阻塞性睡眠呼吸暂停与静脉血栓栓塞症相关性研究现状

阻塞性睡眠呼吸暂停(OSA)是多种心血管疾病的重要危险因素。静脉血栓栓塞症是一种常见的慢性致死性疾病,肺血栓栓塞症(肺栓塞)是其突出表现。OSA可致高凝状态,促进静脉血栓栓塞症发生和发展。持续气道正压可改善OSA患者的凝血活性、血小板功能和纤溶系统。然而,需要更多的研究来评估持续气道正压和/或口服抗凝剂治疗能否降低OS...     

老年2型糖尿病患者血糖目标范围内时间与肌少症的相关性研究

目的探讨老年2型糖尿病患者血糖目标范围内时间(TIR)与肌少症的关系。方法选取2018年3月至2020年7月在河南省人民医院就诊的65岁以上2型糖尿病患者673例。所有患者完成问卷调查、体格检查及实验室检查。应用瞬感扫描式持续血糖监测(CGM)系统完成动态血糖监测并计算TIR。应用双能X线评估全身肌肉含量并计算四肢骨骼肌质量指数(ASMI), 测试握力评估肌力, 测试步速评估躯体功能。根据2019版亚洲肌少症工作组(AWGSOP)标准对肌少症进行诊断和分级。排除CGM监测时间不足3 d的患者, 共658例研究对象纳入分析。结果肌少症的总患病率为28.72%。与非肌少症组相比, 一般肌少症和严重肌少症组患者的TIR水平显著下降[55.0%(36.5%, 68.0%), 49.0%(31.0%, 70.5%)对66.0%(44.8%, 79.0%),均P<0.01]。患者的ASMI随TIR四分位数的增加而增加, 在最高四分位组水平最高(P<0.05)。Pearson相关分析显示, TIR与男性患者的ASMI、步速和握力呈正相关(P<0.05或P<0.001);TIR...     

肺血栓栓塞症的自然病程与预后

静脉血栓栓塞症 (ＶＴＥ)可表现为深静脉血栓形成 (ＤＶＴ)或肺血栓栓塞症 (ＰＴＥ) ,或二者同时存在 ,主要可出现以下四种不良后果 :复发性非致死性静脉血栓栓塞、致死性ＰＴＥ、栓塞后综合征 (ＰＴＳ)及慢性栓塞性肺动脉高压 (ＣＴＰＨ)。一、ＰＴＥ的自然病程ＰＴＥ是ＶＴＥ的严重并发症 ,可引起一系列肺循环和呼吸功能障碍表现 ,其程度与肺动脉被阻塞的范围成正比 ,也与患者栓塞前的心肺功能状态有关。小的栓子可迅速溶解而不出现临床症状 ;巨大栓子可引起低血压、心原性休克或呼吸衰竭而致猝死。急性ＰＴＥ是一个复杂动态的过程 ,对于…     

可溶性肿瘤坏死因子受体Ⅰ在肝癌治疗前后的变化

本文用双抗体夹心ELISA法检测了26例应用LAK细胞及肝动脉插管栓塞化疗的肝癌者治疗前后血清可溶性肿瘤坏死因子受体I的(sTNFRI)含量。结果显示正常成人血清sTNFRI含量为56.70±21.40u/ml,未治疗的肝癌患者血清sTNFRI含量为187.24±143.21u/ml,高于正常对照。而治疗后一周其sTNFRI水平又较治疗前明显升高。(P<0.01)从而提示;动态监测血清sTNFRI含量变化可能为肝癌患者的免疫状态,对治疗的反应以及病情变化提供参考。     

肾病综合征相关静脉血栓栓塞症的发病机制及防治研究进展

静脉血栓栓塞症（VTE）是肾病综合征（NS）常见、多发的严重并发症,包括深静脉血栓形成（DVT）和肺血栓栓塞症（PTE）。NS患者长期处于“血栓形成倾向”状态,其VTE发病率逐年增高。对于疑诊PTE患者,可先应用临床可能性评分进行临床评估,并联合D-二聚体检测进一步筛查,PTE的确诊检查包括CT肺动脉造影、核素肺通气/灌注显像、磁共振肺动脉造影、肺动脉造影等;DVT确诊影像学检查包括加压静脉超声、CT静脉造影、核素静脉显像、静脉造影等。NS患者常存在肾功能不全,需临床医师谨慎选择适合的检查方式。NS相关VTE的治疗通常包括肝素、华法林,需根据不同患者制定个体化治疗方案,未确诊VTE的NS患者是否常规预防性抗凝存在争议。     

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1865年法国Armand Trousseau教授首次报道静脉血栓与肿瘤之间存在联系,这可能是人们对易栓症(thrombo-phlilia)的最早认识。易栓症不是单一疾病,而是指由于抗凝蛋白、凝血因子、纤溶蛋白等的遗传性或获得性缺陷或存在获得性危险因素而容易发生血栓栓塞的疾病或状态。易栓症的血栓栓塞类型主要为静脉血栓栓塞[1-2]。1易栓症分类易栓症分为遗传性易栓症和获得性易栓症两类[1-2],见表1。常见的遗传性易栓症有蛋白C(PC)缺陷症、蛋白S(PS)缺陷症、抗凝血酶(AT)缺陷症、因子ⅤLeiden(FⅤLeiden)和凝血酶原20210A突变等,是基因缺陷导致相应蛋…     

CTPA对烧伤并发肺动脉栓塞患者诊断与疗效评估

<正>近几年来,由于多方面的因素,烧伤患者较往年增多,相对并发肺动脉栓塞的患者也有增多,对于烧伤并发肺动脉栓塞患者的早期诊断及治疗至关重要。烧伤患者常并发重度脱水,其血液呈高凝状态,且需卧床休息,这正是引起肺动脉栓塞的重要原因。本文主要探讨肺动脉CT血管造影(Computed tomographic pulmonary angiography,CTPA)对烧伤并发肺动脉栓塞患者诊断与疗效评估。     

高龄急性腹主动脉血栓栓塞症开放手术与介入治疗对比

目的探讨高龄病人发生急性腹主动脉血栓栓塞症的诊治经验。方法回顾性分析2006年1月至2015年3月该院急性腹主动脉血栓栓塞高龄病人29例〔年龄(72±4.9)岁〕,其中行开放手术治疗22例,介入或介入联合手术治疗7例,术后给予持续肾替代治疗(CRRT)7例。结果开放手术组死亡8例(36.4%),介入或介入联合手术组死亡1例(14.3%);截肢4例。高危病人术后未行CRRT死亡5例,给予CRRT者死亡2例。结论急性腹主动脉血栓栓塞症一旦确诊,应尽早治疗,最大程度地缩短发病至手术的时间。根据病情选择合适的手术方式,对于缺血时间超过24 h者,可行介入或介入联合手术治疗。注意围术期的监测,必要时可应用CRRT。     

重视动脉粥样硬化性心血管疾病合并静脉血栓栓塞症的抗栓治疗——2021美国心脏病学会抗栓决策路径专家共识解读

抗血小板治疗是动脉粥样硬化性心血管疾病(ASCVD)抗栓治疗的主要手段,而抗凝治疗是静脉血栓栓塞症(VTE)和心房颤动抗栓治疗的必由之路.在临床上,抗血小板治疗与抗凝治疗常联合应用,然而联合抗栓治疗的出血发生风险显著增加,需仔细平衡出血与血栓栓塞的发生风险.目前,ASCVD合并心房颤动的抗栓治疗方案已得到深入研究并不断...     

肿瘤相关静脉血栓栓塞症的风险评估及预防策略——基于放疗科“无栓病房”的临床实践

［摘要］　肿瘤相关静脉血栓栓塞症（CAT）是指恶性肿瘤合并静脉血栓栓塞症,包括深静脉血栓形成、浅表性血栓静脉炎和肺栓塞,是肿瘤患者常见的并发症和死亡原因。肿瘤疾病存在复杂性,血栓风险和出血风险随肿瘤类型、分期和疾病进展而变化。“无栓病房”是一种全新的医护管理模式,对住院患者采用静脉血栓栓塞症风险评估表进行评分,根据评估结果将患者分为低危和高危患者并进行适当干预,以更好地监测患者的实时栓塞风险,及早预防静脉血栓栓塞症的发生。通过打造“无栓病房”,有效提高医护人员对血栓的诊疗水平,强化患者和家属对血栓的认识。该文基于该院放疗科“无栓病房”的临床实践,对CAT的现状、风险评估以及预防策略进行综述。     

Thromboembolic risk and anticoagulant therapy in COVID-19 patients: emerging evidence and call for action

Emerging evidence shows that severe coronavirus disease 2019 (COVID-19) can be complicated with coagulopathy, namely disseminated intravascular coagulation, which has a rather prothrombotic character with high risk of venous thromboembolism. The incidence of venous thromboembolism among COVID-19 patients in intensive care units appears to be somewhat higher compared to that reported in other studies including such patients with other disease conditions. D-dimer might help in early recognition of these high-risk patients and also predict outcome. Preliminary data show that in patients with severe COVID-19, anticoagulant therapy appears to be associated with lower mortality in the subpopulation meeting sepsis-induced coagulopathy criteria or with markedly elevated d-dimer. Recent recommendations suggest that all hospitalized COVID-19 patients should receive thromboprophylaxis, or full therapeutic-intensity anticoagulation if such an indication is present.     

COVID-19 and Peripheral Artery Thrombosis: A Mini Review

For more than 2 years, health care systems have been floundering in a massive crisis of coronavirus disease 2019 (COVID-19) pandemic. While acute respiratory distress syndrome is the main complication in patients with COVID-19, as the pandemic continues, more data about the nonrespiratory effects of the coronavirus is obtained, including developing Coagulopathy-related manifestations, in the form of venous and arterial thromboembolism. Although arterial thrombosis a rare complication of this disease, it proves to be an effective factor in the mortality and morbidity of COVID-19 patients. The pathophysiology of thrombosis reveals a complex relation between hemostasis and immune system that can be disrupted by COVID-19. Thrombectomy, anticoagulant therapy, and thrombolysis are the main treatments in these patients. In addition, appropriate thromboprophylaxis treatment should be considered in COVID-19 patients. In this article, we have successfully reviewed the arterial thrombotic events in patients reported around the world, including the diagnostic and management method of choice.     

COVID-19 Severity Potentially Modulated by Cardiovascular-Disease-Associated Immune Dysregulation

Patients with underlying cardiovascular conditions are particularly vulnerable to severe COVID-19. In this project, we aimed to characterize similarities in dysregulated immune pathways between COVID-19 patients and patients with cardiomyopathy, venous thromboembolism (VTE), or coronary artery disease (CAD). We hypothesized that these similarly dysregulated pathways may be critical to how cardiovascular diseases (CVDs) exacerbate COVID-19. To evaluate immune dysregulation in different diseases, we used four separate datasets, including RNA-sequencing data from human left ventricular cardiac muscle samples of patients with dilated or ischemic cardiomyopathy and healthy controls; RNA-sequencing data of whole blood samples from patients with single or recurrent event VTE and healthy controls; RNA-sequencing data of human peripheral blood mononuclear cells (PBMCs) from patients with and without obstructive CAD; and RNA-sequencing data of platelets from COVID-19 subjects and healthy controls. We found similar immune dysregulation profiles between patients with CVDs and COVID-19 patients. Interestingly, cardiomyopathy patients display the most similar immune landscape to COVID-19 patients. Additionally, COVID-19 patients experience greater upregulation of cytokine- and inflammasome-related genes than patients with CVDs. In all, patients with CVDs have a significant overlap of cytokine- and inflammasome-related gene expression profiles with that of COVID-19 patients, possibly explaining their greater vulnerability to severe COVID-19.     

新型冠状病毒肺炎合并心血管疾病的抗栓策略

新型冠状病毒肺炎患者常伴有高凝状态,且多合并需抗栓治疗的心血管疾病,这些疾病主要包括急性冠状动脉综合征、心房颤动和深静脉血栓等。在对新型冠状病毒肺炎患者进行抗栓治疗时,既要考虑新型冠状病毒肺炎的特殊性,又要兼顾抗栓的有效性,还要考虑特殊药物相互作用,这就需结合新型冠状病毒肺炎特点、心血管疾病的特点、血栓和出血风险评估以及患者自身情况进行个体化治疗。针对上述情况,心血管疾病的抗栓治疗需要在遵循常规指南的基础上有所调整,以达到更高的治疗安全性和有效性。因此,及时了解新型冠状病毒肺炎患者抗栓治疗情况并制定安全有效的抗栓策略对新型冠状病毒肺炎患者的预后意义重大。     

Challenges in the management of patients with systemic light chain (AL) amyloidosis during the COVID-19 pandemic

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated coronavirus disease 2019 (COVID-19) is primarily manifested as a respiratory tract infection, but may affect and cause complications in multiple organ systems (cardiovascular, gastrointestinal, kidneys, haematopoietic and immune systems), while no proven specific therapy exists. The challenges associated with COVID-19 are even greater for patients with light chain (AL) amyloidosis, a rare multisystemic disease affecting the heart, kidneys, liver, gastrointestinal and nervous system. Patients with AL amyloidosis may need to receive chemotherapy, which probably increases infection risk. Management of COVID-19 may be particularly challenging in patients with AL amyloidosis, who often present with cardiac dysfunction, nephrotic syndrome, neuropathy, low blood pressure and gastrointestinal symptoms. In addition, patients with AL amyloidosis may be more susceptible to toxicities of drugs used to manage COVID-19. Access to health care may be difficult or limited, diagnosis of AL amyloidosis may be delayed with detrimental consequences and treatment administration may need modification. Both patients and treating physicians need to adapt in a new reality.     

Antiphospholipid antibodies in critically ill COVID-19 patients with thromboembolism: cause of disease or epiphenomenon?

Coronavirus 2019 disease (COVID-19) is associated with coagulation dysfunction that predisposes patients to an increased risk for both arterial (ATE) and venous thromboembolism (VTE) and consequent poor prognosis; in particular, the incidence of ATE and VTE in critically ill COVID-19 patients can reach 5% and 31%, respectively. The mechanism of thrombosis in COVID-19 patients is complex and still not completely clear. Recent literature suggests a link between the presence of antiphospholipid antibodies (aPLs) and thromboembolism in COVID-19 patients. However, it remains uncertain whether aPLs are an epiphenomenon or are involved in the pathogenesis of the disease.

     

初筛核酸阴性的新型冠状病毒肺炎1例

Detection of nucleic acid is a method to first confirm COVID-19 theoretically, but it may show false negative result in clinical practice. This study indicates that suspected patients with COVID-19 cannot be ruled out easily because of once or twice negative results of nucleic acid detection. The epidemiology and radiological findings should be closely monitored. Dynamic test for viral nucleic acid is needed to avoid missed diagnosis, thus causing the spread of disease and missing the best time for early treatment. Clinical epidemiology, radiological findings, sampling time and criteria have posed significance to diagnose the disease and judge the severity.     

Hematological findings and complications of COVID-19

COVID-19 is a systemic infection with a significant impact on the hematopoietic system and hemostasis. Lymphopenia may be considered as a cardinal laboratory finding, with prognostic potential. Neutrophil/lymphocyte ratio and peak platelet/lymphocyte ratio may also have prognostic value in determining severe cases. During the disease course, longitudinal evaluation of lymphocyte count dynamics and inflammatory indices, including LDH, CRP and IL-6 may help to identify cases with dismal prognosis and prompt intervention in order to improve outcomes. Biomarkers, such high serum procalcitonin and ferritin have also emerged as poor prognostic factors. Furthermore, blood hypercoagulability is common among hospitalized COVID-19 patients. Elevated D-Dimer levels are consistently reported, whereas their gradual increase during disease course is particularly associated with disease worsening. Other coagulation abnormalities such as PT and aPTT prolongation, fibrin degradation products increase, with severe thrombocytopenia lead to life-threatening disseminated intravascular coagulation (DIC), which necessitates continuous vigilance and prompt intervention. So, COVID-19 infected patients, whether hospitalized or ambulatory, are at high risk for venous thromboembolism, and an early and prolonged pharmacological thromboprophylaxis with low molecular weight heparin is highly recommended. Last but not least, the need for assuring blood donations during the pandemic is also highlighted.     

COVID-19 and Acute Pulmonary Embolism: A Case Series and Brief Review

The SARS-CoV-2 virus, or COVID-19, is responsible for the current global pandemic and has resulted in the death of over 400,000 in the United States. Rates of venous thromboembolism have been noted to be much higher in those infected with COVID-19. Here we report a case-series of COVID-19 patients with diverse presentations of pulmonary embolism (PE). We also briefly describe the pathophysiology and mechanisms for pulmonary embolism in COVID-19. These cases indicate a need to maintain a high index of suspicion for PE in patients with COVID-19, as well as the need to consider occult COVID-19 infection in patients with PE in the right clinical circumstance.     

COVID-19 et assistance circulatoire

Extracorporeal membrane oxygenation (ECMO) is mainly used as a rescue therapy in COVID-19 patients with severe acute respiratory distress syndrome (ARDS). More rarely, COVID-19 can be complicated by hemodynamic failure due to fulminant myocarditis or massive pulmonary embolism necessitating the implantation of venous-arterial ECMO. The management of ECMO during the COVID-19 pandemic is challenging due to some specificities related to the disease characteristics, such as the management of anticoagulation in patients with a hypercoagulable state and an increased risk of venous thromboembolism. In large retrospective cohorts, survival of ECMO-rescued COVID-19 patients with ADRS was reported to be similar to that reported in previous studies on ECMO support for severe ARDS. Full consideration of ECMO candidacy is crucial for appropriate allocation of resources.