急性冠脉综合征患者血清D-二聚体及同型半胱胺酸水平的变化

目的 通过观察瑞舒伐他汀治疗急性冠脉综合征(ACS)患者血清D-二聚体(D-D)及同型半胱胺酸(Hcy)水平变化,探讨瑞舒伐他汀对凝血和纤溶的影响,以及检测血清D-D和Hcy的临床价值.方法 选择临床确诊的ACS患者85例,在常规治疗(溶栓、阿司匹林、氯吡格雷、低分子肝素、血管紧张素转换酶抑制剂、β2-受体阻滞剂等治疗,不予任何调脂药物)基础上采用瑞舒伐他汀治疗2周,观察血清D-D(检测采用ELISA法)和Hcy(检测采用EIA法)水平变化.结果 ACS患者存在血清D-D和Hcy水平异常升高,显著高于对照组(P＜0.01);瑞舒伐他汀治疗2周后,血清D-D和Hcy水平均显著降低(P＜0.01),但与对照组相比仍具有显著性(P＜0.01);血清D-D与Hcy呈正相关(r=0.419,P＜0.01).结论 瑞舒伐他汀可显著降低ACS患者血清D-D及Hcy水平,具有改善血液凝固、纤溶系统活性亢进、降低高Hcy血症及稳定斑块的作用,动态联合检测ACS患者血清D-D及Hcy水平有利于病情观察、指导治疗及预后判定.     

BISAP联合凝血指标对急性胰腺炎严重程度评估的意义

目的:研究BISAP(bedside index for severity in AP)评分联合凝血指标对急性胰腺炎(acute pancreatitis,AP)严重程度评估的意义.方法:回顾2008-2012年中国医科大学附属盛京医院收治的166例AP患者的临床资料.对所有患者进行入院24h的BISAP、APACHE-Ⅱ评分,48h的Ranson’s及发病72h内CTSI评分,入院24h内抽取静脉血测定部分凝血活酶活化时间、凝血酶原时间、D-二聚体(D-dimer)、纤维蛋白原及血小板水平.分析凝血指标及BISAP评分对AP严重程度判断的意义,并通过ROC曲线分析二者联合对AP严重程度评估的意义.结果:多因素Logistic回归分析发现,D-dimer对AP严重程度评估具有独立预测意义;随着BISAP评分增加,SAP的比率增加;BISAP评分系统评估AP严重程度以2为临界点时Youden指数最大(0.541),ROC曲线下面积为0.836(0.776-0.896),并不逊于传统评分系统;BISAP评分系统联合D-dimer能更好地评估AP患者的严重程度.结论:BISAP是临床判断AP轻重程度的简单有效的指标,将BISAP与D-dimer联合应用使得对AP严重程度的评估更为准确.     

In the Experimental Model of Acute Mesenteric Ischemia,The Correlation of Blood Diagnostic Parameters with the Duration of Ischemia and their Effects on Choice of Treatment

ABSTRACT

Purpose/Aim: Acute mesenteric ischemia is a syndrome characterized by sudden onset abdominal pain followed by intestinal necrosis. Morbidity and mortality increase with delayed diagnosis. Even with the latest radiological diagnostic methods, early diagnosis and initiation of treatment can be delayed. Using an experimental model, here we aim to determine the relationship between the laboratory parameters used to detect acute mesenteric ischemia and the duration of irreversible ischemia. Materials and Methods: A total of 30 male Wistar albino rats were divided into five groups, all of which underwent general anesthesia: (i) Superior mesenteric artery (SMA) dissection with laparotomy was performed, and blood samples and intestinal segment samples were taken after 2 hr (Sham group); (ii) volvulus of one-third of the small intestines was performed manually by laparotomy, and blood samples and intestinal segment samples were taken after 2 hr (Volvulus group); (iii) SMA was ligated with laparotomy, and blood samples and intestinal segment samples were taken after 2 hr (SMA+ligated 2-hr group); (iv) SMA was ligated with laparotomy, and blood samples and intestinal segment samples were taken after 4 hr (SMA+ligated 4-hr group); and (v) SMA was ligated with laparotomy, and blood samples and intestinal segment samples were taken after 6 hr (SMA+ligated 6-hr group). Results: The mean lactate dehydrogenase (LDH) activities of the SMA+ligated 2-hr and SMA+ligated 6-hr groups were statistically higher than the control group (p = .004). Compared to the Sham and Volvulus groups, the mean lactate level of the SMA+ligated 6-hr group was significantly higher (p = .004). Compared to the Sham and Volvulus groups, the mean D-dimer levels of the SMA+ligated 4-hr and SMA+ligated 6-hr groups were significantly higher (p = .004 and .003, respectively). By histopathological evaluation, we found that pathological damage increased as the ischemia lengthened. Conclusions: Mesenteric ischemia leads to an irreversible loss of intestinal perfusion and an increase in parameters of ischemia. Irreversible tissue damage occurs after 4 hr of ischemia and peaks after 6 hr, whereas parameters of ischemia (D-dimer, LDH, and L-Lactate levels) are highest at 2 hr after the onset of ischemia.     

同型半胱氨酸、超敏C反应蛋白、低密度脂蛋白胆固醇、D-二聚体与脑梗死的关系

目的：探讨血清同型半胱氨酸（Hcy）、血脂、超敏c反应蛋白（hs—CRP）、凝血功能、D-二聚体的变化与脑梗死的关系。方法：收集2012年3月-2013年2月于我院住院治疗的急性脑梗死患者172例为观察组,并根据病灶大小分为大梗死组、小梗死组和腔隙性脑梗死组。分别对3组患者入院后次日晨测定血清Hcy、血脂、hs—CRP、凝血功能、D-二聚体。100例健康体检者作为正常对照。结果：脑梗死患者血清Hcy、血脂、hs—CRP、纤维蛋白原（Fib）、D-二聚体水平均高于正常对照组,APTT和TT均低于正常对照组（P〈0．05）。血清Hcy水平与LDL、hs—CRP和血浆胁二聚体水平有一定相关性（r值分别为0．739,0．681和0．803,P〈0．01）。大梗死组、小梗死组血清Hcy、hs—CRP、LDL和血浆D-二聚体水平明显高于腔隙性脑梗死组（P〈0．05）,大梗死组血浆Fib水平明显高于腔隙性脑梗死组和小梗死组（P〈0．05）。脑梗死面积大小与血清Hcy、hs—CRP、LDL和血浆胁二聚体水平具有良好的相关性（r值分别为0．604、0．587、0．515、0．333,P〈0．05或P-〈0．01）。结论：血清Hcy、hs—CRP、LDL和D-二聚体水平升高可能是脑梗死的危险因素。     

D-dimer >2.785 μg/ml and multiple infarcts ≥3 vascular territories are two characteristics of identifying cancer-associated ischemic stroke patients

ABSTRACT

Background: The patterns and mechanisms underlying stroke in cancer patients differ from those of the conventional etiology. In this study, we further investigated the characteristics distinguishing cancer-associated ischemic stroke (CAIS) and the relationship of D-dimer value with CAIS.

Methods: Sixty-one acute ischemic stroke patients with cancer (cancer group) and 76 stroke patients without cancer (control group) were recruited. Cerebrovascular distribution was divided into 3 circulations and 23 vascular territories, and acute multiple brain infarcts (AMBIs) were defined as discrete MRI diffusion-weighted imaging (DWI) lesions in >1 vascular territory.

Results: Cancer patients had higher average D-dimer and fibrinogen degradation product values, and fewer stroke risk factors. The numbers of infarct-affected vascular territories, AMBIs, and AMBIs in multiple circulations were significantly higher in the cancer group. Receiver operating characteristic analysis showed that the cutoff value of D-dimer was 2.785 μg/ml; and above features were particularly evident in cancer patients whose D-dimer values were >2.785 μg/ml, while those with D-dimer values ≤2.785 μg/ml were similar to controls.

Conclusions: D-dimer >2.785 μg/ml may be an effective cutoff value and a sensitive index for identifying CAIS patients. AMBIs in ≥3 vascular territories and AMBIs in both the anterior and posterior circulations are two imaging characteristics of CAIS.     

胰腺癌相关脑梗死的临床特点及发病机制探讨

目的　初步探讨胰腺癌相关脑梗死的临床特点及可能的发病机制。方法　纳入2008年1月—2018年12月在广西医科大学第一附属医院及附属肿瘤医院治疗的胰腺癌相关脑梗死患者（胰腺癌尚未治愈,合并急性脑梗死且不伴有传统卒中因素）为胰腺癌相关脑梗死（PCCI）组,并按照1∶1比例收集同期年龄、性别匹配的单纯胰腺癌患者为（PC）组,对比分析2组患者临床资料。结果　PCCI组共纳入30例患者,其中性粒细胞绝对值、D-二聚体、CA125、CA199水平高于PC组（P＜0.05或P＜0.01）。PCCI组中24例（80.00%）表现为多个动脉供血区域的多发梗死灶,14例（46.67%）最大梗死灶直径≤2 cm,10例（33.33%）最大梗死灶直径为2~5 cm。20例（66.67%）在确诊胰腺癌后6个月内发生急性脑梗死。3例（10.00%）以急性脑梗死为首发表现,在住院期间确诊为胰腺癌。脑梗死TOAST分型以小动脉闭塞型及原因不明型为主。多因素Logistic回归分析显示血浆D-二聚体＞0.5 mg/L及CA199＞120 mg/L是PCCI的独立危险因素。结论　胰腺癌相关脑梗死发生机制可能与血液高凝状态、血管内微小血栓形成有关。     

Hcy D-D UA水平联合检测在子痫前期诊断及重度子痫前期预测中的应用

目的 探讨同型半胱氨酸(Hcy)、D-二聚体(D-D)、尿酸(UA)血清水平联合检测在子痫前期(PE)诊断及重度PE预测中的应用价值。方法 回顾性分析2020年1月至2022年4月铜陵市妇幼保健院收治的229例孕妇的临床资料,参照《妇产科学》第八版中PE诊断标准将其分为PE组(n=148)与非PE组(n=81),根据PE病情严重程度将PE患者分为轻度PE组(n=85)与重度PE组(n=63)。记录并比较各组患者Hcy、D-D、UA水平,以《妇产科学》第八版中的PE、轻度PE、重度PE诊断标准为“金标准”绘制受试者工作特征(ROC)曲线,评价Hcy、D-D、UA水平联合检测在PE诊断及重度PE预测中的应用价值。结果 PE组孕妇收缩压、舒张压、平均动脉压、剖宫产史比例以及24 h尿蛋白均高于非PE组(P均<0.05)。PE组孕妇Hcy(12.85±1.4[JP2]3)μmol/L、D-D(2.39±0.42)μg/mL及UA(407.83±48.86)μmol/L均高于非PE组(9.51±1.14)μmol/L、(1.61±0.27)μg/mL、(321.43±41.67)μmol/L(P均<0.05)。Hcy+D-D+UA联合检测用于诊断PE的曲线下面积(AUC)为0.976,灵敏度为98.65%,特异度为97.53%,Hcy+D-D+UA联合检测PE诊断的效能优于Hcy、D-D、UA单独及任意两指标联合。重度PE组患者Hcy(13.98±1.52)μmol/L、D-D(2.12±0.35)μg/mL及UA(443.17±51.39)μmol/L均高于轻度PE组(12.01±1.37)μmol/L、(2.12±0.35)μg/mL、(381.64±46.98)μmol/L(P均<0.05)。PE患者Hcy水平分别与D-D、UA水平呈正相关(r=0.739、0.861,P均<0.05),D-D水平与UA水平呈正相关(r=0.708,P<0.05);而Hcy、D-D及UA水平分别与PE严重程度均呈正相关(r=0.654、0.813、0.776,P均<0.05)。Hcy+D-D+UA联合检测对重度PE预测的AUC为0.941,灵敏度为90.48%,特异度为95.29%,Hcy+D-D+UA联合检测较Hcy、D-D、UA单独及任意两指标联合用于重度PE预测的效能更优。结论 PE患者Hcy、D-D、UA水平均升高且相互呈正相关,而重度PE患者Hcy、D-D、UA水平均升高更为明显,Hcy+D-D+UA联合检测可提高PE诊断效能与重度PE预测效果,值得借鉴。     

D-二聚体水平对急性主动脉夹层患者死亡预测价值的研究

目的:探讨D-二聚体对急性主动脉夹层(AD)患者在院期间死亡的预测价值。方法:收集2013年1月—2015年12月收治的83例AD患者资料,根据患者在院期间是否死亡分为生存组(62例)和死亡组(21例),比较两组D-二聚体水平及其他相关临床因素,采用回归分析探讨患者死亡的危险因素。结果:两组年龄、性别、吸烟、高血压、糖尿病等因素差异无统计学意义(均P0.05),但死亡组患者比例的A型病变和D-二聚体水平明显高于生存组(均P0.05)。Logistic回归分析显示,A型病变(OR=0.117,95%CI=0.021~0.792)与D-二聚体(OR=3.180,95%CI=1.551~5.984)是患者死亡的风险因素(均P0.05)。D-二聚体水平预测患者死亡的受试者工作特征曲线下面积为0.819(95%CI=0.807~0.974,P0.001),最佳临界点为4.85μg/m L,敏感度和特异性分别为85.7%和75.8%。结论:D-二聚体作为一个快速检测指标,可以对AD患者进行简便危险评估,对于D-二聚体较高的患者,应对进行积极干预。     

血浆D-二聚体检测在肝癌分期与预后中的临床价值

目的：检测肝癌患者血浆中的D-二聚体,探讨其在肝癌不同分期及预后治疗中的临床价值。方法采用免疫比浊法对2012年1月至2014年1月在新疆自治区人民医院就诊且资料完整的50例肝癌患者和35例正常对照组血浆中D-二聚体含量进行检测,比较肝癌患者不同分期及治疗前后的D-二聚体水平变化。结果本组50例肝癌患者各临床期血浆D-二聚体检测含量为Ⅰ期(0.43±0.10) mg/L,Ⅱ期(0.60±0.14) mg/L,Ⅲ期(1.65±0.32) mg/L,与正常对照组比较,肝癌患者血浆中D-二聚体含量均上升且随肿瘤分期逐步进展而升高,差异均有统计学意义(P<0.05或P<0.01);肝癌患者治疗后缓解组40例,未缓解组10例,治疗前D-二聚体含量为(0.84±0.12) mg/L,治疗后缓解组D-二聚体含量为(0.50±0.21) mg/L,治疗后血浆中D-二聚体含量较治疗前明显降低,差异有统计学意义(P<0.05)。结论肝癌患者存在不同程度的继发性纤维蛋白溶解功能亢进,检测血浆中D-二聚体含量可作为判断病情严重程度及治疗预后的参考指标。     

血浆D-二聚体与纤维蛋白原检测结合超声检查对盆腔手术后下肢深静脉血栓的早期评价价值

目的 研究血浆D-二聚体（D-dimer）与纤维蛋白原（FIB）的动态变化对早期预测盆腔手术后下肢深静脉血栓（DVT）的意义,探讨彩色多普勒超声检查对患者DVT的早期诊断价值。方法 选取2014年1月至2016年1月在首都医科大学附属北京潞河医院妇科择期行盆腔手术并具有DVT高危因素的231例患者为研究对象,术前所有患者下肢深静脉彩色多普勒超声检查均为阴性。根据患者术后72~120 h下肢彩色多普勒超声检查结果,将患者分为血栓组（n=36）和非血栓组（n=195）。所有患者于手术前、术后第1天和术后第3天晨检测D-dimer和FIB,并进行统计分析。结果 血栓组与非血栓组比较,术后D-dimer和FIB显著增高,差异有统计学意义（P<0.05）,与术前比较,两组患者术后D-dimer和FIB显著增高,差异有统计学意义（P<0.05）。结论 血浆D-dimer、FIB检测结合彩色多普勒超声检查对妇科盆腔术后患者并发下肢DVT的早期诊断具有重要价值。