血栓通注射液联合利伐沙班治疗髋关节置换术后下肢深静脉血栓的疗效观察

目的探究血栓通注射液联合利伐沙班治疗髋关节置换术后下肢深静脉血栓的临床疗效。方法选取2011年11月—2014年11月在延安大学附属医院骨科接受髋关节置换术后发生下肢深静脉血栓的患者78例,按照治疗方案不同分为对照组和治疗组,每组各39例。对照组口服利伐沙班片,1片/次,1次/d。治疗组在对照组治疗的基础上静脉滴注血栓通注射液,5 m L溶于0.9%生理盐水250 m L中,1次/d。两组均连续治疗14 d。观察两组的临床疗效,比较两组治疗前后D-二聚体、患肢膝上差、膝下差、静脉血流速度、激活部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)的变化情况。结果治疗后,对照组和治疗组的总有效率分别为84.62%、97.44%,两组比较差异有统计学意义(P0.05)。治疗后,两组D-二聚体、膝上差、膝下差、FIB均显著降低,患侧血流速度、APTT、PT、TT显著升高,同组治疗前后差异具有统计学意义(P0.05);且治疗组这些观察指标的改善程度优于对照组,两组比较差异具有统计学意义(P0.05)。结论血栓通注射液联合利伐沙班治疗髋关节置换术后下肢深静脉血栓具有较好的临床疗效,可显著改善患者的凝血状态,具有一定的临床推广应用价值。     

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。     

脂肪乳对PT、APTT和Fib凝血结果的影响与对策

目的探讨减少脂肪乳对凝血酶原(PT)、部分凝活酶时间(APTT)和纤维蛋白原(Fib)干扰的方法。方法制备正常新鲜混合血浆并检测PT、APTT、Fib;在正常新鲜混合血浆中加入不同浓度的脂肪乳并检测其PT、APTT和Fib,取均值计算干扰物影响度,同时在强生干化学分析仪VITRO FS5.1上检测血浆指数,并分析血浆指数与脂肪乳干扰之间的关系。通过CS2000i自带的稀释功能,寻找最佳的稀释倍数,减少脂肪乳对Fib的干扰。结果当添加干扰物脂肪乳4.76%体积分数时,对PT、APTT和国际标准化比值(INR)影响均7.5%,未超过1/2 CLIA’88规定的允许误差;脂肪乳添加的体积与血浆指数存在良好的线性相关:y=18.284x+4.557 9,R2=0.993 3;脂肪乳添加的体积与衍算纤维蛋白原(PT-der fibrinogen,PT-DFbg)添加前后的差值也存在良好的线性相关:y=0.146 9x-0.891 4(x≥6),R2=0.961 7;标本稀释可以很好地消除脂肪乳对Fib检测结果的干扰。结论利用血浆指数,可以减少一定浓度内脂肪乳对PT、APTT和Fib的干扰,标本稀释可以很好地消除脂肪乳对Fib检测结果的干扰。     

Utility of a weight-based heparin nomogram for patients with acute coronary syndromes

Abstract
Background:  Unfractionated heparin has been pivotal in the management of acute coronary syndromes (ACS), and continues to be used widely despite the emerging role of low molecular weight heparins (LMWH). The apparent superiority of LMWH over unfractionated heparin may, at least partially, reside in its more predictable achievement of therapeutic effect, with high rates of non-therapeutic activated partial thromboplastin time (APTT) results being observed in the intravenous heparin treatment groups.
Aim:  To evaluate the impact of introduction of a weight-based heparin nomogram developed for use in patients with ACS on frequency of 'therapeutic' APTT results.
Methods:  The effectiveness of an existing non-weight-based heparin nomogram in achieving a therapeutic APTT was compared sequentially with that of a weight-based heparin nomogram in 89 and 84 consecutive patients admitted with a diagnosis of ACS.
Results:  Patients in whom heparin dosage adjustment was weight based rapidly achieved therapeutic APTT. The median time to achieve an APTT within the target range was 8.75 h in the weight-based group versus >24 h in the non-weight-based group. Utilization of a weight-based nomogram was associated with markedly increased proportions of readings within the therapeutic APTT range at 6 h and at 24 h (51% vs . 26% and 72% vs . 36%, respectively).
Conclusions:  The current study confirms the marked superiority of the weight-based heparin regimen for treatment of patients with ACS. The nomogram dramatically facilitated the attainment of therapeutic APTT, and may represent the optimal method for titration of heparin dosage to individual heparin requirements in patients with ACS. (Intern Med J 2003; 33: 18−25)     

实验条件对PT和APTT测定值的影响

目的 了解实验因素或者人为因素所造成的如溶血对血浆凝血酶原时间测定(PT),活化部分凝血活酶时间测(APTT)的影响,改变和指导实验室检测及加强与临床的沟通.方法 用半自动血凝仪仪器法(武汉中泰生物)检测,严格按标准操作规程操作.结果 溶血对测定结果的影响,无溶血与溶血组之间PT结果有显著性差异(P<0.05),不同溶血程度之间无显著性差异.APTT无溶血组与溶血组之间有显著性差异,不同溶血程度之间有显著性差异(PAPTT有显著性差异(P＜0.05),轻度乳糜血和中度乳糜血之间无差异,重度乳糜血标本测定不出结果.结论 对于凝血项目的 测定时,严格按标本采集的标准进行标本采集,避免溶血的发生,得到更加可靠的检测结.     

Safety evaluation of Lactobacillus pentosus strain b240

Lactobacillus pentosus has a long history of use in cooked and uncooked fermented foods. Viable and heat-killed nonviable preparations of L. pentosus strain b240 were evaluated for short term and subchronic toxicity and genotoxic potential. Dose levels were determined through acute oral toxicity tests with viable (LD₅₀ > 2500 mg/kg) and nonviable (LD₅₀ > 2000 mg/kg) b240. In the short term study, rats received 2500 mg/kg/day (∼1.7 × 10¹¹ cfu/kg/day) viable b240 for 28 days. In the subchronic study, rats received 500, 1000 or 2000 mg/kg/day (up to ∼3.0 × 10¹² cfu equivalents/kg/day) nonviable b240 for 91 days followed by a 28-day recovery. No mortalities occurred. No treatment-related effects were identified for general condition, body weight, food-water consumption, ophthalmology, urinalysis, hematology, blood chemistry, organ weights, histopathology and gross pathology. Although statistically significant effects were noted for several endpoints in the short term and subchronic studies, none were related to the test materials. The NOAEL for nonviable b240 was 2000 mg/kg/day, the highest dose tested. Additionally, nonviable b240 (?5000 μg/plate) was not mutagenic in Salmonella typhimurium or Escherichia coli tester strains nor did nonviable b240 orally administered to rats at levels ? 2000 mg/kg/day for two days, induce a clastogenic response.     

阿藿烯对大鼠抗血栓活性作用研究

目的:研究阿藿烯对大鼠血栓形成和凝血功能的影响,评价其抗血栓活性。方法:将SD大鼠随机分为空白对照组、血塞通阳性药组(50mg/kg)、阿藿烯低剂量组(25mg/kg)、中剂量组(50mg/kg)、高剂量组(75mg/kg),各组动物连续灌胃5d,末次给药2h后建立下腔静脉结扎模型、FeCl3致动脉血栓模型、断尾流血时间测定模型测定阿藿烯对血栓形成和凝血的影响;并测定各组大鼠给药前及给药后2h血浆凝血酶原时间(PT)、活化部分凝血酶时间(APTT)。结果:阿藿烯能抑制动静脉血栓的形成,使血栓重量降低,且高剂量阿霍烯对动静脉血栓形成的抑制率均大于40%;同时有效延长大鼠断尾流血时间,并能使大鼠血浆APTT、PT明显延长(P<0.05),且都具有剂量依赖关系。结论:阿藿烯有抗血栓活性。     

APTT ACTIN FSL试剂对APTT及Ⅷ因子检测的影响

目的探讨Siemens公司活化部分凝血活酶时间(APTT)ACTIN FSL试剂对APTT及Ⅷ因子检测的影响。方法选取20例标本分别使用APTT ACTIN和APTT ACTIN FSL 2种试剂检测APTT,比较阴阳性符合率。选取70例标本分别使用以上2种试剂检测Ⅷ因子,比较阴阳性符合率。选取120例体检者建立APTT及Ⅷ因子新的生物参考区间。选取20例体检者及20例确诊静脉血栓或血友病的患者验证新建参考区间的适用性。结果改用APTT ACTIN FSL试剂后重新建立APTT和Ⅷ因子的生物参考区间分别为25.2~32.6 s和60%~189%。使用新的生物参考区间,明显提高了APTT及Ⅷ因子使用2种试剂检测结果的阴阳性符合率,分别为95.0%和90.0%。分别采用体检者及患者APTT及Ⅷ因子的结果验证新参考区间均为合格。结论将Siemens公司的APTT ACTIN试剂升级为APTT ACTIN FSL试剂后,对APTT及Ⅷ因子的检测影响较大,实验室应修改或重新建立新的生物参考区间,并进行验证。     

The responsiveness of different APTT reagents to mild factor VIII,IX and XI deficiencies

Introduction: The sensitivity of APTT reagents to deficiencies of factors VIII, IX, XI and XII varies because of their composition. The APTT is used as a screening test for these factors, and a deficiency should manifest with a prolongation to the APTT, which may trigger the need for specific factor assays to be performed. Methods: The suitability of APTT reagents to detect mild deficiencies can be assessed by the analysis of the APTT of plasma, which has an increasing concentration of the factor in question. The APTT responsiveness can be determined from the intersection of the curve and the upper limit of the APTT normal reference range for that APTT reagent. We assessed the APTT responsiveness (in U/dl) to factors VIII, IX and XI of four APTT reagents; Actin FS (Siemens), Synthasil (IL), STA‐PTTA (Stago) and Dapttin (Technoclone). Results: Actin FS was the most sensitive reagent to mild reductions of factors VIII, IX and XI [Correction added on 26 October 2010, after first online publication: Synthasil was corrected to Actin FS]. STA‐PTTA showed less sensitivity than Synthasil and Actin FS; Dapttin was insensitive to mild deficiencies of factors IX and XI and should not be used as a screening test. Conclusion: Both Synthasil and Actin FS are acceptable reagents to screen for reduced factors VIII, IX and XI, and the number of mildly reduced factors not diagnosed will be limited.     

Uneventful Cesarean Delivery with Administration of Factor XI Concentrate in a Patient with Severe Factor XI Deficiency

Factor XI (FXI) is a procoagulant factor and antifibrinolytic agent, and its absence causes a bleeding tendency. FXI deficiency is autosomal in inheritance, with severe FXI deficiency in homozygotes and partial deficiency in heterozygotes. A 24-year-old primigravida with an uneventful pregnancy and no history of bleeding manifestations was admitted to our department at 38 weeks of gestation. Her blood count and serum biochemistry findings were normal except for a coagulation screen, which revealed a prolonged activated partial thromboplastin time (APTT) of 63 seconds (normal range, 24-35 seconds). The measured FXI coagulant activity of 8 IU/dL (reference range, 70-150 IU/dL) established a diagnosis of severe FXI deficiency. The breech presentation of the fetus prompted the decision for cesarean delivery under general anesthesia. We administered a single dose of FXI concentrate (15 IU/kg), which corrected the APTT to 34 seconds. The cesarean delivery was uncomplicated, and postpartum recovery of the mother and her baby was uneventful with no bleeding complications. The finding of an isolated prolonged APTT should prompt obstetricians to consider FXI deficiency. The appropriate use of factor FXI concentrate in managing obstetric patients with FXI deficiency can minimize potential bleeding complications and ensure an optimal outcome for both mother and neonate.