肺栓塞与血小板活化标志物

目的探讨肺栓塞与血小板活化的关系,以发现更加简便、可靠的检测血小板活化的方法。方法用酶联免疫吸附法测定血浆中可溶性P-选择素（PS）;流式细胞术检测血小板膜上活化标记物P-选择素（CD62p）。结果PTE患者血小板膜上P-选择素及血浆中可溶性P-选择素均明显高于高危人群及正常对照组（P〈0．01）;高危人群血小板膜上P-选择素及血浆中可溶性P-选择素高于正常对照组;栓塞面积越大血小板膜上P-选择素及血浆中可溶性P-选择素越高,血小板的活化程度越高;说明血小板活化在肺栓塞的发病中起重要作用。结论PTE时,血浆P-选择素水平明显增高,参与了PTE的发生、发展。通过早期监测高危人群血浆P-选择素,对于预防肺栓塞有一定帮助。P-选择素可以作血栓性疾病的导向诊断和治疗提供崭新的途径。P-选择素简单、易测,上述两种方法均可作为常规检查的指标。     

血清可溶性P-选择素水平与急性脑梗死的相关性研究

目的探讨急性脑梗死患者血清可溶性P-选择素水平的变化及其临床意义。方法选择急性脑梗死患者120例,根据病情分为首发组64例,复发组56例,同时选取同期门诊体检的健康者72例为对照组,比较各组间血清可溶性P-选择素水平,并分析其与脑梗死的相关性。结果首发组和复发组血清可溶性P-选择素高于对照组,且复发组高于首发组。单因素相关分析显示,可溶性P-选择素与超敏C反应蛋白（hsCRP）、纤维蛋白原（Fib）、血压、血小板分布宽度（PDW）、血小板平均体积（MPV）、梗死体积及人院时神经功能评分呈正相关,与HDL—C、PLT呈负相关。多因素非条件Logistic回归分析显示,脑梗死与可溶性P-选择素、hsCRP呈正相关。结论血清可溶性P-选择素水平升高可能是脑梗死独立的危险因素。     

心房颤动患者对血浆P-选择素水平的影响

血栓形成是房颤患者最严重的并发症之一.P-选择素(P-selectin)又称为血小板颗粒膜糖蛋白140,是血小板被激活后最敏感的检测指标之一.血浆P-选择素水平的升高,主要为血小板被激活后所致[1].本研究观察了一组心房颤动(简称房颤)患者及一组正常对照患者血浆P-选择素表达水平的差异,以探讨房颤对血浆P-选择素表达水平的影响.     

老年急性冠脉综合征与血小板P-选择素表达率的相关性研究

目的探讨血小板P-选择素表达率在老年急性冠脉综合征（ACS）患者中的变化以及血小板P．选择素与冠状动脉狭窄程度的相关性。方法应用流式细胞仪对经冠状动脉造影确诊的51例老年ACS患者、33例稳定型心绞痛（SAP）患者和34例老年正常对照者的血小板P-选择素表达率进行检测，分析血小板P-选择素表达率与老年冠心病的稳定性、狭窄程度的关系。结果老年急性冠脉综合征患者P-选择索的表达率明显高于对照组和稳定性心绞痛组（P〈0．05），而SAP组和对照组无统计学差异。老年冠心病患者冠脉狭窄程度Gensini评分与血小板膜P-选择素表达率之间无很好的相关性（P〉0．05）。结论P-选择素参与炎症反应和血栓形成，血小板P-选择素表达率可作为老年冠心病患者动脉粥样硬化斑块稳定性的判定指标。     

帕金森病患者血浆可溶性P-选择素和血管性血友病因子的变化

目的 观察帕金森病(PD)患者血浆可溶性P-选择素、血管性血友病因子(vWF)水平的变化,探讨其临床意义.方法 应用酶联免疫吸附试验检测57例PD患者(PD组)和40例健康体检者(对照组)的血浆可溶性P-选择素和vWF水平.结果 PD组血浆可溶性P-选择素、vWF水平显著高于对照组(P均<0.001).结论 血浆可溶性P-选择素和vWF水平升高可促进PD的发生、发展,可作为诊断PD的重要指标.     

脑梗死患者P-选择素和细胞间粘附分子-1表达改变及其意义

目的 探讨缺血性脑卒中患者P-选择素（CD62P）和血浆中可溶性细胞间粘附分子-1（sICAM-1）表达的规律及其意义。方法 运用酶联免疫吸附测定（ELISA）的方法检测30例脑梗死患者和30名健康对照者CD62P、sICAM-1的表达水平。结果 缺血性脑卒中患者急性期CD62P和sICAM-1表达显著高于其恢复期及健康对照组（均P〈0．01），恢复期CD62P和sICAM-1表达仍高于健康对照组（P〈0．05）。结论CD62P、sICAM-1参与了缺血性脑卒中炎症反应和血小板活化的病理过程，血清CD62P和sICAM-1水平可作为缺血性脑血管病发生发展及病情监测的参考指标。     

可溶性P-选择素与急性冠状动脉综合征的关联性

目的 :观察急性冠状动脉综合征与血清中可溶性 P-选择素的关联性。方法 :采用 EL ISA法检测 32例不稳定型心绞痛 （U A）、47例急性心肌梗死 （AMI）、30例稳定型心绞痛 （SA）患者和 40例健康者 （对照组 ）血清可溶性 P-选择素水平。结果 :对照组和 SA组分别为 132 1± 12 1ng· L- 1和 15 2 0± 113ng· L- 1 ,而 U A组和 AMI组可溶性P-选择素明显升高 （分别为 76 45± 95 0 ng· L- 1和 46 6 5± 44 4ng· L- 1 ,P<0 .0 5 ）。结论 :可溶性 P-选择素与急性冠状动脉综合征有关联。     

急性缺血性脑血管病病人血浆溶血磷脂酸水平的变化

目的探讨急性缺血性脑血管疾病病人血浆溶血磷脂酸(LPA)水平的变化.方法选择189例急性缺血性脑血管疾病病人,根据病情将其分为脑梗死组103例、短暂性脑缺血组86例,并选择95例查体健康者作为正常对照组,分别测定其血浆LPA水平.结果脑梗死组血浆LPA为(3.10±1.42)μmol/L,短暂性脑缺血组为(3.04±1.29)μmol/L,均明显高于正常对照组(1.95±0.14)μmol/L;其中异常增高率脑梗死组为67.0%,短暂性脑缺血组为44.2%,正常组为3.2%,脑梗死组、短暂性脑缺血组在进行抗凝、抗血小板聚集治疗后,LPA明显下降.结论血浆LPA作为体内凝血和血栓形成过程早期释放的酶标记物,在预测急性缺血性脑血管病发生、发展及指导合理应用抗凝抗血小板药物及治疗效果评价等方面,有一定应用前景.     

冠心病及冠心病合并糖尿病患者血糖与血浆P-选择素相关性研究

目的 研究血糖、血浆可溶性P选择素活性在冠心病及合并糖尿病患者体内水平及之间的相关性.方法 选择冠心病组(B组)58例,冠心病组又分为不稳定型心绞痛组(B1组)28例和急性心肌梗死组(B2组)30例;冠心病合并2型糖尿病组(C组)44例,C组分为不稳定型心绞痛组(C1组)24例和急性心肌梗死组(C2组)20例.另设正常对照组(A组)30名.结果 与A组比较,B组的P-选择素明显升高(P<0.05),且C组高于B组(P<0.05);B2组P-选择素高于B1组(P<0.05),C2组P-选择素高于C1组(P<0.05).结论 冠心病及合并糖尿病有明显的P-选择素升高,同时P-选择素升高程度与血糖水平相关.     

血浆同型半胱氨酸水平与缺血性脑血管病的关系

目的 探讨血浆同型半胱氨酸(Hcy)水平与缺血性脑血管病的关系及其与病情严重程度的关系.方法 酶联免疫吸附法检测90例脑梗死患者、44例短暂性脑缺血发作(TIA)患者和40例同期门诊体检者(对照组)血浆Hcy水平,并记录脑血管病患者的传统危险因素;对脑梗死组患者进行神经系统功能缺损评分(NIHSS).分析血浆Hcy水平与缺血性脑血管病的关系及其与缺血性脑血管病的部分类型以及病情严重程度的相关性.结果 缺血性脑血管病组、脑梗死组与TIA组患者血浆Hcy水平均高于对照组(P＜0.05),脑梗死与TIA患者血浆Hcy水平比较无差异(P＞0.05);血浆Hcy水平与NIHSS评分无明显相关性(r =0.155,P=0.323).结论 血浆Hcy水平升高可能是与传统危险因素无关的缺血性脑血管病的独立危险因素,但Hcy水平与其类型及临床表现严重程度无关.     

The effects of antiplatelet agents on platelet–leukocyte aggregations in patients with acute cerebral infarction

Background Studies have shown that platelet-leukocyte aggregates (PLA) are sensitive to platelet activation which might exist before the onset of cerebral infarction. In this study, we investigated the formation of PLA in patients with cerebral infarction and the effects of antiplatelet agents on PLA. Methods The level of soluble P-selectin, C-reaction protein, platelet aggregation rate and leukocyte-platelet aggregations were measured in 40 patients with acute cerebral infarction and 20 normal controls. The 40 patients were randomly assigned to two treatment groups: aspirin group (n = 20) and clopidogrel group (n = 20). Both groups were monitored for Scandinavian stroke scale (SNSS), soluble P-selectin, serum C-reaction protein, platelet aggregation rate and PLA before and after the treatment. Flow cytometry was used to detect the levels of PLA in the blood. Results The percentage of platelet-monocyte aggregates (PMA) in patients with cerebral infarction was significantly increased compared with the controls (P < 0.001), which was positively correlated to soluble P-selectin, C-reaction protein and platelet aggregation rate (P < 0.05). After the treatment, the levels of PMA and platelet aggregation rate were decreased in both groups (P < 0.05). The level of PMA and platelet aggregation rate in the clopidogrel group was significantly lower than that in the aspirin group (P < 0.05). Conclusions PMA are a sensitive biomarker to platelet activation in patients with cerebral infarction. In addition, although both aspirin and clopidogrel lowered the level of PMA, clopidogrel is a more effective treatment than aspirin in inhibiting platelet activation.     

中青年缺血性脑血管病与血浆高同型半胱氨酸血症的关系研究

目的：探讨中青年缺血性脑血管病与血浆高同型半胱氨酸血症之间的关系。方法：纳入我院2014年1月至2015年12月确诊为脑梗死的中青年患者100例,短暂性脑缺血组100例,健康对照组100例,分别于确诊后检查各组的血浆高同型半胱氨酸水平及高同型半胱氨酸血症的发生率,分析高同型半胱氨酸血症与中青年缺血性脑血管病之间的关系。结果：脑梗死组和短暂性脑缺血组中青年患者的同型半胱氨酸明显高于对照组,差异具有统计学意义（P＜0.05＝;脑梗死组（90.00%）和短暂性脑缺血组（84.00%）中青年患者的高同型半胱氨酸血症的发病率明显高于对照组（10.00%）,差异具有统计学意义（P＜0.05＝;高同型半胱氨酸血症中青年患者中缺血性脑血管病的发生率(94.57%)明显高于无高同型半胱氨酸血症者（P＜0.05＝。结论：高同型半胱氨酸血症与中青年缺血性脑血管病的发生存在一定关联,同型半胱氨酸值可能可以成为一个预测缺血性脑血管发生及预后的指标,但仍需要进一步研究。     

Plasma P-selectin is increased in thrombotic consumptive platelet disorders

P-selectin is a 140-kD protein found in the alpha-granules of platelets and the Weibel-Palade bodies of endothelial cells that on cell activation is expressed on the cell surface and also secreted into the plasma. The secreted form of P-selectin, like plasma P-selectin, differed from platelet membrane P-selectin in that its molecular mass was approximately 3 kD lower under reducing conditions. Both the secreted and plasma forms of P-selectin contained cytoplasmic sequence as determined by Western blot analysis with an affinity-purified rabbit anti-P-selectin cytoplasmic peptide antibody. We have measured plasma P- selectin and beta-thromboglobulin (beta TG) concurrently in (1) patients with consumptive thrombotic disorders, including disseminated intravascular coagulation (DIC), heparin-induced thrombocytopenia (HIT), and thrombotic thrombocytopenic purpura (TTP)/haemolytic uremic syndrome (HUS); (2) patients with idiopathic thrombocytopenic purpura (ITP); and (3) healthy controls. Patients with DIC, HIT, and TTP/HUS, but not ITP, had significantly elevated plasma P-selectin and beta TG levels when compared with their age-matched healthy controls. The increased plasma P-selectin and beta TG in patients with thrombotic disorders were likely to be the result of in vivo platelet and endothelial cell damage or activation. We also found that avoidance of veno-occlusion and other tedious measures customarily taken during blood collection and sample preparation to prevent in vitro platelet activation did not affect plasma P-selectin assay results. In addition, plasma P-selectin levels were not influenced by the presence of renal failure or heparin administration. These results indicate that plasma P- selectin may be a useful new marker for thrombotic diseases.     

急性脑梗死患者同型半胱氨酸与叶酸、维生素B_(12)和血脂水平的关系

目的 探讨急性脑梗死患者与正常对照者血浆同型半胱氨酸(homocysteine,Hcy)水平的差别,以及急性脑梗死患者血浆Hcy水平与叶酸、维生素B_(12)和血脂水平以及临床症状之间的关系.方法 纳入年龄、性别、高血压和糖尿病等配比因素无显著性差异的91例首次发病的急性脑梗死患者和100例无脑血管意外的对照者,采用循环酶法测定血浆Hcy水平,化学发光法测定叶酸、维生素B_(12)水平,生化分析仪速立法测量血脂水平,急性脑梗死患者进行美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评价.结果 急性脑梗死组血浆Hcy水平为(21.22±7.29)μmol/L,显著高于对照组的(13.19±2.13)μmol/L(P＜0.05);急性脑梗死组血浆Hcy水平与叶酸(r=-0.307,P＜0.05)和维生素B_(12)(r=-0.27,P＜0.05)水平均呈显著负相关,与低密度脂蛋白呈显著正相关(r=0.282,P＜0.05),与高密度脂蛋白呈显著负相关(r=-0.219,P＜0.05);急性脑梗死组血浆Hcy水平均值随NIHSS评分升高而增高(P＜0.05).结论 高Hcy血症是急性脯梗死的独立危险因素,叶酸和维生素B_(12)水平随着Hey水平的升高而降低;血浆Hcy水平越高,临床症状越严重;Hcy可能通过影响血脂代谢增高缺血性脑血管病的风险.     

Endothelial markers and adhesion molecules in acute ischemic stroke--sequential change and differences in stroke subtype

The progress of a stroke concerns the activation of endothelial cells and platelets. We measured the plasma activities of von Willebrand factor (vWf) and the serum levels of soluble thrombomodulin (sTM) as endothelial markers, and the plasma concentrations of soluble P-selectin (sP-selectin) and soluble E-selectin (sE-selectin) as adhesion molecules during the acute (within 48 h from onset) and subacute (after 1 month from the onset) phases of 52 consecutive patients with acute ischemic stroke and 86 age-matched control subjects. The plasma vWf activities and levels of sP-and sE-selectins in stroke patients were significantly elevated compared with those in controls during both the acute and subacute phases. The serum levels of sTM in stroke patients were significantly higher than those in controls only during the subacute phase. In atherothrombotic infarction, the vWf activities and the levels of sP-selectin, markers for endothelial and platelet activation, remained higher until the subacute phase compared with controls, and the concentrations of sTM, a marker for endothelial injury, were increased during the subacute phase compared with during the acute phase. In lacunar infarction, the levels of sTM and sE-selectin of patients were higher only during the acute phase than controls. These findings suggest that the endothelial cell damage might be maintained until the subacute phase in atherothrombotic infarction, whereas it is remarkable only during the acute phase in lacunar infarction. The evaluation of endothelial markers and adhesion molecules would represent the pathophysiological states of stroke and may provide useful information for the treatment of the ischemic infarction.     

抗血小板药物对脑梗死患者血小板-白细胞聚集体的影响

目的观察急性脑梗死患者血小板一白细胞聚集体（PLA）的变化以及阿司匹林和氯吡格雷对其的影响。方法对急性脑梗死和对照组患者血小板聚集率（PAR）、可溶性P选择素（sP—sel）、C-反应蛋白（CRP）和PLA进行检测。同时将急性脑梗死患者随机分为阿司匹林组和氯吡格雷组,观察两组患者治疗前后斯堪的纳维亚神经卒中量表（SNSS）评分、PAR、sP—sel、CRP和PLA的变化。结果急性脑梗死患者血小板单核细胞聚集体（PMA）显著高于对照组（P〈0．001）;PMA水平与PAR、sP-sel、CRP、血糖、胆固醇和纤维蛋白原正相关（P〈0．05）;与SNSS评分负相关（P〈0．05）。脑梗死患者治疗后PMA、PAR明显下降（P≤0．001）,且治疗后氯吡格雷组PMA和PAR（ADP）降低较阿司匹林组更明显（P〈0．05）,但PAR（AA）两组间差异无统计学意义;sP-sel在氯吡格雷组治疗后显著下降（P〈0．001）。结论急性脑梗死患者反映血小板活化的敏感指标PMA明显增高,阿司匹林和氯吡格雷可以降低PMA水平,其中氯吡格雷作用较阿司匹林更为明显。     

汉族急性脑血管病患者血浆血栓调节蛋白的变化和血栓调节蛋白基因Ala455Val(C1418T)多态性研究

目的 探讨急性脑血管病患者血浆可溶性血栓调节蛋白(soluble thrombomodulin,sTM)含量的变化和血栓调节蛋白基因Ala455Val(C1418T)多态性的分布.方法 在79例汉族急性脑血管病患者(脑出血患者30例,脑梗死患者49例)和30名年龄和性别相匹配的健康对照者中,采用聚合酶链反应限制性酶切片段长度多态性分析技术检测TM Ala455Val(C1418T)多态性,酶联免疫吸附试验检测血浆sTM含量.结果 脑梗死组和脑出血组sIM含量分别为(32.08±6.98)ng/ml和(38.93±6.77)ng/ml,显著高于正常对照组的(9.90±3.09)ng/ml(P均<0.01),而且与高血压、糖尿病、心脏病等高危因素无关;脑出血组和脑梗死组TM 1418C/C基因型频率分别为53.3%和57.1%,高于对照组的40%,但无统计学差异.结论 无论足脑出血还是腑梗死患者,血浆sTM含量均显著高于正常人群;汉族人群中脑出血和脑梗死患者TM 1418C/C基因型频率虽然高于正常人群,但并非脑血管病的易感基因.     

缺血性脑血管病患者血浆肾上腺髓质素与内皮素的测定及其临床意义

目的　监测缺血性脑血管病患者血浆肾上腺髓质素 (ADM)含量变化及其与血浆内皮素 (ET- 1)的关系 ,探讨其在缺血性脑血管病发生发展中的作用及其临床意义。方法　应用放射免疫法测定 88例缺血性脑血管病患者 (包括 4 0例脑梗死和 4 8例腔隙性脑梗死 )和 4 5例正常对照者的血浆 ADM和 ET- 1含量。结果　缺血性脑血管病组患者血浆 ADM含量及 ET- 1含量均高于正常对照组含量 (P<0 .0 5 ) ;脑梗死组血浆 ADM水平高于腔隙性脑梗死组的水平 (P<0 .0 5 ) ;缺血性脑血管病组血浆 ADM水平与血浆 ET- 1呈显著正相关 (r=0 .5 85 ,P<0 .0 5 )。结论　肾上腺髓质素参与了缺血性脑血管病的发生发展过程 ,可能对缺血性脑组织有保护作用。血浆ADM可作为脑梗死患者血管内皮损伤程度的指标之一     

Clinical utility of remote platelet function measurement using P-selectin: assessment of aspirin,clopidogrel, and prasugrel and bleeding disorders

Vascular diseases such as myocardial infarction and ischemic stroke are associated with increased platelet function whilst the risk of recurrence is reduced by antiplatelet agents such as aspirin, clopidogrel, and prasugrel. However, some patients exhibit high platelet reactivity, especially with clopidogrel. Existing platelet function tests may not be ideal in that they can be expensive, are often time consuming, and measurements must be made near to the patient and within a few hours of blood collection. Platelet activation leads to translocation of P-selectin from alpha-granules to the cell surface. Following activation with arachidonic acid (which is blocked by aspirin) or adenosine diphosphate (inhibited by clopidogrel) and fixation, samples may be stored or posted to a laboratory performing flow cytometric quantification of platelet P-selectin expression. Acute myocardial infarction and ischemic stroke are associated with high platelet reactivity on clopidogrel in 6–58% of patients when assessed with P-selectin expression, and high reactivity was associated with an increased risk of recurrence after myocardial infarction. Use of P-selectin expression tests may also be of relevance to surgical and veterinary practice and the diagnosis of mild bleeding disorders. The present review explores this topic in further detail.     

缺血性脑血管病患者血脂、凝血及纤溶指标的变化

目的　观察缺血性脑血管病 (ICVD)患者血脂、凝血及纤溶指标的变化。方法　对缺血性脑血管病 113例 [包括脑梗死 (CI)急性期 2 5例 ,恢复期 30例 ;短暂性脑缺血发作 (TIA) 5 8例 ]和正常对照组 77名进行血脂、血浆组织型纤溶酶原激活物 (t PA)、纤溶酶原激活物抑制物 (PAI)和D 二聚体浓度进行测定。结果　CI组甘油三酯 (TG)、总胆固醇 (TC)、载脂蛋白B10 0 (ApoB10 0 )、氧化型低密度脂蛋白 (ox LDL)水平显著高于对照组 ;CI急性期、恢复期和TIA组PAI高于对照组 ,而t PA活性均低于对照组 ;TIA伴有梗死灶者血浆D 二聚体和PAI含量明显高于无梗死灶者 ,t PA含量低于无梗死灶者。结论　ICVD患者不仅存在血脂代谢紊乱 ,且体内凝血活性增强 ,纤溶功能下降。