ANTITHROMBIN III SUPPLEMENTATION IN CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA TREATED WITH L-ASPARAGINASE

The change of plasma antithrombin III (AT) levels after supplementation of AT concentrates was examined in ALL children with acquired AT deficiency following L-asparaginase (ASP) administration. The patients received AT concentrates of 34.5 &#45 7.6 U/kg. The increase of plasma AT activity and antigen was 2.07 &#45 0.62% and 0.70 &#45 0.16 mg/dL per unit AT infused per kilogram of body weight, respectively. The activity decreased to 62.0 &#45 7.7% of the peak values by 48 hours after supplementation. The administration of AT concentrates constantly increased the plasma AT activity in ALL children treated with ASP, which may minimize the acquired prothrombotic state.     

乌司他丁对脊柱手术患者围术期凝血功能的影响

[目的]观察胰蛋白酶抑制剂乌司他丁对脊柱手术患者围术期凝血功能及血小板聚集率的影响.[方法]选择36例无血液疾病及凝血功能障碍、肝肾功能异常或未服用影响血小板功能药物的择期脊柱手术患者(ASAⅡ～Ⅲ),随机分为乌司他丁组(W组,5000 U/kg,n=18)和生理盐水组(C组,n=18)；分别于注射前(T0)、注射后1 h(T1)、注射后2 h(T2)、注射后3 h(T3)抽出静脉血测定凝血酶原时间(PT)、部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、国际标准化比值(INR)、及血小板1 min,5 min和最大聚集率(PAG1、PAG5、PAGM),并记录两组手术出血量.[结果]注射乌司他丁组后1h,W组APTT,PT较注射前明显延长(P＜0.05),用药后2h,TT较注射前明显延长(P＜0.05),用药后3h,APTT,PT,TT差异无统计学意义(P＞0.05).与C组比较,注射后1h,APTT显著性延长(P＜0.01),用药后2h,PT显著性延长(P＜0.05),用药后3h,APTT,PT,TT差异无统计学意义(P＞0.05).两组注射前后及组间比较PAgT差异无统计学意义(P＞0.05).两组患者出血量比较差异无统计学意义(P＞0.05).[结论]围术期应用5000 U/kg乌司他丁可改善脊柱手术患者术中患者的凝血状态,减少术中微血栓综合征,预防术中术后血栓形成.     

Early and repeated use of plasma for the management of Ebola patients: Reflection around a case

In December 2013, the most widespread epidemic of Ebola virus disease began in Guinea and continued for over 2 years. At the request of the Guinean state, France deployed a military field hospital to treat Ebola infected healthcare workers. From January to July 2015, our center supported 26 healthcare workers suffering from Ebola virus disease. Despite an individualized care and optimal treatment, the fatality rate remained high at 30.7%. Improved therapies are required to reduce mortality risk in Ebola virus disease. We report the case of a patient admitted to the hospital on the 4th day after onset, who survived despite several clinical and biological predictors of fatal outcome. We transfused plasma at a high dose and spread over time. This innovative therapeutic approach was based on our clinical experience of Ebola patients’ management, literature review and knowledge of plasma ability to restore coagulation disorders and endotheliopathy. Even without any bleeding sign, coagulopathy and endothelial permeability disorders participate in hypovolemia and fatal multi-system organ failure. Early intake of therapeutic plasma at repeated doses seems to reduce the endothelial permeability and coagulation disorders related to Ebola virus disease.     

BILT肝病治疗仪对肝硬化患者血小板参数与凝血的影响

目的探讨肝硬化患者采用BILT肝病治疗仪治疗对血小板参数与凝血的影响。方法本次共选择80例肝硬化患者,分组就常规对症支持(对照组)与加用BILT肝病治疗仪(观察组)治疗。对凝血机制和预后的影响进行比较。结果观察组临床情况优于对照组(P<0.05)。结论肝硬化患者采用BILT肝病治疗仪治疗,可显著减轻临床症状,具较高安全性,值得广泛推广应用。     

The polysaccharide fucoidan inhibits microvascular thrombus formation independently from P- and L-selectin function in vivo

BACKGROUND: Adhesion molecules of the selectin family (mainly P- and L-selectin) have been suggested to mediate interactions between platelets, leukocytes and endothelial cells in thrombus formation. The polysaccharide fucoidan has anticoagulative properties, but is also able to bind and block the function of the selectins. Here, we investigated in vivo (i) if fucoidan can prevent microvascular thrombus formation, and (ii) whether this is potentially mediated by the inhibition of P-and/or L-selectin. MATERIALS AND METHODS: For this purpose, we used intravital microscopy in the mouse cremaster microcirculation in which thrombosis was induced photochemically by light exposure to individual arterioles and venules after intravenous (i.v.) injection of FITC-dextran. RESULTS: We found that intravenous administration of fucoidan significantly prolonged the time required for complete occlusion in arterioles and venules by almost seven- and nine-fold, respectively. In contrast, treatment with monoclonal antibodies against P- and L-selectin had no effect on the development of microvascular thrombosis. Fucoidan and also the anti-P-selectin antibody completely inhibited baseline venular leukocyte rolling in the cremaster muscle, indicating that these treatment regimes abolished P-selectin function. Importantly, fucoidan and the anti-P-selectin antibody had no effect on systemic platelet and leukocyte counts. On the other hand, we found that fucoidan treatment significantly altered coagulation parameters, including prothrombin time (Quick percentage), activated partial thromboplastin time (APTT) and thrombin clotting time (TCT), which may explain the potent in vivo anticoagulative effect of fucoidan observed here. CONCLUSIONS: Taken together, our novel findings suggest that fucoidan effectively prevents microvascular thrombus formation induced by endothelial damage in arterioles and venules in vivo. This protective effect of fucoidan is not attributable to inhibition of P- and L-selectin function but may instead be related to the anticoagulative capacity of fucoidan.     

氟比洛芬酯对骨癌大鼠肾功能、凝血功能及其血小板聚集的影响

目的 连续7d腹腔注射氟比洛芬酯注射液,研究其对骨癌痛大鼠肾脏、凝血功能、血小板聚集影响. 方法 36只成熟雌性SD大鼠完全随机分为6组:肿瘤+生理盐水组(C组)、肿瘤+氟比洛芬酯10 mg· kg1·d-1组(CK10组)、肿瘤+氟比洛芬酯25 mg·kg-1·d-1组(CK25组)、肿瘤+氟比洛芬酯50 mg· kg-1·d-1组(CK50组)、氟比洛芬酯50 mg· kg-1·d-1单纯组(K50组)和假手术组+生理盐水组(sham组),每组6只.制作骨癌痛模型14 d后,每天分别腹腔注射相应剂量氟比洛芬酯或生理盐水2次,连续7d后处死大鼠.腹主动脉采血,检测血尿素氮(blood urea nitrogen,BUN)、肌酐(creatinine,Cr)、Na+、K+、凝血酶原时间(protrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、纤维蛋白原(fibrinogen,Fib)、血小板聚集功能(platelet aggregation,PA)及其观察肾病理学变化.结果 腹腔给予氟比洛芬酯7d后,分别与sham组和C组比较,CK50组(9.9±1.5) mmol/L、K50组(9.7±1.4)mmol/L血BUN水平明显增高(P＜0.05),CK50组(137±8) mmol/L、K50组(138±8)mmol/L Na+和CK50组(3.9±0.3)mmol/L、K50组(3.9±0.4) mmol/L K+显著降低(P＜0.05),Cr、PT、APTT、Fib和PA值变化无统计学意义(P＞0.05);CK10、CK25组血BUN、Cr、PT、APTT、Fib、Na+、K+和PA值分别与sham组、C组比较,差异无统计学意义(P＞0.05).CK50、K50组病理学变化为肾小球缩小,肾小球毛细血管充盈不足;C组、sham组、CK10、CK25组肾组织结构清晰,未见异常变化. 结论 腹腔重复注射不同剂量氟比洛芬酯对骨肿瘤大鼠凝血功能及其血小板聚集功能无明显影响,然而大剂量氟比洛芬酯(50 mg·kg-1·d-1)影响尿素氮、钠钾离子的代谢及肾小球毛细血管充盈.     

先天性心脏病患儿体外循环围术期凝血指标检测的临床意义

目的研究先天性心脏病患儿体外循环(CPB)围术期凝血功能的变化。方法取患儿围术期4个时段的标本,分别以凝固法、发色底物法等检测凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原含量(FIB)、抗凝血酶(AT)活性等凝血及抗凝功能指标。结果以上指标的检测可判断患儿血液肝素化后凝血功能的变化。结论各凝血指标特别是AT活性可作为CPB围术期抗凝效果的监测和早期弥漫性血管内凝血(D IC)的诊断。     

急性脑梗死患者血浆凝血纤溶指标的变化及临床意义研究

目的：观察急性脑梗死患者血浆中凝血纤溶指标的含量变化，并探讨其临床意义。方法：采集42例急性脑梗死患者血浆，测定其纤维蛋白原、D－二聚体及纤溶酶原含量，并与对照组进行比较。结果：急性脑梗死患者血浆中纤维蛋白原、D－二聚体含量明显高于对照组（P＜0．01），纤溶酶原活性却下降（P＜0．05），且各项指标的变化与病情轻重相关。结论：脑梗死患者急性期存在凝血纤溶系统的异常。     

不同急性胰腺炎凝血功能紊乱的临床研究

目的 探讨急性胰腺炎时凝血功能的变化.方法 选择急性胰腺炎患者55例,其中仅有局部表现的患者20例(局部症状组),有全身炎症反应综合征(SIRS)而无器官功能障碍的患者20例(SIRS组),出现器官功能障碍的患者10例(器官功能障碍组),死亡患者5例(死亡组).择期胆囊切除术术前检查凝血功能正常的同期住院患者10例(对照组).检测上述患者的血小板计数、凝血酶原时间、活化部分凝血酶时间和纤维蛋白原.结果 局部症状组血小板计数、凝血酶原时间、活化部分凝血酶时间和纤维蛋白原与对照组比较差异均无统计学意义;SIRS组、器官功能障碍组和死亡组血小板计数显著低于对照组,凝血酶原时间、活化部分凝血酶时间显著长于对照组,纤维蛋白原显著高于对照组.结论 急性胰腺炎发展到SIRS、器官功能障碍和死亡阶段时,凝血功能表现为紊乱状态.     

Blood and tissue fibrinolytic profiles in patients with colorectal carcinoma

Summary In patients with colorectal cancer, profound alterations of the plasminogen activator system have been described at the tumor level, but conflicting results have been obtained for fibrinolytic parameters in plasma. Components of the fibrinolytic system, including tissue-type and urokinase-type plasminogen activators and their inhibitors type 1 and 2, were measured in tissue and/or plasma from 41 patients with colorectal cancer and in 40 controls. Procoagulant activity of freshly isolated mononuclear cells (basal activity) and the procoagulant activity and fibrinolytic proteins produced by the cells after incubation for 18 h without exogenous stimulation were also evaluated. Malignant tissue extracts had significantly higher levels of urokinase-type plasminogen activator and plasminogen activator inhibitor-1, but lower levels of tissue-type plasminogen activator than normal mucosa. Plasminogen activator inhibitor-1 alone was higher in advanced (Dukes' stages C+D) than limited (B) tumors. Plasminogen activator inhibitor-2 was not different in malignant tissue and normal mucosa. Plasma levels of plasminogen activator inhibitor-1 antigen were significantly increased in cancer patients compared with controls, but there were no differences in tissue-type and urokinase-type plasminogen activator, in plasminogen activator inhibitor-2, and D-dimer levels. Intra-patient analysis revealed no significant correlation between tumor and plasma levels of plasminogen activators or type 1 inhibitor. Tissue-type plasminogen activator, but not the urokinase type or inhibitor type 1, was higher in venous than in arterial blood collected at the tumor site during surgery. Basal procoagulant activity of mononuclear cells and the procoagulant activity and inhibitor type-2 produced by the cells after shortterm culture were comparable in patients and controls. These findings indicate that, at least in our patients with colorectal cancer, the profound changes occurring at tumor level are barely detectable in the blood. Thus, the clinical relevance of plasma fibrinolytic parameters, especially urokinase-type plasminogen activator antigen, as tumor markers in colorectal cancer remains to be established.