蚓激酶对中风后遗患凝血—纤溶功能影响的前瞻性，随机、双盲对照研究

目的：探讨蚓激酶（普恩复）对凝血纤溶系统的作用。方法：采用前瞻性、随机、双盲对照研究的方法,对52例缺血性中风慢性期患者服药前后行神经功能缺失评分,血浆中KPTT、PT、FIB,t-PA,PAI-1,D-dimer,vWF、血小板聚集率进行测定。结果：患者口服6个月后（400mg,3次／日）神经功能缺失评分减少（P＜0．05）,FIB减少（P＜0．05）,t－PA活性明显增强（P＜0．01）,vWF含量明显降低（P＜0．01）,以上指标在安慰剂组无明显变化（P＞0．05）。 治疗组、安慰剂组KPTT、PT、PAI－1在用药前后均无明显变化（P＞0．05）。6个月时血小板聚集率抑制最大,聚集率的抑制与vWF的降低呈显著正相关（P＜0．05）与t－PA活性的增强呈显著负相关（P＜0．05）。结论：蚓激酶对缺血性中风慢性期患者所起的作用与纤溶激活,血小板聚集的抑制有关。     

实验性心肌梗塞大鼠冠脉等组织纤溶因子表达的变化

通过观察大鼠实验性急性心肌梗塞（AMI）时，冠状动脉及周围心肌组织组织型纤溶酶原激活剂（t－PA），及其特异性抑制因子（PAI－1）基因表达及t－PA活性变化，从纤洛因子失衡方面探讨AMI发病机理，并研究缺血预处理调整纤溶功能的保护作用。结果表明，缺血和缺血再灌时组织t－PA活性均显著降低（P＜0．01），经预处理的缺血心肌t－PA活性有所升高（与缺血组相比P＜0．01）。AMI时t－PA、PAI－1表达均呈高水平，分别为对照组的1．19信和4．59倍而预处理组表达减弱。说明t－PA、PAI－1失衡参与AMI发展过程，缺血预处理对心肌的保护可能与纠正上述纤溶因子失衡有关。     

金纳多改善冠心病高粘状态的临床观察

将冠心病伴血液高粘状态60例随机分为（1）对照组：用常规药物治疗；（2）金纳多组：在常规治疗基础上加用金纳多。对照组总有效率73．3％。金纳多组总有效率是90．1％（P＜0．01）。发现金纳多组红细胞压积明显降低（P＜0．01），血浆粘度及血小板聚集率降低，血浆纤溶酶原激活剂抑制物（PAI）活性降低，血浆组织型纤溶酶原激活剂（t－PA）活性升高。在高放大倍数布氏显微镜视野下，用药后血小板呈解聚集状态。结果揭示：金纳多能明显改善冠心病时的高粘状态，尤其在抑制血小板聚集方面作用明显，并且无副作用，是临床有前途的防治冠心病药物。     

胺碘酮、美托洛尔对家免急性心肌梗死血小板活化、纤溶活性、内皮血管活性物质的影响

目的：探讨胺碘酮、美托洛尔对兔急性心肌梗死(AMI)血小板活化、纤溶活性、内皮血管活性物质的影响。方法：新西兰家兔50只，随机分为5组，每组10只。I组：假手术组，Ⅱ组：AMI组，Ⅲ组：AMI 利多卡因组，Ⅳ组：AMT 胺碘酮组，Ⅴ组：AMI 美托洛尔组；Ⅱ、Ⅲ、Ⅳ、Ⅴ组分别结扎冠状动脉左室支中点后，4h取血分别测定血栓素B2(TXB2)、6—酮—前列腺素F1a(6—Keto—PGF1a)、内皮素(ET)、一氧化氮(NO)和组织型纤溶酶原激活剂(t—PA)、纤溶酶原微活剂抑制物(PAI)水平；摘取心脏，测定心肌梗死范围。结果：Ⅱ、Ⅲ、Ⅳ、Ⅴ组血浆TXB2、ET、NO浓度和则活性显著高于I组(P＜0．01)，6—Keto—PGF1a浓度和t—PA活性显著低于I组(P＜0．01)，Ⅱ、Ⅲ、Ⅳ组之间比较，血浆TXB2、6—Keto—PGF1a。浓度、t—PA活性及心肌梗塞范围无显著差异(P＞0．05)，Ⅳ组血浆ET、NO浓度和PAI水平明显低于Ⅱ组（P＜0．01)，Ⅴ组血浆TXB2、ET、NO浓度和PAI水平明显低于Ⅱ组(P＜0．01)，6—Keto—PGF1Aa。浓度、t—PA活性显著高于Ⅱ组(P＜0．01)，心肌梗塞范围小于Ⅱ组(P＜0．01)。结论：胺碘抑制AMI早期PAI活性，减少ET和NO的释放；美托洛尔抑制AMI早期血小板活化，改善纤溶活性，减少ET和NO的再释放，缩小心肌梗塞范围。利多卡因无上述作用。     

锡类散凝胶对兔输液性静脉炎治疗效果的初步观察

目的探讨锡类散凝胶对兔实验性输液性静脉炎的治疗效果及可能机制。方法将大白兔随机分为对照组、静脉炎组和锡类散治疗组，每组20只。静脉炎组在耳缘静脉注射甘露醇构建实验眭输液性静脉炎动物模型，对照组以生理盐水替代甘露醇，治疗组在造模前经锡类散预处理；在造模后相应的时间点检测兔血浆中TT（凝血酶时间）、PT（凝血酶原时间）、APTT（活化部分凝血酶时间）、PAI-1（I型纤溶酶原激活物抑制因子）和t—PA（组织型纤溶酶原激活剂）含量，并作病理学检查及评分，最后进行统计分析。结果治疗组与静脉炎组相比较（P〈0．05），能明显纠正因甘露醇而造成的高凝状态，有效降低血清t—PA水平及减轻输液静脉损害；而PAI—1含量在三组之间没有统计学差异（P〉0．05）。结论锡类散凝胶能有效改善甘露醇所致的输液胜静脉炎损害，其机制可能通过抑制血清t—PA升高而发挥治疗作用。     

脑梗塞患者甘油三脂与纤溶活性异常的研究

目的 :探讨脑梗塞患者血高甘油三酯与纤溶系统异常的危险因素。方法 :采用酶联免疫吸附双抗体夹心法、酶法 ,对 5 1例脑梗塞患者及 5 0例健康对照组血组织型纤溶酶原激活物 (t PA) ,纤溶酶原激活物抑制物 1(PAI 1)和甘油三酯 (TG)水平进行了对比分析。结果 :血高TG、高PAI 1,与低t PA含量变化为脑梗塞患者异常变化特征 ,与正常组相比有显著性差异 (P <0 .0 1)。结论 :高甘油三酯通过改变纤溶活性是诱发脑梗塞疾病发生、发展的危险生物学因素     

脑梗塞患者体外模拟血栓试验的研究

目的 探讨脑梗塞病人的体外模拟血栓试验的意义。方法 用标准摆动式旋转CAST法对深圳市43例脑梗塞患者和51例健康人进行体外模拟血栓指数的试验，并对30例患者用降纤酶治疗和治疗前后进行比较。结果 患者模拟血栓湿重和指数Q值与健康人有显著差异（P＜0．05），血栓长度改变不明显（P＞0．05）；用降纤酶治疗前后，血栓长度、湿重均有显著性改变（P＜0．05）、Q值有极显著性改变（P＜0．01）。结论 对脑梗塞病人和溶栓治疗病人进行体外模拟血栓检查对了解血栓形成的趋势有积极意义。     

下肢骨折围手术期凝血-抗凝及纤溶指标动态变化的意义

目的：探讨下肢骨折患者围手术期凝血一抗凝及纤溶指标动态变化规律,指导临床有针对性预防下肢深静脉血栓形成。方法：选择下肢骨折需卧床治疗患者35例为实验组,选择上肢骨折患者30例为对照组。分别于术前、术后1d、术后3d及术后14d采集静脉血,检测血浆凝血酶原时间（PT）、活化部分凝血活酶时间（AFIT）、纤维蛋白原（FIB）、纤维蛋白（原）降解产物（FDP）、D．二聚体（D-D）、抗凝血酶活性（AT）。结果：FIB、FDP和D-D：实验组术后1d和术后14d与术前比较差异有非常显著性意义（P〈0．01）,对照组术后1d与术前比较差异有非常显著性意义（P〈0．01）;AT：实验组术后14d与术前比较差异有非常显著性意义（P〈0．01）。结论：下肢骨折患者术后局部血流减慢,FIB、FDP和D-D增高,AT降低,提示机体可能处于血栓前状态或有血栓形成。     

氦—氖激光血管内照射改善妊高征患者血液粘度的临床观察

目的：探讨低能量He－Ne激光血管内照射血液（ILIB）改善妊高征患者血粘度与临床疗效的关系。方法：对35例妊高征病例采用ILIB治疗，观察治疗前后血液流变学的改变，以及血压、头痛、头晕等症状的变化。结果：治疗后全血粘度均下降（P＜0．01或P＜0．05），收缩压，舒张压下降明显（P＜0．01），临床症状改善明显。结论：ILIB能显著降低妊高征患者的血粘度，同时降低血压，改善临床症状。     

血浆纤维蛋白原、D-二聚体联合检测对乙型肝炎临床意义的探讨

目的探讨血浆纤维蛋白原（FIB）、D-二聚体（D—Dimer，D—D）的含量在乙型肝炎病程发展中的临床意义。方法将入选的131例经消化科确诊的患者分成四组：慢性肝炎54例，急性肝炎46例，重型肝炎6例，肝硬化25例。以52例正常人为对照。用乳胶凝集法和免疫透射比浊法分别测定D．D、FIB含量。结果乙型肝炎患者存在不同程度的纤溶活性增强和凝血功能障碍。其中急性肝炎，重型肝炎，肝硬化组D—D阳性检出率明显高于慢性肝炎和对照组（P〈0．05）；重型肝炎，肝硬化FIB含量明显降低（P〈0．05）。结论联合检测D．D、FIB含量有助于病情的判断和疗效观察。     

Venous occlusion test: Assessment of fibrinolytic capacity by D-dimer latex agglutination test

The fibrinolytic capacity of 36 individuals was investigated by venous occlusion (VO) test. The specific components of fibrinolysis — plasminogen activator (t-PA) and plasminogen activator inhibitor activity (PAI) - were measured before and after 20 min VO and the subjects ,were divided into good (n=24) and poor (n=12) responders according to the presence of residual PAI activity after VO test. The ranking of the patients according to residual PAI activity correlated closely with that obtained by an index entitled the net fibrinolytic capacity (nFC) that expresses the ability of secreted t-PA to overcome PAI activity. Residual PAI and nFC were further compared with a recently published screening method based on fibrin degradation (D-dimer concentration) in a clotted blood sample obtained after VO. The D-dimer concentrations measured by a semiquantitative latex agglutination test agreed closely with the ranking of patients by residual PAI and nFC and had a close correlation with the concentrations of the specific components of fibrinolysis. We conclude that D-dimer test after 20 min VO qualifies well for screening of impaired fibrinolytic capacity.     

Acute changes of coagulation and fibrinolysis parameters after experimental thromboembolic stroke and thrombolytic therapy

Thrombolysis is the only effective pharmaceutical therapy in acute ischemic stroke in humans but has a high risk of intracerebral hemorrhage. We aimed to establish an animal model to study changes of coagulation and fibrinolytic parameters during thromboembolic ischemic stroke and thrombolysis with recombinant tissue plasminogen activator (rt-PA). We used a thromboembolic stroke model in the rat. Animals were treated with rt-PA thrombolysis (n=10) and compared with untreated (n=10), sham operated (n=10) and control animals (n=20). Coagulation parameters (APTT, PT, TT, fibrinogen, AT III, TAT) and fibrinolytic parameters (t-PA antigen concentration, t-PA activity, PAI-1 concentration, PAI activity, plasminogen, antiplasmin) were measured at two time points (2.5 and 5h after stroke induction) with a battery of commercially available test kits. We observed an (1) initiation of coagulation and inhibition of fibrinolysis by the operation procedure itself, (2) simultaneous activation of fibrinolysis and its inhibitors after stroke induction and (3) potent initiation of fibrinolysis and consumption of fibrinolysis inhibitors after rt-PA therapy of stroke. We established a model system to monitor coagulation and fibrinolysis during thrombolytic therapy of stroke in the rat. This model may be used to study the influence of these parameters on hemorrhagic stroke transformation and outcome in experimental stroke in future.     

大鼠实验性心肌梗塞时血浆蛋白C,纤溶活性变化及人参皂甙作用的研究

通过观察实验性大鼠急性心肌梗塞（ＡＭＩ）时血浆蛋白Ｃ（ＰＣ）活性和组织型纤溶酶原激活剂（ｔ－ＰＡ）及纤溶酶原激活剂的特异性抑制因子（ＰＡＩ）活性的变化，初步探讨了心肌缺血时ＰＣ活性变化与纤溶系统的关系以及人参皂甙对其变化的影响。结果表明，１．ＡＭＩ时血浆ＰＣ活性显著低于正常对照组，且与缺血程度呈负相关。２．ＡＭＩ时ｔ－ＰＡ活性降低，ＰＡＩ活性增高。３．人参皂甙可提高ＡＭＩ时血浆ＰＣ活性，降低ＰＡＩ     

早期雄性自发性高血压大鼠凝血和纤溶系统的变化及其意义

目的 :观察早期雄性自发性高血压大鼠 (spontaneouslyhyperten siverats ,SHR)凝血和纤溶指标的变化 ,探讨凝血和纤溶系统在高血压血栓栓塞性和 /或出血性并发症发生、发展过程中的作用。方法 :15周龄雄性SHR10只和同龄雄性WistarKyoto(WKY)大鼠 10只 ;检测血浆凝血酶原时间 (prothrombintime ,PT )、纤维蛋白原含量(fibrinogen ,FIB)、组织型纤溶酶原激活物活性 (tissue typeplasmino genactivatoractivity ,t PA∶A)、纤溶酶原激活物抑制剂活性 (plas minogenactivatorinhibitoractivity ,PAI∶A)和α2 纤溶酶抑制物活性(α2 plasmininhibitoractivity ,α2 PI∶A)。结果 :与WKY组比较 :早期雄性SHR血压显著增高 (P <0 .0 1) ,血浆FIB显著增高 (P <0 .0 1) ,血浆α2 PI :A显著降低 (P <0 .0 1) ,t PA∶A显著增高 (P <0 .0 5 )。结论 :早期雄性SHR已处于慢性隐性过代偿型弥散性血管内凝血(disseminatedintravscularcoagulation ,DIC)凝溶期 ,存在着血栓栓塞和 /或出血的危险性     

溶栓治疗对急性心肌梗塞患者纤溶系统功能的影响

本文通过观察纤溶系统活性,纤维蛋白原(Fg)、纤维蛋白降解产物(FDP)含量变化,探讨蛇毒抗栓酶(SVATE)、UK溶栓治疗对急性心肌梗塞(AMI)的临床意义。结果表明,静脉一次大剂量UK治疗,患者血浆PL、ELA、t-PA活性和FDP出现快速大幅度增高,PAI、Fg降低、这种作用仅持续短时间、SVATE静脉首次大剂量以后小剂量维持2周处理,血浆上述纤溶指标逐渐恢复,ELA、t-PA和PAI活性2～3周接近正常水平。结果提示,SVATE、UK溶栓治疗使AMI患者纤溶功能得到改善,若采用二者联合用药,效果可能更理想。     

凝血纤溶异常与早期糖尿病肾病的关系

目的:分析凝血纤溶异常在糖尿病肾病(DN)发生、发展中的作用,为早期诊断DN提供检测指标。方法:将90例2型糖尿病(DM)病人分为:无并发症组、正常白蛋白尿组(DMa组)、微量白蛋白尿组(DMb组)和临床蛋白尿组(DMc组)。测定其抗凝血酶-Ⅲ(AT-Ⅲ)、蛋白C(PC)、凝血酶-抗凝血酶复合物(TAT)、组织型纤溶酶原激活物(t-PA)、纤溶酶原激活抑制物(PAI)等指标水平。结果:①无并发症组PAI、TAT、PC水平升高,AT-Ⅲ、t-PA活性降低,并随UAE增加而加重。②TAT、AT-Ⅲ水平在DMa、DMb、DMc组与无并发症组间,呈显著性差异(P<0.01),且DMc组TAT水平依次高于DMb组、DMa组(P<0.01);AT-Ⅲ水平DMc组依次低于DMb组、DMa组(P<0.01)。③PC、TAT、PAI与DM病程呈正相关。结论:DN患者早期即存在凝血功能亢进、纤溶活性低下,并随DN的进展而逐渐加重。     

Acute changes of coagulation and fibrinolysis parameters after experimental thromboembolic stroke and thrombolytic therapy

Thrombolysis is the only effective pharmaceutical therapy in acute ischemic stroke in humans but has a high risk of intracerebral hemorrhage. We aimed to establish an animal model to study changes of coagulation and fibrinolytic parameters during thromboembolic ischemic stroke and thrombolysis with recombinant tissue plasminogen activator (rt-PA). We used a thromboembolic stroke model in the rat. Animals were treated with rt-PA thrombolysis (n = 10) and compared with untreated (n = 10), sham operated (n = 10) and control animals (n = 20). Coagulation parameters (APTT, PT, TT, fibrinogen, AT III, TAT) and fibrinolytic parameters (t-PA antigen concentration, t-PA activity, PAI-1 concentration, PAI activity, plasminogen, antiplasmin) were measured at two time points (2.5 and 5 h after stroke induction) with a battery of commercially available test kits. We observed an (1) initiation of coagulation and inhibition of fibrinolysis by the operation procedure itself, (2) simultaneous activation of fibrinolysis and its inhibitors after stroke induction and (3) potent initiation of fibrinolysis and consumption of fibrinolysis inhibitors after rt-PA therapy of stroke. We established a model system to monitor coagulation and fibrinolysis during thrombolytic therapy of stroke in the rat. This model may be used to study the influence of these parameters on hemorrhagic stroke transformation and outcome in experimental stroke in future.     

Untersuchung zur Frage von persistierenden Veränderungen der Fibrinolyseparameter t-PA und PAI bei Patienten nach juvenilem ischämischen cerebralem Insult

Summary In diseases associated with thrombotic or thromboembolic complications, a reduction in the fibrinolytic potential may contribute to the risk to develop thrombosis.To investigate whether iuvenile cerebral infarction is associated with a permanent defect of the fibrinolytic system we measured the main components of the fibrinolytic system, tissue plasminogen activator (t-PA) and its fast acting inhibitor (PAI) in plasma samples of 21 patients (aged 21–44 years) 3–24 months after the acute event. The data obtained were compared to those from thirteen healthy young volunteers (22–46 years). A direct effect of known risk factors on the fibrinolytic system could be excluded because patients avoided their risk factors immediately after the ischemic cerebral attack. Hypertension and the combination of oral contraceptives and smoking had been the most striking original risk factors.Levels of t-PA antigen and t-PA activity before and after venous occlusion, or PAI activity were not different between patients and controls suggesting that at least a permanent decrease in the activity of the fibrinolytic system does not exist in these patients. However, our findings do not exclude that a temporary defect in fibrinolysis might have contributed to the acute onset of the thrombotic cerebral event possibly induced by the risk factors originally present.

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Abkürzungen t-PA tissue plasminogen activator - PAI plasminogen activator inhibitor - RIND reversibles ischämisches neurologisches Defizit - KS kompletter Schlaganfall - TIA transitorisch ischämische Attacke     

脂蛋白的氧化修饰对血凝及纤溶活性的影响

目的:研究脂蛋白的氧化修饰对凝血及纤溶活性的影响。方法:用Cu²⁺法及次氯酸法氧化修饰超速离心分离的正常人血浆极低密度脂蛋白(VLDL)、低密度脂蛋白(LDL)及高密度脂蛋白(HDL)。分别将天然及氧化修饰脂蛋白N-VLDL、Ox-VLDL;N-LDL、Ox-LDL、N-HDL及Ox-HDL加入由正常人新鲜混合血浆构成的反应系统中,以相应天然脂蛋白为对照,测定凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、组织型纤溶酶原激活物(t-PA)活性、纤溶酶原激活物抑制剂1(PAI-1)活性及血小板最大聚集率。结果:VLDL、LDL及HDL经Cu²⁺法及次氯酸法氧化修饰后其REM、234nm吸光度值、TBARS含量均显著大于对照组(P<0.01)。Ox-VLDL、Ox-LDL及Ox-HDL使PT及APTT明显短于对照组(P<0.05或P<0.01),血小板聚集率明显高于对照组(P<0.01)。Ox-VLDL及Ox-LDL使t-PA活性高于对照组,PAI-1活性低于对照组(P<0.05及P<0.01),而Ox-HDL对t-PA活性及PAI-1活性的影响与对照组无明显差别。结论:N-VLDL、N-LDL及N-HDL对凝血及纤溶活性无影响。Ox-VLDL、Ox-LDL及Ox-HDL促进血凝及血栓形成;Ox-VLDL及Ox-LDL使纤溶活性增加,而Ox-HDL对纤溶活性无明显影响。