老年心力衰竭患者肾素-血管紧张素系统与纤溶活性变化的意义

目的探讨老年心力衰竭(HF)患者血浆肾素-血管紧张素系统(RAS)与纤溶活性的变化。方法老年HF患者46例(HF组),非器质性心脏病住院患者18例(对照组),取静脉血分别检测血浆纤溶酶原激活剂抑制物1(PAI-1)、组织纤溶酶原激活剂(t-PA)活性、血浆肾素活性(RA)及血管紧张素Ⅱ(AngⅡ)含量。结果老年HF患者血浆RA、PAI-1活性、AngⅡ含量明显高于对照组(P<0.05),t-PA活性则降低(P<0.05);血浆PAI-1活性与AngⅡ含量水平呈显著正相关(r=0.396,P<0.01)。结论老年HF过程中血浆RAS激活对纤溶活性改变有重要影响。     

血清肾脏功能指标、炎症指标及凝血-纤溶指标与脑小血管病的关系

目的探讨血清肾脏功能指标、炎症指标及凝血-纤溶指标与脑小血管病(CSVD)的关系。方法收集68例CSVD患者及30例头颅MRI和神经系统查体均正常者的临床资料,并检测相关血液指标。入院后行头颅MRI检查,根据MRI结果将CSVD患者分为急性亚组和慢性亚组。结果对照组与CSVD组年龄、高血压病比率、胱抑素C、尿酸、肾小球滤过率、纤维蛋白原、D-二聚体、超敏C反应蛋白(hs-CRP)水平差异有统计学意义(均P<0.05)。CSVD组急性亚组及慢性亚组血肌酐水平、白细胞计数差异有统计学意义(均P<0.05)。调整混杂因素后,年龄、高血压病、胱抑素C、尿酸、hs-CRP及D-二聚体为CSVD的独立危险因素(均P<0.05);慢性CSVD的独立危险因素与CSVD相同(均P<0.05),而急性CSVD的独立危险因素为年龄、高血压病、胱抑素C、尿酸和D-二聚体(均P<0.05)。结论年龄、高血压病、胱抑素C、尿酸、CRP及D-二聚体是CSVD及慢性CSVD的独立危险因素,年龄、高血压病、胱抑素C、尿酸和D-二聚体是急性CSVD的独立危险因素。     

Effects of Xuezhikang capsule on blood lipids, platelet activation and coagulation-fibrinolysis activity in patients with hyperlipidemia

Objective: To investigate the effects of Xuezhikang capsule (XZK) on blood lipids level, platelet activation and coagulation-fibrinolysis activity in patients with hyerlipidemia.Methods: Seventy-six patients of hyperlipidemia were randomly divided into two groups, the XZK group (n = 38) treated with XZK 600mg, taken two times per day and the Simvastatin (SIM) group (n = 38) treated with SIM 20mg per day, with the treatment lasting 8 weeks for both groups. Levels of fasting serum lipids, including total cholesterol (TC), triglyceride (TG), high and low density lipoprotein cholesterol (HDL-C and LDL-C), plasma GMP-140, fibrinogen (FIB), tissue plasminogen activator (t-PA), plasminogen activator inhibitor type-1 (PAI-) and prothrombin time (PT) were all measured before and 8 weeks after treatment. Data were compared before and after treatment and also compared with those measured in 20 healthy subjects of control.Results: Before treantment the levels of TC, TG and LDL-C were obviously higher and HDL-C level was significantly lower in hyperlipidemia patients than those in healthy subjects (P<0.05 orP<0.01). After 4–8 weeks of XZK treatment, the levels of TC, TG, LDL-C and FIB and activities of GMP-140 and PAI-1 were obviously lowered (P<0.05 orP<0.01). But in the SIM group there was no obvious change in FIB (P>0.05), instead it showed obvious increase of HDL-C and decrease of TC and LDL-C after treatment (P<0.05 orP<0.01).Conclusion: XZK could inhibit platelet activity and improve coagulation-fibrinolysis function, besides its lipids lowering effect.     

Effects of Xuezhikang Capsule(血脂康胶囊) on Blood Lipids,Platelet Activation and Coagulation-Fibrinolysis Activity in Patients with Hyperlipidemia

Objective: To investigate the effects of Xuezhikang capsule (XZK, 血脂康胶囊) on blood lipids level, platelet activation and coagulation-fibrinolysis activity in patients with hyerlipidemia. Methods:Seventy-six patients of hyperlipidemia were randomly divided into two groups, the XZK group (n = 38) treated with XZK 600mg, taken two times per day and the Simvastatin (SIM) group (n = 38) treated with SIM 20mg per day, with the treatment lasting 8 weeks for both groups. Levels of fasting serum lipids, including total cholesterol (TC), triglyceride (TG), high and low density l ipoprotein cholesterol (HDL-C and LDL-C),plasma GMP-140, fibrinogen (FIB), tissue plasminogen activator (t-PA), plasminogen activator inhibitor type-1 (PAl-) and prothrombin time (PT) were all measured before and 8 weeks after treatment. Data were compared before and after treatment and also compared with those measured in 20 healthy subjects of control. Results: Before treantment the levels of TC, TG and LDL-C were obviously higher and HDL-C level was significantly lower in hyperlipidemia patients than those in healthy subjects ( P＜0.05 or P＜0.01). After 4-8 weeks of XZK treatment, the levels of TC, TG, LDL-C and FIB and activities of GMP-140 and PAl-1 were obviously lowered (P＜0.05 or P＜0.01). But in the SIM group there was no obvious change in FIB (P＞0.05), instead it showed obvious increase of HDL-C and decrease of TC and LDL-C after treatment ( P＜0.05 or P＜0.01). Conclusion: XZK could inhibit platelet activity and improve coagulation-fibrinolysis function, besides its lipids lowering effect.     

芪龙胶囊对大鼠血浆凝血-纤溶系统的影响

目的观察芪龙胶囊对大鼠凝血,纤溶系统的影响。方法小鼠眼眶取血测定凝血时间,大鼠取抗凝血测定凝血因子和优球蛋白降解时间(ELT),采用 FeCl_3所致单侧大脑中动脉凝闭所致局灶性脑缺血模型(MCAO),用发色底物法和酶联免疫分析法测定血浆中分子标志物的。结果芪龙胶囊0.84、0.42g/kg 组可明显延长正常小鼠凝血时间(P<0.01);芪龙胶囊0.6g/kg 组对大鼠凝血酶时间(TT)、凝血酶原时间(PT)、部分凝血活酶时间(APTT)均有明显延长作用,芪龙胶囊0.3g/kg 组对大鼠 TT、PT 有明显延长作用(P<0.05,P<0.01;芪龙胶囊0.6、0.3g/kg 组对正常大鼠 ELT 有明显缩短作用(P<0.05;P<0.01);芪龙胶囊0.6、0.3g/kg 组可显著降低模型血浆纤维蛋白原(Fbg)含量,提高模型血浆抗凝血酶Ⅲ(AT-Ⅲ)活性,还可显著提高模型血浆组织型纤溶酶原激活物(t-PA)活性(P<0.01),降低纤溶酶原抑制物(PAI)活性(P<0.01),提高 t-PA/PAI(P<0.01),降低纤溶酶原(Plg)活性(P<0.01),提高 D 二聚体和纤维蛋白降解产物(FDP)含量...     

丹红注射液联合磺达肝癸钠治疗肺栓塞的临床研究

目的探讨丹红注射液联合磺达肝癸钠治疗肺栓塞的临床效果。方法选取2015年1月—2017年12月延安市人民医院收治的肺栓塞患者98例,随机分成对照组(49例)和治疗组(49例)。对照组皮下注射磺达肝癸钠注射液,2.5 mg/次,1次/d,第4天联用华法林进行抗凝治疗,联用5 d,当国际标准化比值(INR)稳定在2~3时,于治疗5 d后停用磺达肝癸钠,继续服用华法林。治疗组在对照组的基础上静脉滴注丹红注射液,20 m L加入250 m L生理盐水,1次/d。两组均连续治疗14 d。观察两组患者临床疗效,同时比较治疗前后两组患者主要症状缓解时间、动脉血氧分压(p O_2)值、肺动脉阻塞指数(PAOI)、肺动脉收缩压(PASP)、心肌肌钙蛋白I(c Tn I)、右室舒张末期内径(RVd)、凝血酶原时间(PT)、血小板计数(PLT)、纤维蛋白原降解产物(FDP)、D-二聚体(D-D)、补体C3、白细胞介素-6(IL-6)及外周血CD4~+/CD8~+、CD3~+水平。结果治疗后,对照组临床有效率为71.4%,显著低于治疗组的87.8%,两组比较差异具有统计学意义(P0.05)。治疗后,治疗组患者发绀、胸痛和呼吸困难缓解时间均显著短于对照组(P0.05)。治疗后,两组p O_2值较治疗前均显著增加(P0.01),PAOI、PASP、RVd值和血清c Tn I水平均显著降低(P0.01),且治疗后治疗组p O_2、PAOI、PASP、RVd值和血清c Tn I明显优于对照组(P0.01)。治疗后,两组PT、PLT值均显著升高(P0.01),血清FDP、D-D水平显著下降(P0.01),且治疗后治疗组上述凝血–纤溶指标明显优于对照组(P0.01)。治疗后,两组血清补体C3、IL-6水平及外周血CD4~+/CD8~+比值较治疗前明显降低(P0.05),外周血CD3~+值均明显升高(P0.05),且治疗后治疗组免疫学指标明显优于对照组(P0.05)。结论丹红注射液联合磺达肝癸钠治疗肺栓塞可明显改善患者病情,调控体内凝血–纤溶系统,抑制炎性反应,调节细胞免疫,疗效显著。     

谷红注射液联合丹参多酚酸盐治疗急性脑梗死的临床研究

目的探讨谷红注射液联合丹参多酚酸盐治疗急性脑梗死的临床效果。方法选取2016年5月—2019年5月山东省耳鼻喉医院(山东省立医院西院)收治的脑梗死患者400例,随机分为对照组(200例)和治疗组(200例)。对照组静脉滴注注射用丹参多酚酸盐,200 mg/次加入生理盐水250 mL,1次/d。治疗组在对照组基础上静脉滴注谷红注射液,20 mL/次加入生理盐水250 mL,1次/d。两组患者均治疗2周。观察两组患者临床疗效,同时比较治疗前后两组患者血浆黏度、全血低切黏度、血浆纤维蛋白原、全血高切黏度,以及肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、丙二醇(MDA)、超氧化物歧化酶(SOD)、单个核细胞血红素加氧酶(HO-1)和转录因子红系衍生核因子E2相关因子2(Nrf2)水平。结果治疗后,对照组和治疗组临床有效率分别为86.00%和92.50%,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者血浆黏度、全血低切黏度、血浆纤维蛋白原和全血高切黏度均显著低于治疗前(P0.05),且治疗组比对照组更低(P0.05)。治疗后,两组患者TNF-α、IL-6、MDA水平均较治疗前显著降低(P0.05),而SOD、HO-1和Nrf2水平显著高于治疗前(P0.05),且治疗组患者上述指标明显好于对照组(P0.05)。结论谷红注射液联合丹参多酚酸盐治疗脑梗死疗效确切,可明显减轻炎性及氧化应激反应,安全性高。     

Evaluation of coagulation and fibrinolysis in haemodialysis patients at different haematocrit levels: Comparison between patients with and without diabetes

SUMMARY: There is an insufficient number of reports concerning the optimal haematocrit level for haemodialysis patients with diabetes. Although many reports have indicated that recombinant human erythropoietin (rHuEPO) therapy does not influence the incidence of intravascular thrombosis, no study has focused its attention on the difference of the coagulation-fibrinolysis system between haemodialysis patients with and without diabetes. We studied eight patients with diabetes and seven patients without diabetes who had been undergoing regular haemodialysis. In all 15 patients, rHuEPO administration was started at a haematocrit level of 20% and toe haematocrit tevels were gradually increased from 20 to 30%. Coagulation and fibrinolysis functions, measured at haematocrit levels of 20,25 and 30%, respectively, were compared between the two groups. In the diabetic group, platelet count, fibrinogen, thrombin-antithrombin III complex, frtmn/fibrinogen degradation products = D dimer, platelet factor 4 and platelet adhesion were statistically higher ( P < 0.05), and plasminogen and α2-plasmin inhibitor was statistically lower ( P < 0.05) than those in the non-diabetic group, even at the 20% level. These abnormalities at the baseline were extremely enhanced in connection with haematocrit increased by rHuEPO. the diabetic group, in particular, showed greater increases of platelet factor 4, platelet adhesion and thrombomodulin and a decrease of α2-plasmin inhibitor from the 20% to the 30% level ( P < 0.05) than the non-diabetic group. These findings suggest that haemodialysis patients with diabetes generally have enhanced thrombotic parameters compared with haemodialysis patients without diabetes, and the increase of haematocrit makes the difference greater. Accordingly, the target level of haematocrit for patients with diabetes should be set separately from that of patients without diabetes.     

六味地黄丸联合黄芪三七口服液治疗早期高血压肾损害48例

目的:探讨六味地黄丸联合黄芪三七口服液对高血压早期肾损害的保护作用及对炎症因子和凝血纤溶系统的影响。方法:95例患者采用随机按数字表法分为对照组47例和联合组48例。对照组口服马来酸依那普利片,10 mg/次,1次/d;氨氯地平阿托伐他汀钙片,10 mg/次,1次/d,口服。联合组在对照组治疗的基础上加用六味地黄丸,6 g/次,3次/d,和黄芪三七口服液,10 m L/次,2次/d,口服。两组疗程均为12周。检测治疗前后24 h尿微量白蛋白(m Alb),尿微量白蛋白与肌酐的比值(ACR),胱抑素(Cys C),β2微球蛋白(β2-MG),尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG),白细胞介素-6(IL-6),肿瘤坏死因子-α(TNF-α),血浆D-二聚体(D-D)和血浆纤维蛋白原检测(FIB),尿素氮(BUN)和肌酐(Cr);进行治疗前后肝肾阴虚兼血瘀证评分。结果:经Ridit分析,联合组血压控制情况及中医证候疗效均优于对照组(P0.05);治疗后联合组m Alb和ACR水平低于对照组(P0.01),两组BUN和Cr治疗前后变化不明显,均在正常范围内;治疗后联合组Cys C,β2-MG和NAG水平均低于对照组(P0.01);治疗后联合组D-D,FIB,IL-6和TNF-α水平均低于对照组(P0.01)。结论:采用六味地黄丸和黄芪三七口服液与西药常规疗法的联合方案对高血压早期肾损害的保护优于单纯西药治疗,其作用机制可能与减轻炎症反应,调节凝血纤溶系统有关。     

低分子肝素钙联合他克莫司治疗膜性肾病的临床研究

目的 探讨低分子肝素钙联合他克莫司治疗膜性肾病的临床效果。方法 选取2016年1月—2018年6月陕西省人民医院收治的膜性肾病患者94例,随机分成对照组（47例）和治疗组（47例）。对照组餐前1 h口服他克莫司胶囊,0.05 mg/（kg·d）,2次/d。治疗组在对照组基础上腹壁皮下注射低分子肝素钙注射液,5000 AXa单位/次,1次/d。两组均连续治疗4周。观察两组患者临床疗效,同时比较治疗前后两组患者24 h尿蛋白定量（24 h-UTP）、肌酐（Cr）、白蛋白（ALB）、总胆固醇（TC）、三酰甘油（TG）及凝血纤溶指标及炎性因子水平。结果 治疗后,对照组和治疗组的总有效率分别为78.7%和93.6%,两组比较差异具有统计学意义（P<0.05）。治疗后,两组24 h-UTP及血清Cr、TC、TG水平较治疗前均显著降低（P<0.05）,血清ALB浓度均显著升高（P<0.05）,且治疗后治疗组24 h-UTP、Cr、ALB、TC、TG水平明显优于对照组（P<0.05）。治疗后,两组患者血浆纤维蛋白原（FIB）、血管性血友病因子（vWF）水平及血清D-二聚体（D-D）、白介素-4（IL-4）、IL-10水平均显著下降（P<0.05）,且治疗组上述凝血纤溶指标和炎性因子明显低于对照组（P<0.05）。结论 低分子肝素钙联合他克莫司治疗膜性肾病可明显减轻患者症状,改善凝血纤溶状态,抑制炎症反应,保护肾功能。