controls at rest. This blood vitamin E level was significantly correlated with the resting level of plasma TBARs in the COPD patients. This study mainly showed that quadriceps exercise induced systemic oxidative stress in chronic obstructive pulmonary disease patients and that vitamin E levels were decreased in these patients at rest. The exact relevance of these findings to chronic obstructive pulmonary disease myopathy needs to be elucidated.     

Hypoxemia during air travel in patients with chronic obstructive pulmonary disease

STUDY OBJECTIVE: To quantitate and identify determinants of the severity of hypoxemia during air travel in patients with chronic obstructive pulmonary disease. DESIGN: Prospective study of physiologic variables before and during intervention. SETTING: Referral-based pulmonary disease clinic at a U.S. Army medical center. PATIENTS: Eighteen ambulatory retired servicemen (age 68 +/- 6 [SD] years) with severe chronic obstructive pulmonary disease (forced expiratory volume in the first second [FEV1] 31% +/- 10% of predicted). INTERVENTION: Altitude simulation equivalent to 2438 meters (8000 feet) above sea level in a hypobaric chamber. MEASUREMENTS AND MAIN RESULTS: Radial artery catheter blood oxygen tension in the patients declined from a ground value (PaO2G) at sea level of 72.4 +/- 9 mm Hg to an altitude value (PaO2Alt) of 47.4 +/- 6 mm Hg after 45 minutes of steady state hypobaric exposure. The PaO2G correlated with PaO2Alt (r = 0.587; P less than 0.01). Multiple regression analysis revealed that the preflight FEV1 reduced the variability in PaO2Alt not explained by PaO2G in the equation: PaO2Alt = 0.453 [PaO2G] + 0.386 [FEV1% predicted] + 2.440 (r = 0.847; P less than 0.001). Residuals from two previously published formulas using PaO2G also correlated with FEV1 (r greater than or equal to 0.765; P less than 0.001). CONCLUSIONS: Arterial blood oxygen tension declined to clinically significant levels in most patients during hypobaric exposure. When combined with the preflight arterial PO2 at ground level (PaO2G), the measurement of the preflight FEV1 improved prediction of PaO2 at altitude (PaO2Alt) in patients with severe chronic obstructive pulmonary disease.