血小板膜微粒的制备及止血功能的研究

目的探讨血小板膜微粒(IPMs)的制备工艺,并对研制的IPMs的止血功能及对凝血系统的影响进行动物实验研究。方法用街头采集的全血制备浓缩血小板悬液,用血小板型去白细胞滤器去除白细胞,轻离心去除红细胞后,用生理盐水洗涤血小板并调血小板浓度为2×109/ml,置-80℃反复冻溶3次,再用生理盐水洗涤,然后置60℃、20h灭活病毒,用高压匀质机进行匀质化破碎血小板膜,即为IPMs。用粒度测定仪检测IPMs的粒度;应用活化血浆凝固时间(APCT)检测IPMs的体外促凝血活性;将IPMs输入血小板减少症兔出血动物模型体内,观察IPMs止血效果及对凝血系统的影响。结果制备的IPMs颗粒均匀,大小为200～300nm;50μg/mlIPMs相当于250×109/L新鲜血小板的体外促凝血活性;将IPMs按2mg/Kg输入兔血小板减少症的出血动物模型体内,在输注2～12h内,兔耳出血时间和APCT均明显缩短,而其他凝血指标(PT、APTT、Fg、TT)均无明显变化。结论血小板膜微粒止血效果好,输注IPMs并不影响凝血系统,是一个很有前途的生物止血剂。     

急性脑出血患者血液中微粒促凝活性的变化

Objective To study the procoagulant activity of microparticles (MP) in patients with acute in-tracerebral hemorrhage (ICH) and to evaluate the correlation between procoagulant activity of MPs and disease out-come. Method From August 2006 through August 2008, 83 consecutive patients with history of hypertension ad-mitted for spontaneous basal ganglia hemorrhage including 54 male and 29 female, aged (60.9±9.7) years ranged from 41 to 79 years, were enrolled into this study. The control group was consisted of 30 age- and sex-matched (P= 0.429; P = 0.415) patients admitted for mild soft tissue injury. Patients with history of head trauma or previ-ous stroke, under the antiplatelet or anticoagulant medication, severe infection, or presence of previous cerebrovas-cttlar disease were excluded. Venous blood sample was kaken within the first 24 hours after disease onset. The MPs procoaulant potential was measured with a prothrombinase assay, and the levels of IL-6,TNF-α, D-dimer (DD)and thrombin-antithrombin Ⅲ complex (TAT) in plasma were measured with enzyme-linked immunosorbent assay. The multivariate analysis was made with forward stepwise logistic regression to determined the predictors of one. month mortality. The plasma levels of MPs were compared between ICH group and control group, between patients with intraventricular hemorrhage (IVH) and those without IVH,and between survivors and non-survivors with the Mann-Whitney U-test. The Spearman' s rank correlation coefficient was used to analyze the correlations between the plasma levels of MPs and ICH volume, Glasgow coma scale (GCS), and plasma levels of IL-6, TNF-α, DD and TAT. A receiver operating characteristic curve (ROC curve) identified the plasma MPs cutoff levels that predicted one-month mortality of patients. Under ROC curve, z statistic analysis was used to compare the area under curves (AUCs) between plasma IMPs and Glasgow coma scale, ICH volumes, and plasma levels of IL-6, TNF-α, DD and TAT for one-month mortality. Results Thirty-six patients (43.4%) died of ICH in a month. The multivariate analyses sorted out the GCS (odds ratio = 0.558, 95%CI:0.367-0.850, P = 0.007), Hematoma volume (odds ratio= 1.061, 95%C1:1.012- 1.113, P = 0.015) and IVH (odds ratio= 5.537, 95%CI:1.035-29.629, P = 0.045) as the independent pcedictors for one-week mortality. The MPs procoagulant activity in the ICH group (6.72±3.26 U/mL) was significantly higher than that in control group (1.84±0.82) U/mL (P = 0.000). The IMPs procoagulant activity in the non-survival group (8.51±3.45) U/mL was significantly higher than that in the survival group (5.35±2.33) U/mL (P = 0.000). The MPs procoagulant activity in the IVH group (7.66±3.39) U/mL was significantly higher than that in the non-lVH group (5.36±2.53) U/mL (P = 0.001). The MPs procoagulant activity was highly associated with GCS scores (r = -0.690, P = 0.000), ICH volumes (r =0.590, P = 0.000), and plasma IL-6 (r = 0.465, P = 0.015), TNF-α (r = 0.464, P = 0.016), DD(r= 0.567, P = 0.001) and TAT(r = 0.469, P = 0.014) in ICH. The ROC curve identified cutoff levels of MPs procoagulant activity to be 7.47 U/mL that predicted one-month mortality of patients with high sensitivity (77.8%) and specificity values (76.6%). Areas under curves (AUCs) of MPs procoagulant activity (AUC =0.825±0.048) were significantly larger than those of plasma IL-6 (AUC = 0.685±0.060, P = 0.042), TNF-α(AUC = 0.681±0.060, P =0.036) and TAT (AUC = 0.644±0.062, P =0.008).The AUCs ofMPs procoag-ulant activity were larger than those of plasma DD (AUC = 0.743±0.056), but this difference was not statistical significance (p = 0.226). Conclusions The procoagulant activity of MPs may contribute to the pathophysiology of ICH. The propcoagulant activity of MPs after spontaneous onset of ICH seems to correlate with clinical outcome in these patients. Its procoagulant activity can be used as an useful clinical marker for evaluating the prognosis of ICH.     

测定血液乳糜程度的新方法

献血者在采血前大量食用脂类食品 ,被人体吸收后 ,在血液中能形成主要成分为甘油三酯、胆固醇的乳糜微粒 [1 ] ,造成乳糜血。严重的乳糜血不仅影响血液质量 ,尤其是冰冻血浆的质量 ,而且难以为临床所接受 ,常造成血液的浪费。本中心曾采用肉眼观察血浆的方法 ,来测定血液乳糜程度。但这种判定方法无任何参照标准 ,又受观察者主观因素的影响 ,常造成乳糜血判定结果的差异。为此 ,笔者根据乳糜微粒大小约在 80～ 5 0 0 nm、成分复杂 [2 ]等特征 ,参考中国药品生物制品检定所目测法检测细菌悬液中含细菌数的原理 [3] ,以及临床定性测定胆红素中…     

7种常用中药注射剂与0.9％氯化钠配伍的稳定性研究

目的 观察7种常用中药注射剂与0.9％氯化钠注射液配伍的稳定性,以指导临床药物护理.方法 分别检测红花黄色素、复方苦参注射液、黄芪注射液、康艾注射液、艾迪注射液、注射用灯盏花素、注射用丹参与0.9％氯化钠配伍后0～4 h的颜色、澄明度、微粒数、pH值及吸光度.结果 4h内溶液澄明,未见沉淀生成及变色,pH值在正常范围内略有变化,不溶性微粒未发生大幅度改变,吸光度在正常值范围内.结论 7种常用中药注射剂与0.9％氯化钠配伍后溶液在4h内基本稳定,其中1～2 h配伍使用最为稳定.建议中药注射剂配伍静置一段时间后输注,以提高输液安全性.     

不同备药方法对静脉输液配置室内洁净度的影响

目的探讨不同的备药方法,对静脉输液配置室内空气微粒的影响。方法分别使用4种不同的备药方法,进行模拟配液加药,在配液过程中使用空气粒子计数器对配置室内空气微粒数进行检测,以了解配液操作时空气微粒的污染情况。结果A、B组与C、D组的备药方法对配置室内配液操作时空气微粒数的影响差异有显著性(P<0.001)。结论A、B组备药方法对配置室内空气微粒污染明显,操作时释放微粒多,提示此备药方法不可取,C、D组备药方法对配置室内空气微粒数影响小,适合静脉输液配置的备药,尤其是D组可实现快速备药,提高工作效率,值得推广使用。     

静脉输液中微粒污染的原因与预防的研究现状

静脉输液中,微粒污染对人体造成的危害越来越引起人们的关注。因此,近年来对微粒污染的原因和预防进行了大量而深入的研究,本文现就其研究现状综述如下。 1 微粒污染发生的原因 1.1 输液器和注射器本身的微粒污染 这是由于输液器和注射器在生产过程中引入的微粒所造成的。其主要原因有     

微粒化非诺贝特与辛伐他汀对糖尿病并高脂血症的疗效

目的:观察微粒化非诺贝特(MF)与辛伐他汀治疗2型糖尿病(NIDDM)合并高脂血症的疗效。方法:30例NIDDM病人用MF胶囊治疗,另30例NIDDM病人用辛伐他汀治疗,比较二者的疗效。结果:两组均显著降低总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白-胆固醇(LDL-C)水平,升高高密度脂蛋白-胆固醇(HDL-C)水平(P<0.01);MF组降低TG、LDL-C,升高HDL-C水平更著(P<0.05)。结论:MF是治疗NIDDM合并高脂血症病人有效的调脂药物,对于TG、LDL-C、HDL-C比辛伐他汀更有效。     

微粒化非诺贝特降脂疗效的临床观察

采用前后比较的方法观察微粒化非诺贝特２００ｍｇ，每晚一次，治疗５６例高脂血症患者８周的调脂疗效和安全性。５６例高脂血症的分型为：Ⅱｂ型１４例，Ⅳ型４２例。治疗８周末，Ⅱｂ型患者血清总胆固醇降低；Ⅱｂ型和Ⅳ型患者血清甘油三酯明显降低，分别为５５％和４３％；此外，两型高脂血症患者的ＨＤＬ－Ｃ水平均有明显升高，ＡｐｏＢ水平明显降低，说明该药具有全面调脂作用。     

微粒化力平脂治疗原发性高脂血症疗效的初步观察

22例原发性高脂血症患者服用微粒化力平脂200mg，每晚一次，共8周，并随机设立空白对照11例。结果显示：治疗8周后，患者血清甘油三酯明显降低（P＜0．001），显效率为86．4％，高密度脂蛋白胆固醇明显升高（P＜0．01），纤维蛋白原明显降低（P＜0．01），而血清总胆固醇降低未达到统计学意义。结论：微粒化力平脂特别适用于IV型高脂血症患者并对纤维蛋白原升高者有益。