红花注射液对脂多糖诱导的兔弥散性血管内凝血的作用

 目的：研究红花注射液对脂多糖（LPS）诱导的兔弥散性血管内凝血（DIC）的作用。方法：兔耳缘静脉持续滴注LPS建立兔DIC模型。采用全自动凝血分析仪检测活化部分凝血活酶时间（APTT）和凝血酶原时间（PT）;凝固法测定纤维蛋白原含量;全自动血细胞分析仪进行血小板计数;发色底物法测定蛋白C及抗凝血酶Ⅲ的活性;全自动血浆分析仪测定丙氨酸氨基转移酶（ALT）和血尿素氮（BUN）;ELISA法检测血浆纤维蛋白（原）降解产物（FDP）和肿瘤坏死因子 α（TNF-α）含量。结果：DIC模型组APTT和PT进行性延长,ALT活性和BUN含量显著升高,蛋白C和抗凝血酶Ⅲ的活性显著降低,血小板计数进行性减少,血浆FDP和TNF-α含量显著升高。给予红花注射液后,DIC模型兔APTT和PT的延长明显缩短,血小板计数、纤维蛋白原含量、蛋白C及抗凝血酶Ⅲ活性均明显恢复,血浆ALT、BUN、FDP和TNF-α水平均明显降低。结论: 红花注射液对LPS诱导的兔DIC有较好的拮抗作用。     

血栓通注射液对LPS诱导的兔弥散性血管内凝血的拮抗作用

 目的：研究血栓通注射液对脂多糖（LPS）诱导的兔弥散性血管内凝血（DIC）的影响。方法：对兔耳缘静脉持续滴注LPS以建立兔DIC模型,记录各组动物在24 h后的生存率;全自动血浆分析仪测定丙氨酸氨基转移酶(ALT)和血尿素氮(BUN);用全自动凝血分析仪检测活化部分凝血活酶时间（APTT）和凝血酶原时间（PT）;用凝固法测定纤维蛋白原含量;全自动血细胞分析仪进行血小板计数;发色底物法测定蛋白C和抗凝血酶Ⅲ的活性;ELISA法检测血浆中肿瘤坏死因子α（TNF-α）的含量。结果：持续从兔耳缘静脉滴注LPS后,DIC模型组动物大量死亡,ALT和BUN显著升高,APTT和PT显著延长,蛋白C和抗凝血酶Ⅲ的活性明显降低,血小板计数明显减少,血浆中TNF-α的含量显著升高。注射血栓通注射液后,动物的死亡率明显下降,ALT和BUN明显下降,APTT和PT明显缩短,血小板计数明显上升,纤维蛋白原含量显著提高,蛋白C和抗凝血酶Ⅲ活性明显提升;血浆TNF-α的含量明显降低。结论：血栓通注射液对LPS所诱导的兔DIC有良好的拮抗作用。     

清开灵注射液对LPS诱导的兔弥散性血管内凝血的作用

目的: 研究清开灵注射液对脂多糖(LPS)诱导的兔弥散性血管内凝血(DIC)的作用。方法: 采用耳缘静脉持续滴注LPS的方法建立兔弥散性血管内凝血模型,观察各组动物24 h内各时点生存率;采用全自动凝血分析仪检测活化部分凝血活酶时间(APTT)和凝血酶原时间(PT);凝固法测定纤维蛋白原含量;全自动血细胞分析仪进行血小板计数;全自动血浆分析仪测定丙氨酸氨基转移酶(ALT)以及血尿素氮(BUN);发色底物法测定蛋白C及抗凝血酶Ⅲ的活性;ELISA法检测血浆肿瘤坏死因子α(TNF-α)含量。结果: 兔静脉持续滴注LPS后,APTT和PT显著延长,ALT和BUN显著升高,蛋白C和抗凝血酶Ⅲ的活性明显降低,血小板计数显著减少,血浆TNF-α含量显著升高。给予清开灵注射液后,APTT和PT的延长明显缩短,血小板计数、纤维蛋白原含量、蛋白C及抗凝血酶Ⅲ活性均明显恢复;ALT、BUN以及血浆TNF-α含量明显降低。结论: 清开灵注射液对LPS所诱导的兔弥散性血管内凝血有良好的拮抗作用。     

蝮蛇毒蛋白C激活物对家兔实验性DIC的干预作用

目的:观察蝮蛇毒蛋白C激活物(PCA)对家兔实验性弥散性血管内凝血(DIC)的干预作用并探讨其作用机理。方法:健康青紫蓝家兔24只随机分为:正常对照组、DIC组、PCA干预组(n=8),采用耳缘静脉注射兔脑粉浸液建立DIC模型,检测各组的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(Fbg)含量和血小板计数(PLT)。结果:与正常对照组相比,DIC组PT、APTT延长的百分率、TT缩短的百分率、Fbg、PLT显著升高(P0.01);PCA干预组PT、APTT延长的百分率,TT缩短的百分率与Fbg、PLT降低的百分率均明显降低(P0.01)。结论:蝮蛇毒PCA对家兔实验性DIC有一定的防治作用,其机制可能与PCA抗凝、抑制血小板聚集有关。     

重症肝病患者凝血和纤溶指标观察

重症肝病患者因肝细胞的严重损害,致使肝脏功能减退,全身各系统受损,凝血系统发生不同程度的异常改变。本文报道48例重症肝病（包括慢性重症肝炎和肝硬化）患者血浆凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（Fib）、凝血酶时间（TT）、D-二聚体（D-D）、抗凝血酶-Ⅲ（AT—Ⅲ）、纤溶酶原（PLG）和血小板计数（PLT）的检测结果,观察重症肝病患者凝血、抗凝和纤溶功能变化。     

中药脑血宝制剂对凝血和血小板聚集率的影响

目的和方法:本研究在体内、体外实验的基础上,通过测定血浆中活化的部分凝血活酶时间(APTT)、凝血酶原时间(PT)、抗凝血酶III(AT-Ⅲ)活性、凝血酶时间(TT)、纤维蛋白原(Fng)、纤溶酶原(Plg)的变化以及血浆中血小板聚集率来观察脑血宝制剂对血液凝固过程不同阶段和血小板聚集率的影响,分析其抗血栓作用的机制。结果:脑血宝预防组,血浆中APTT、PT均比血栓组延长(P＜0.05,P＜0.01),AT-Ⅲ的活性高于血栓组(P＜0.05,P＜0.01),Fng含量低于血栓组,TT延长,Fng和TT呈负性相关关系,血小板聚集率明显低于血栓组(P＜0.05,P＜0.01)。结论:脑血宝制剂对凝血的多个环节均有抑制作用,从而对抗血栓的形成。     

不同程度烧伤患者凝血功能变化及意义

目的探讨不同程度烧伤患者凝血指标包括血浆凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血酶时间(APTT)和纤维蛋白原含量(FIB)、D-二聚体(DD)以及血小板(PLT)计数的变化情况,为临床治疗方案的选择提供参考。方法回顾性分析2017年4月至2018年12月第一次烧伤并在我院接受治疗的183例烧伤患者,根据其烧伤程度分为轻度、中度、重度及特重度烧伤组,对各组凝血指标包括PT、APTT、FIB、TT以及DD和PLT进行检测,比较各组患者同类指标水平的差异;根据重度及特重度烧伤患者入院以后是否发生DIC将患者分成DIC组和非DIC组,分析两组患者入院时的FIB、PLT及DD水平,比较两组结果是否有差异。结果随着烧伤程度的加重,从轻度组到特重度组烧伤患者凝血指标及DD水平逐步增高,PLT水平逐步降低。其中特重度组的凝血指标及DD水平最高,轻度组最低,特重度组的PLT水平最低,而轻度组的PLT水平最高。四组之间两两比较结果如下:轻度组与中度组相比,DD结果有显著差异,其他指标不存在差异;与重度组比较,PT、APTT、TT、DD以及PLT有差异,FIB无差异;与特重度组相比,PT、APTT、FIB、TT、DD以及PLT均有差异;中度组与重度组比较,DD有差异,其他指标无差异;与特重度组相比PT、APTT、FIB、TT、DD以及PLT均有差异;重度组与特重度组相比,FIB、DD结果有显著差异,其他指标无差异。DIC组患者的血小板水平低于非DIC组(P<0.05),而FIB及DD水平高于非DIC组(P<0.05)。结论不同程度的烧伤患者的凝血指标、DD及PLT水平存在较大差异,尤其重度及特重度烧伤患者烧伤面积较大,及时监测患者凝血系统及纤溶系统指标,对患者病情判断、预防弥散性血管内凝血(DIC)的发生具有重要临床价值。     

标本采集量不足对凝血检测项目结果的影响

目的 分析标本采集量不足对凝血检测项目结果的影响.方法 收集采集量不足及足量采血的对照组标本共23对,分别检测凝血酶原时间(PT),活化部分凝血活酶时间(APTT),凝血酶时间(TT),纤维蛋白原(FIB),D-二聚体(D-Dimer)和纤维蛋白/纤维蛋白原降解产物(FDP)的含量.结果 采血量不足组与对照组相比PT、APTT、TT显著延长,FIB和D-Dimer含量显著降低,而FDP含量没有明显变化.结论 凝血标本采集量不足会影响检测结果的准确性.     

胆汁中凝血状态与胆囊结石形成关系的研究

目的:通过研究胆固醇结石(简称胆石)病人胆囊胆汁中的凝血状态及其与交联纤维蛋白生成的关系来探讨胆石的形成机制。方法:收集胆石病人胆囊胆汁26份和非胆石病人胆囊胆汁17份, 测定胆汁中的凝血酶原片段F₁₊₂抗原、凝血因子Ⅷ抗原、纤维蛋白原抗原、抗凝血酶Ⅲ抗原和活性、组织因子抗原、组织因子途径抑制物抗原、蛋白C抗原、蛋白C活性、总蛋白S和游离蛋白S。结果:胆石组胆汁中纤维蛋白原抗原、凝血因子Ⅷ抗原、抗凝血酶Ⅲ抗原和组织因子抗原均高于非胆石组(P＜0.01);胆石组凝血酶原片段F₁₊₂抗原、抗凝血酶Ⅲ抗原与活性之比高于非胆石组(P＜0.05), 抗凝血酶Ⅲ活性低于非胆石组(P＜0.05);两组间组织因子途径抑制物抗原和蛋白C抗原无显著差异。结论:组织因子是胆石病人胆囊胆汁中凝血活性亢进的启动因子;胆石病人胆囊胆汁中凝血活性增高, 但抗凝活性并没有相应增强。     

肾病综合症患者凝血与血小板参数检测的临床价值

目的　了解肾病综合症 (NS)患者凝血与血小板参数变化的临床意义 .方法　对 30例肾病综合症患者的凝血酶原时间 (PT)、活化部分凝血酶时间 (APTT)、纤维蛋白原 (Fbg)、凝血酶时间 (TT)四项凝血指标和血小板计数(PLT)、平均血小板体积 (MPV)、血小板压积 (PCT)、血小板分布宽度 (PDW)等血小板参数进行测定 ,并与 30例正常人进行对照 .结果　NS组与对照组相比 ,Fbg、PLT、MPV、PCT显著升高 (p <0 .0 1) ,APTT明显缩短 (p<0 .0 5 ) ,差别有显著性意义 ,而PT、PDW、TT变化不明显 (p >0 .0 5 ) .结论　NS患者存在高凝状态 ,上述指标的监测对NS病情分析和预防静脉血栓形成有重要临床价值     

The effect of fibrinolytic enzyme FIIa from Agkistrodon acutus venom on disseminated intravascular coagulation in rabbits

A novel fibrinolytic enzyme, FII(a), was isolated from Agkistrodon acutus venom, which can degrade fibrin/fibrinogen and dissolve thrombus without activating plasminogen or influencing the activities of tissue plasminogen activator (t-PA) and plasminogen activator inhibitor type-1 (PAI-1). In this study, we evaluated the effect of FII(a) on lipopolysaccharide (LPS)-induced experimental disseminated intravascular coagulation (DIC) in rabbits, through the continuous infusion of 100-microg/kg/h LPS for a period of 6 h. Seven groups were established: LPS control, FII(a) (0.1, 0.3, and 0.6 mg/kg/h, respectively), heparin control (100 IU/kg/h), heparin + FII(a) (heparin 100 IU/kg/h associated with FII(a) 0.3 mg/kg/h), and a saline control group. A continuous injection of LPS induced a gradual impairment in hemostatic parameters, kidney fibrin deposition, and a high mortality rate. The intravenous administration of FII(a) improved the concentration of fibrinogen, the activities of protein C, plasminogen, t-PA, antithrombin III (ATIII), and PAI-1. Kidney fibrin deposition and the mortality also decreased. In the in vitro experiments, FII(a) can degrade fibrin/fibrinogen and high-dose FII(a) enhanced the activity of protein C. These findings suggest that the effects of FII(a) on LPS-induced DIC were from fibrinogen degradation and enhanced protein C activity. The simultaneous administration of FII(a) and heparin further improved all the hemostatic parameters, including decreased kidney fibrin deposition, and none of the rabbits died within 24 h, which indicates that the effects were mediated by degradation of fibrin/fibrinogen together with thrombin inhibition. We conclude that FII(a) may be useful in the treatment of DIC.     

一个纤维蛋白原γ链Arg275His突变导致的遗传性异常纤维蛋白原血症家系

目的　对一个遗传性异常纤维蛋白原血症家系进行表型和基因型分析。方法　采集家系3代5人外周血,吸取上层血浆用血凝仪检测活化部分凝血酶原时间、凝血酶原时间、凝血酶时间、蛋白C活性、蛋白S活性和抗凝血酶活性,纤维蛋白原活性和抗原分别用Clauss法和免疫比浊法进行检测。以常规酚-氯仿法抽提家系所有成员外周血基因组DNA,PCR扩增纤维蛋白原基因FGA、FGB和FGG所有外显子及其侧翼序列,PCR产物纯化后直接测序以检测基因突变。结果　先证者活化部分凝血酶原时间、凝血酶原时间正常,凝血酶时间超出正常上限值2倍以上,纤维蛋白原活性明显下降,抗原也低于正常范围,且活性显著低于抗原;其母表型检测结果与之相似。基因分析显示先证者呈纤维蛋白原FGG基因第8外显子g.5 6 78G>A杂合碱基置换,导致Arg2 75 His错义突变,该突变来源于母系。结论　纤维蛋白原γ链Arg2 75 His杂合错义突变是引起该家系异常纤维蛋白原血症的原因。     

An immunohistochemical study of experimental disseminated intravascular coagulation (DIC)

The experiment was focused on clarifying changes in fibrin or fibrinogen related materials (FRMs) in blood, urine, and renal tissues of rats with disseminated intravascular coagulation (DIC). DIC was induced by a continuous infusion of massive volume of physiologic saline (100 ml) immediately after endotoxin injection. FRM response was checked by biochemical and histochemical examinations at various intervals. In the blood of DIC rats, platelet and fibrinogen levels initially decreased, followed by an increasing plasma fibrin degradation products (FDP). Parallel with elevation of blood FDP the percentage of glomeruli with FRMs increased. Thereafter, FRMs were observed in renal tubuli and urine. Our observations indicated that FRMs in renal tubuli were derived from glomerular capillaries via Bowman's space. In conclusion, in DIC the immunoenzymehistochemical (IEH) procedure appeared necessary for an accurate pathological diagnosis, and the presence of FRMs in renal tubuli appeared to be an important finding even in absence of FRMs in glomeruli.     

AN IMMUNOHISTOCHEMICAL STUDY OF EXPERIMENTAL DISSEMINATED INTRAVASCULAR COAGULATION (DIC)

The experiment was focused on clarifying changes in fibrin or fibrinogen related materials (FRMs) in blood, urine, and renal tissues of rats with disseminated intravascular coagulation (DIC). DIC was induced by a continuous infusion of massive volume of physiologic saline (100 ml) immediately after endotoxin injection. FRM response was checked by biochemical and histo-chemical examinations at various intervals. In the blood of DIC rats, platelet and fibrinogen levels initially decreased, followed by an increasing plasma fibrin degradation products (FDP). Parallel with elevation of blood FDP the percentage of glomeruli with FRMs increased. Thereafter, FRMs were observed in renal tubuli and urine. Our observations indicated that FRMs in renal tubuli were derived from glomerular capillaries via Bowman's space. In conclusion, in DIC the immunoenzymehistochemical (IEH) procedure appeared necessary for an accurate pathological diagnosis, and the presence of FRMs in renal tubuli appeared to be an important finding even in absence of FRMs in glomeruli.     

Effects of membrane plasma exchange on the hemostatic system and on thyroid hormones in critically ill patients

The present study examined the effects of repeated plasma exchanges with membrane filtration (Plasmaflux P2 membrane, 4.3 I human albumin solution) on the hemostatic system and on thyroid hormones in critically ill patients. Clotting factors V, VII, VIII, IX, X, XI, XII, XIII, fibrinogen, antithrombin III (ATIII), prothrombin time (PT), activated partial thromboplastin time (PTT), total (TT3) and free tri-iodothyronine (FT3), total (TT4) and free thyroxine (FT4), and thyroxine binding globulin (TBG) were determined before, immediately after, 1, 3, 6 and 24 h after plasma exchange in 6 patients (3 with glomerulonephritis, 2 with IgG myeloma, 1 with chronic polyneuritis) during 18 plasma exchanges. After plasma exchange levels of clotting factors and ATIII were markedly lowered but except for fibrinogen and factor XIII, they were not reduced by repeated exchange procedures. Thyroid hormones and TBG were reconstituted after 24 h. Pre-exchange levels, except for TT4 and TBG, were not lowered by repeated exchange procedures. Risk of bleeding or thrombosis is small and there is no appreciable risk of loss of thyroid hormones during repeated plasma exchanges.     

Coagulation Studies and Correlative Histology During Experimental Hemoglobinemia in Rabbits

Evidence of disseminated intravascular coagulation (DIC) was sought in New Zealand white rabbits infused with autologous, hemolyzed whole blood. Hemoglobinemia was induced in 17 rabbits by rapid intravenous injection of frozenthawed whole blood. Three dose regimens yielded mean peak plasma hemoglobin concentrations of 325, 615 and 860 mg/100 ml respectively (range 260 to 1050 mg/100 ml). Eleven control animals were infused with autologous, nonhemolyzed whole blood in similar doses. Rabbits were killed at either 15, 60, 120 or 180 minutes following infusion and multiple organ biopsies obtained immediately post-mortem. Coagulation studies demonstrated no significant alterations in prothrombin time, partial thromboplastin time, thrombin time or fibrinogen. Fibrin degradation products were not found. Histologic examination of lung, heart, liver, spleen and kidney revealed no fibrin deposition, thrombus formation or other abnormalities. We conclude from our study that induction of brief, experimental hemoglobinemia in New Zealand white rabbits, utilizing moderately large doses of autologous, hemolyzed whole blood, does not result in the development of DIC.     

Criteria for diagnosing DIC

The differences between reagents of prothrombin time (PT), fibrinogen and fibrin and fibrinogen degradation products(FDP) were examined in patients with disseminated intravascular coagulation (DIC) and without DIC. The sensitivity of the PT ratio for DIC is lowered by the PT reagent with a high international sensitivity index, and the difference between PT reagents was marked. The sensitivity of PT-international normalized ratio (INR) for DIC was higher than that of the PT ratio and the difference between reagents in PT-INR was low. Though the difference between reagents for fibrinogen is slight, the usefulness in diagnosing DIC is also slight. Though the sensitivity of FDP for DIC was good, the difference between FDP reagents was marked. Therefore, standardization of PT and FDP seems to be necessary. Concordance of overt-DIC diagnostic criteria by the International Society of Thrombosis and Haemostasis (ISTH) and DIC diagnostic criteria of Japanese Ministry of Health and Welfare (JMHW) was about 70%, and overt-DIC diagnostic criteria of ISTH seemed to diagnose the typical type of DIC diagnosed by JMHW criteria. Finally, the diagnostic criteria of non-overt DIC are expected to become increasingly important.