Pre- and postoperative hemodynamic and cineangiocardiographic assessment of left ventricular function in patients with aortic regurgitation.

Hemodynamic and angiocardiographic analysis was performed prior to and 14 months on the average following valve replacement in 11 patients with severe, isolated, pure, chronic aortic regurgitation.The aortic diastolic pressure, reduced prior to surgery, reverted to normal as did the cardiac index. Left ventricular filling pressure, elevated prior to surgery, returned to normal while aortic systolic pressure did not vary substantially. The markedly increased stroke volume returned to normal as did the net left ventricular stroke work. Left ventricular end-diastolic and end-systolic volumes, also markedly elevated, decreased but did not return to normal levels.The shape of the left ventricle, which was more spherical than normal during end-systole prior to surgery, as evidenced by the decrease in the systolic axis ratio, reverted to normal.The ejection fraction, severely reduced before surgery, increased moderately (46 ± 13 vs 51 ± 19 per cent) as did the extent of circumferential fiber shortening (δD) (21 ± 8 vs 27 ± 12 per cent). The mean velocity of fiber shortening ($\text{VCF}$) increased significantly (0.68 ± 0.2 vs 1.03 ± 0.47 circ./sec.), as did the mean left ventricular ejection rate (1.32 ± 0.48 vs 1.91 ± 0.76).Comparative analysis of the evolution of left ventricular function indices and of extramyocardial factors (end-diastolic fiber stretching and impedance to ejection) showed that whereas in some cases myocardial damage appeared to be irreversible, in others dramatic improvement sometimes occurred following surgery. It was not possible, however, to determine the threshold below which the damage was irreversible.It may therefore be concluded that in some patients with severe regurgitation attended by profound myocardial insufficiency, correction of the valvular defect could produce not only clinical and hemodynamic improvement, but also improvement in myocardial contractile status.     

血液采集量对凝血功能检测影响的研究

目的：探讨采血量对于凝血功能检测中各项指标的影响情况。方法：收集2012年3月～2012年10月长沙市中医医院（市八医院）心胸外科病人标本32例、血液科病人30例及正常健康者标本30例,以血液采集量不足（1.4～1.5mL）为实验组,重抽采血量合格标本（1.8mL）为对照组,运用 sysmex CA1500全自动凝血分析仪检测各组样本凝血七项（血浆凝血酶原时间（PT）、纤维蛋白原（Fbg）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原降解产物（FDP）、D 二聚体（D-D）、抗凝血酶Ⅲ（AT-Ⅲ））。运用统计学分析血液采集量对于健康者、心胸外科病人与血液内科病人凝血功能检测的影响。结果：与对照组相比,各实验组 APTT、FDP、D-D 测定值均明显增加,AT-Ⅲ明显减小,具有统计学差异。心胸外科病人则凝血七项检测值均有统计学差异。血液科病人的 PT、Fbg、TT 则无显著性差异。正常健康组 PT 无差异。结论：血液采集量影响凝血功能的检测。特别是对心胸外科的影响较血液内科病人和正常健康人更甚。     

限制性液体复苏孕兔失血性休克对凝血因子的影响

目的 探讨限制性液体复苏孕兔失血性休克时凝血因子的变化规律.方法 制作孕兔失血性休克模型,采取两种不同输液方法复苏孕免失血性休克,对比研究各组各时间点的PT、APTT、Fbg变化情况.结果 孕兔失血性休克会可导致PT、APTT时间延长,Fbg浓度降低.模型第90 min、180 min、4h限制性输液组与传统输液组相比,PT、APTT、Fbg统计学均有显著差异,P<0.01,且限制性输液组在第4h的Fbg值接近正常水平.结论 孕免失血性休克会后PT、APTT时间延长,Fbg浓度降低.限制性输液能减轻组织供氧不足状态,减少内皮细胞的损害,有效缓解了盯、PT、APTT时间的延长;同时避免了传统输液造成的酸中毒、血液稀释、组织再灌注损伤等不良反应,阻止了Fbg的进一步下降,不失为一种理想的容量复苏方法.     

脑梗塞患者血LP(a)、ox-LDL、D-D、Fbg含量的研究

本研究按不同年龄组分别测定了110例正常人和123例脑梗塞患者急性期和恢复期血中LP（a）、ox-LDL、D-D、Fbg的含量，结果显示：脑梗塞患者血中LP（a）、ox-LDL、D-D、Fbg较正常对照组显著升高（P＜0．01），并且LP（a）、ox-LDL、D-D在脑梗塞人血中呈正相关（r=0.876，P＜0．05）。正常人D-D的含量随年龄的增高有增长趋势，低年龄组与高年龄组有显著性差异（q=4．82，P＜0．01）。LP（a）、OX-LDL、Fbg含量各年龄组无差异（P＞0．05）。D-D随年龄增长塔高明显（R=0．596P＜0．01）并且与梗塞面积正相关（r=0．819，P＜0．01），而LP（a）、OX-LDL、Fbg与梗塞面积无关。同时发现D-D在脑梗塞恢复期明显降低（P＜0．05），证实了脑梗塞急性期确实存在高凝状态和内源性纤溶功能活跃。     

血浆纤维蛋白原变化及其临床意义

纤维蛋白原(Fbg)是肝脏合成产生的,它是一种应激蛋白,其增加往往是机体的一种非特异性反应。由于老年人血凝功能亢进,有血栓形成趋势,易导致一些心脑血管疾病,在其它一些常见疾病中如癌症、肝损伤、肺心病,感染等也易出现血凝亢进及其继发纤溶状态,而Fbg在血凝与纤溶状态,在对血浆粘稠度的影响方面均占有很重要的地位,因而,研究Fbg的变化时其发病机理及预防治疗等方面均有实际意义。为此我在临床工作中,对老年期和老年前期的几种老年常见疾病状态下Fbg的变化进行了统计学分析。包括正常人群中,老年人Fbg的变化。现将检验结果及分析讨论介绍如下:     

ACO患者血清Fbg、FeNO、IgE水平变化与肺功能相关性研究

目的探讨支气管哮喘-慢性阻塞性肺疾病重叠综合征(ACO)患者血清中纤维蛋白原(Fbg)、呼出气一氧化氮(FeNO)、免疫球蛋白E(IgE)的变化水平与肺功能的相关性。 方法选择2016年1月至2018年5月期间在我院接受治疗的支气管哮喘急性发作期患者56例,慢阻肺急性加重期患者51例,ACO急性加重期患者45例,同时选取50例健康者作为对照。检测受试对象的外周血嗜酸性粒细胞数量、Fbg和IgE水平、FeNO以及肺功能指标。采用Pearson相关性分析Fbg、FeNO、IgE与1 s用力呼气容积(FEV₁),FEV₁改善值,用力肺活量(FVC)的关系。绘制受试者工作特征(ROC)曲线,并计算Fbg、FeNO、IgE指标曲线下面积(AUC)。 结果①三组患者嗜酸性粒细胞数量和血浆IgE水平明显高于对照组(P<0.05);但是三组患者之间比较,未见统计学差异(P>0.05)。ACO患者血清Fbg水平高于哮喘组患者(P<0.05),FeNO检测值高于慢阻肺患者(P<0.05);②ACO患者FEV₁、FEV₁改善值和FVC值明显高于对照组和慢阻肺组受试者,但是FEV₁值高于哮喘组患者,而FEV₁改善值和FVC值低于哮喘组患者(P<0.05);③ACO患者血浆Fbg水平与FEV₁、FEV₁改善值和FVC值均呈负相关性(P<0.05),而FeNO值仅与FEV₁值呈负相关性(P<0.05)。而血浆IgE水平与FEV₁改善值呈正负关性(P<0.05);④经ROC曲线分析,Fbg、FeNO、IgE联合检测ROC曲线的AUC为0.892(95%CI：0.773-0.948),敏感性和特异性分别为89%和78%。 结论Fbg、FeNO和IgE与ACO患者肺功能指标密切相关,有助于临床鉴别ACO、支气管哮喘以及慢性阻塞性肺疾病。     

子痫前期患者高血黏度原因探讨

目的:通过测定子痫前期妇女血清血脂和血浆纤维蛋白原水平,探讨其临床意义。方法:对68例子痫前期及32例正常妊娠妇女,采用生化分析仪定量检测空腹血清血脂和血浆纤维蛋白原水平。结果:重度子痫前期患者血清胆固醇、甘油三酯、极低密度脂蛋白和血浆纤维蛋白原水平均明显增高(P<0.05),但轻度子痫前期患者与正常妊娠妇女间差异无显著性。结论:血清胆固醇、甘油三酯、极低密度脂蛋白和血浆纤维蛋白原水平在妊高征患者中明显升高,并与疾病严重程度相一致,而高脂血症和血液的高凝状态均可致子痫前期患者血黏度升高。     

凝血功能变化对术后脓毒症预后的影响

目的探讨术后脓毒症患者凝血功能的变化,为临床诊治提供科学依据。方法将入住综合ICU的57例外科术后患者分为脓毒症组（37例）和非脓毒症组（20例）,另选健康对照组20例,再将37例脓毒症患者按照预后分为存活组和死亡组,分别检测血小板数（PLT）、凝血酶原时间（阿）、凝血酶时间（TT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（Fbg）、D-二聚体（DD）6项涉及到与凝血功能有关的实验室指标。结果脓毒症组的TT、PT、APTT、DD均高于非脓毒症组和对照组（P〈0．05）;脓毒症组的PLT、Fbg均低于非脓毒症组及对照组（P〈0．05）。脓毒症组的死亡组与存活组比较,APTT延长,PLT降低,DD升高,并与预后有显著相关性（P〈0．05）。结论脓毒症时存在凝血系统功能紊乱,机体抗凝物质减少。PLT、APTT、DD的检测对判断脓毒症的预后及评价病情严重程度有一定指导意义。     

The monoclonal antibody that recognizes an epitope in the C-terminal region of the fibrinogen alpha-chain reacts with soluble fibrin and fibrin monomer generated by thrombin but not with those formed as plasmin degradation products

INTRODUCTION: The presence of soluble fibrin (SF) provides evidence of thrombin activation in the blood; therefore, SF is a useful marker for diagnosing blood coagulation diseases such as disseminated intravascular coagulation (DIC). The antibody that specifically detects SF could be a useful tool for diagnosing thrombotic diseases. MATERIALS AND METHODS: By using an acid-solubilized desAA-FM (fibrin monomer) as an immunogen, we developed a monoclonal antibody, namely J2-23, which specifically reacts with SF and FM. We examined the specificity of J2-23 by ELISA and immunoblotting and confirmed the reactivity of J2-23 with SF and FM by gel filtration. RESULTS AND CONCLUSIONS: J2-23 specifically reacted with SF, but not with fibrinogen or plasmic fibrinogen-derived Fbg-X, Fbg-Y, Fbg-E, and D; thrombin-treated Fbn-X, Fbn-Y, and Fbn-E; and plasmic cross-linked fibrin (DD, XDP). The epitope recognized by J2-23 was located within the Aalpha 502-521 region on the C-terminal of the fibrinogen alpha-chain. The reactivity of J2-23 disappeared following the action of the fibrinolytic enzyme plasmin. Furthermore, J2-23 reacted not only with SF but also with FM in plasma from DIC patients. This indicated that J2-23 specifically detected coagulation without reflecting the plasmin action. We demonstrated the potential of J2-23 as a useful antibody for detecting SF for diagnosing blood coagulation.     

乙型肝炎后肝硬化病人凝血功能变化指标检测的临床意义

目的研究乙型肝炎后肝硬化病人凝血功能变化与Child-Pugh肝功能分级的关系。方法测定88例乙型肝炎后肝硬化病人与28例健康者的凝血酶原时间（PT）、活化部分凝血酶时间（APTT）、纤维蛋白原。结果乙型肝炎后肝硬化病人存在不同程度凝血功能障碍，PT、APTT、Fbg水平与对照比较，差异有非常显著性，检测结果显示A、B、C级之间PT、APTT、Fbg相互比较，差异有非常显著性。结论乙型肝炎后肝硬化病血浆PT、APTT、Fbg，可作为判定病变程度的指标，可对预后作出有价值的判断，为治疗提供依据。