组织因子、组织因子途径抑制物与肾脏病

组织因子(TF)及组织因子途径抑制物(TFPI)是外源性凝血系统中的重要物质。肾脏病变时,机体存在高凝状态和出血倾向,而TF和TFPI的平衡对保持机体出、凝血机制的稳定是十分重要的。本文就TF、TFPI在肾脏疾病外周血、尿及肾组织中含量、活性的变化及其意义进行综述。     

深静脉血栓形成中医证型与黏附因子的相关性研究

目的:探讨深静脉血栓形成(DVT)不同中医证型与黏附因子的关系。方法:将70例DVT患者按中医辨证分为湿热下注组(A组)、血瘀湿重组(B组),并设正常对照组(C组)30例,检测各组细胞间黏附因子-1(ICAM-1)、P-选择素和E-选择素的水平。结果:ICAM-1在湿热下注组、血瘀湿重组及正常对照组水平分别是(194.746±18.237)ng/m L、(206.742±23.361)ng/m L、(160.435±23.410)ng/m L,DVT各组ICAM-1水平显著高于正常对照组(P<0.01),血瘀湿重组ICAM-1水平高于湿热下注组(P<0.01);P-选择素在3组水平是(54.093±6.606)ng/m L、(49.889±7.363)ng/m L、(31.166±6.945)ng/m L,依次降低(P<0.05,P<0.01);E-选择素在3组的表达水平分别为(64.125±8.482)ng/m L、(30.975±8.723)ng/m L、(27.465±4.934)ng/m L,湿热下注组高于血瘀湿重组及正常对照组(P<0.01,P<0.05),但血瘀湿重组与正常对照组相比无明显差异(P>0.05)。结论:黏附因子与深静脉血栓形成的中医证型之间存在一定的关系,而ICAM-1、P-选择素和E-选择素的水平高低可协助中医辨证。     

组织因子、组织因子途径抑制物与肾脏病

组织因子(TF)及组织因子途径抑制物(TFPI)是外源性凝血系统中的重要物质。肾脏病变时，机体存在高凝状态和出血倾向，而TF和TFPI的平衡对保持机体出、凝血机制的稳定是十分重要的。本文就TF、TFPI在肾脏疾病外周血、尿及肾组织中含量、活性的变化及其意义进行综述。     

组织因子途径抑制物-2影响人前列腺癌细胞凋亡的实验研究

目的：将人组织因子途径抑制物-2（TFPF2）基因转染人人前列腺癌细胞株PC3M，探讨TFPb2对PC3M凋亡的影响。方法：应用脂质体介导的基因转移技术将人TFPF2基因真核表达载体pBos—Cite-neo／TFPI2导人人前列腺癌细胞株PC3M中，并分别通过RT-PCR和Western blot技术检测TFPb2在人前列腺癌细胞中的表达，然后采用AnnexinV／PI法，通过流式细胞仪分别对稳定转染的PC3M—TFPI-2组细胞和未转染的PC3M组细胞进行双参数分析，检测两组细胞的凋亡情况。结果：转染成功的PC3M-TFPb2组细胞中证实有TFPF2mRNA和相应蛋白质的表达，转染TFPF2的PC3M—TFPI-2组细胞有部分发生凋亡，凋亡率为25．17％，而未转染TFPI-2的PC3M组细胞仅有极小部分发生了凋亡，其凋亡率为4．13％。结论：人TFPb2基因真核表达载体成功转染人PC3M并可以在PC3M中得到表达，TFPF2表达可以促进人前列腺癌细胞发生凋亡，这可为将来前列腺癌的基因治疗提供一个新的靶向。     

组织因子途径抑制物2基因对Panc-1细胞裸鼠成瘤及转移的影响

目的观察组织因子途径抑制物2（TFPI-2）对胰腺癌细胞系Pane-1细胞裸鼠成瘤及转移的影响。方法将Pane-1-TFPI-2细胞接种到裸鼠皮下作为实验组，观察肿瘤生长情况并测量其大小；取皮下新生肿瘤组织进行原位胰腺接种，观察其对周围组织浸润及远处转移能力的影响。同时以Pane-1-V和Pane-1-P细胞作为对照组。结果实验组和对照组裸鼠皮下均成瘤，但实验组肿瘤体积小于对照组，分别为（438．0±69．8）、（852．0±102．9）和（831．0±78．1）mm’，差异有统计学意义（P〈0．05）。原位胰腺接种，对照组移植瘤浸润胰腺组织，有肝、肺、淋巴结及腹膜转移灶形成，免疫染色显示转移灶CEA阳性，证实其为胰腺肿瘤转移而来。实验组移植瘤包膜完整，无明显浸润及转移现象。结论TFPI-2能抑制肿瘤细胞生长、周围组织浸润及远处转移，为胰腺癌的基因治疗奠定了实验基础。     

组织因子在下肢深静脉血栓动物模型中的表达变化及其作用机制

目的:构建大鼠下肢深静脉血栓(DVT)模型,探讨组织因子(TF)表达及作用机制。方法:构建TF小干扰RNA(siRNA)特异性沉默TF表达,转染大鼠成纤维细胞RFL-6,反转录-聚合酶链反应(RT-PCR)和蛋白质印迹法(Western blot)实验检测转染效率。通过大鼠尾静脉注射进行动物预处理及分组,72只雄性6～...     

组织因子及其途径抑制物对妇科肿瘤术后深静脉血栓形成的影响

目的探究分析血浆组织因子(TF)及其途径抑制物(TFPI-1)对妇科肿瘤患者术后深静脉血栓形成的影响。方法随机选取本院2014年10月至2015年10月期间收治的48例妇科肿瘤患者为观察组,并选取同期来本院体检的健康者20例为对照组。分别检测两组研究对象血浆中的组织因子及其途径抑制物含量,并进行统计分析。结果妇科肿瘤术后有深静脉血栓形成患者的TF水平(51.04±20.05)IU/L显著高于健康对照组患者(1.98±1.72)IU/L及妇科肿瘤术后无深静脉血栓形成患者(23.59±18.73)IU/L,各组比较具有统计学意义(P<0.05)。妇科肿瘤术后有深静脉血栓形成患者的TFPI-1水平(120.32±15.50)μg/L明显高于健康对照组患者(75.10±15.44)μg/L,但是与妇科肿瘤术后无深静脉血栓形成患者(125.78±10.72)μg/L比较无显著统计学意义(P>0.05)。结论血浆组织因子及组织因子途径抑制物水平较高的患者在妇科肿瘤术后容易发生妇科深静脉血栓,因此,临床上可以将血浆组织因子及组织因子途径抑制物水平检测作为妇科肿瘤手术患者术后深静脉血栓形成预估的重要指标。     

组织因子途径抑制物2抑制胰腺癌血管生成的研究

目的研究组织因子途径抑制物2（TFPI-2）对胰腺癌血管生成的影响，探讨其抑制胰腺癌生长及侵袭、转移的机制。方法建立裸鼠角膜微囊移植模型，将3组细胞Pane-1TFPI-2、Pane-1-P和Pane-1-V分别接种裸鼠角膜微囊，观察角膜新生血管的形成；再将上述3组细胞接种于裸鼠皮下，观察裸鼠皮下肿瘤生长及转移情况，并采用抗CD34抗体进行血管免疫组织化学染色检测皮下肿瘤的微血管密度（MVD）。Pane-1-TFPI-2组为实验组，Panc-1-P和Pane-1-V组作为对照组。结果实验组角膜新生血管积分比对照组明显减少（P〈0．05），实验组和对照组裸鼠皮下均成瘤，实验组肿瘤体积（438．0±69．8）mm^3，对照组分别为（852．0±102．9）mm^3和（831．0±78．1）mm^3（P〈0．05）；同对照组比较，实验组未见明显远处转移，其肿瘤微血管密度（9．68±1．12），对照组分别为（18．69±2．51）和（20．32±2．08），差异有统计学意义（P〈0．05）。结论组织因子途径抑制物2能抑制肿瘤血管的形成，抑制胰腺癌生长。     

体外循环心内直视手术围术期组织因子途径抑制物的变化

组织因子途径抑制物(ｔｉｓｓｕｅｆａｃｔｏｒｐａｔｈｗａｙｉｎｈｉｂｉｔｏｒ,ＴＦＰＩ),又称外源性凝血途径抑制物,是正常生理条件下血液中存在的天然抗凝物质,主要作用于依赖组织因子的外源性凝血途径,有重要的调节机体凝血系统作用。体外循环心脏手术过程对机体凝血系统将产生一系列变化,我们对体外循环心脏手术围术期血液中ＴＦＰＩ及激活凝血时间(ＡＣＴ)的变化进行了初步观察。资料与方法选择1996年3～5月住院心脏手术病人20例,男13例,女7例。年龄4～37岁,平均(142±86)岁。包括室间隔缺损11例,二尖瓣置换6例,房间隔缺损、肺动脉…     

大肠癌发病风险与细胞间黏附分子-1基因多态性的关系

目的 探讨中国华北地区汉族人群中细胞间黏附分子-1(ICAM-1)基因编码区单核苷酸多态性(SNPs)与大肠癌发病风险的关系.方法 采用序列特异-聚合酶链反应(PCR-SSP)方法检测87例大肠癌患者(大肠癌组)和102例正常对照者(对照组)ICAM-1基因型和等位基因频率的分布.结果 大肠癌组和对照组ICAM-1-241G/R多态的基因型均为G/G,未检测出R241等位基因.ICAM-1-469K/E多态3种基因型频率(K/K,K/E,E/E)在大肠癌组和对照组中分别是57.47%(50/87)、32.18%(28/87)、10.35%(9/87)和42.16%(43/102)、43.14%(44/102)、14.70%(15/102),与K/E+E/E基因型比较,K/K基因型罹患大肠癌的风险明显增加(OR=1.85,x2=4.406,95%CI:1.04～3.31,P＜0.05);与E等位基因比较,K等位基因携带者增加大肠癌的发病风险(OR=1.58,x2=4.194,95%CI:1.02～2.46,P＜0.05).ICAM-1-469K/E多态的K/K基因型在大肠癌组中与肿瘤分化程度有关(x2=4.564,P＜0.05);而与临床其他病理参数包括性别、年龄、肿瘤部位及Dukes分期无关(P＞0.05).结论 ICAM-1-241G/R多态在我国华北地区汉族人群中不存在多态性;ICAM-1-469K/E多态K等位基因或K/K基因型的存在可明显增加大肠癌的发病风险;ICAM-1-469K/E多态K/K基因型与肿瘤分化程度有关.     

Tissue factor and tissue factor pathway inhibitor

The classical 'cascade/waterfall' hypothesis formulated to explain in vitro coagulation organised the amplification processes into the intrinsic and extrinsic pathways. Recent molecular biology and clinical data indicate that tissue factor/factor-VII interaction is the primary cellular initiator of coagulation in vivo. The process of blood coagulation is divided into an initiation phase followed by a propagation phase. The discovery of tissue factor pathway inhibitor further supports the revised theory of coagulation. Tissue factor is also a signalling receptor. Recent evidence has shown that blood-borne tissue factor has an important procoagulant function in sepsis, atherosclerosis and cancer, and other functions beyond haemostasis such as immune function and metastases.     

Incidence and risk factors for deep vein thrombosis among pediatric burn patients

BackgroundPatients with major burns covering a large total body surface area (%TBSA) fulfill all the criteria of Virchow’s triad, as a sequela of their injury. This places these patients at increased risk for developing deep vein thrombosis (DVT). However, data regarding the incidence of DVT in burn patients are minimal, especially in the pediatric age group. Therefore, the aim of this study is to determine the incidence of DVT in pediatric burn patients, identify possible risk factors for developing DVT, and explore the need for prophylactic treatment.MethodsA retrospective chart review of 95 patients admitted to our Burn Unit was conducted. We included all pediatric patients with second- and third-degree burns admitted to the unit. Exclusion criteria were adult patients, those with first-degree burns and admitted to the unit for <72 h, patients discharged against medical advice, those admitted for elective reconstructive surgery, secondary admissions for non-healing/infected burns, and patients with trauma-induced skin loss. A data collection sheet was utilized.ResultsThe total incidence of thrombosis in our population was 4.2% (DVT, 3.1%; arterial thrombosis, 1.1%). Factors significantly associated with DVT included length of hospitalization (p = 0.012), central venous catheter placement (p = 0.013), and %TBSA (p = 0.004). Unlike adult patients, weight for age (percentile) and body mass index were not significant risk factors for DVT in our patients.ConclusionBurns are a major risk factor for DVT, especially when covering large surface areas (≥40% TBSA) and combined with other factors (i.e., prolonged hospitalization and central lines). Thus, investigations for DVT and prophylactic anticoagulation should be considered for pediatric burn patients with these risk factors, even if they are asymptomatic.     

Tissue factor pathway inhibitor in childhood nephrotic syndrome

It is now recognised that the extrinsic tissue factor pathway is the main trigger to the coagulation system in vivo. Its main inhibitor, tissue factor pathway inhibitor (TFPI), has never been studied in childhood nephrotic syndrome. The aim of the study was to monitor the level of TFPI in childhood nephrotic syndrome. One hundred and thirty-nine nephrotic children were classified into the following groups: group 1 (n=25), in relapse and receiving no treatment; group 2 (n=37), in relapse but receiving steroid treatment; group 3 (n= 45), in early remission and on steroids; group 4 (n=24), in established remission and receiving no steroids; group 5 (n=8), steroid-resistant. The controls (n=84) were healthy and age-matched. There was significant elevation of total TFPI levels in groups 1 and 2 and 3; levels were comparable to those of the healthy controls in group 4. The highest levels of total TFPI were recorded in group 5. Like total TFPI, the levels of the free form of TFPI showed a statistically significant increase in groups 1, 2, 3 and 4, when compared with levels in healthy controls. The highest levels of free TFPI were recorded group 5. We concluded that the elevated levels of both the total and free TFPI in various phases of nephrotic syndrome add another natural anticoagulant mechanism, which will attenuate the hypercoagulability of childhood nephrotic syndrome.     

骨折术后深静脉血栓的防治

目的 探讨骨折术后合并深静脉血栓的临床特点和防治措施。方法 抗凝治疗下肢深静脉血栓5例。结果 5例经及时诊断和抗凝治疗后均获得好转。结论 深静脉血栓具有隐蔽性临床征象，容易延误早期治疗。对高危患者应重点预防。围手术期采用3种预防方法能够显著减少深静脉血栓的发生率。     

肝移植术后下肢深静脉血栓的超声检测与危险因素分析

目的 探讨肝移植术后下肢深静脉血栓(deep vein thrombosis,DVT)的超声影像特征和DVT形成的危险因素.方法 选取深圳市第三人民医院行肝移植手术患者141例,术前均采用超声检查下肢静脉,记录有无DVT,术后1、7、14 d复查DVT发生情况.分析性别、年龄、高血压、糖尿病、肿瘤史、长期饮酒史、 胆固...     

膝关节周围骨折病人术后下肢深静脉血栓形成的危险因素分析

目的探讨膝关节周围骨折病人术后下肢深静脉血栓形成(deep vein thrombosis,DVT)的危险因素。方法回顾性分析西安交通大学医学院附属红会医院创伤骨科2014年9月至2018年12月收治的497例膝关节周围骨折且术前超声检查未发现DVT的病人的临床资料,根据术后超声检查结果将病人分为血栓组和无血栓组,记录血栓发生部位及发生率,将年龄、性别、骨折部位、骨折侧别、合并外伤、合并内科疾病、美国麻醉医师协会(America Society of Anesthesiologists,ASA)分级、术中失血量、术中输液量、术中输血量、止血带使用时间、手术时间、术后1 d血红蛋白、术后1 d红细胞压积、术后1 d的D-二聚体列为观察指标,先后采用单因素分析和多因素Logistic回归分析确定术后DVT的独立危险因素。结果497例病人中,术后有175例发生DVT,发生率为35.21%,其中发生近端血栓2例(2/175,1.14%),远端血栓162例(162/175,92.57%),混合血栓11例(11/175,6.29%)。单因素分析结果显示两组间年龄、性别、冠状动脉粥样硬化性心脏病(冠心病)、术后1 d D-二聚体的差异均有统计学意义(P均<0.05)。多因素Logistic回归分析结果提示年龄>60岁[OR=1.888,95%CI(1.213,2.930),P=0.005)、女性[OR=1.841,95%CI(1.268,2.673),P=0.001]、冠心病[OR=1.086,95%CI(1.190,3.945),P=0.011]、术后1 d D-二聚体[OR=1.077,95%CI(1.019,1.138),P=0.009]是术后DVT的独立危险因素。结论膝关节周围骨折病人术后DVT发生率较高,以远端DVT为主。对于年龄>60岁、女性、冠心病、术后D-二聚体升高的病人应注意重点预防下肢DVT的发生,防止发生致命性肺栓塞。     

肾病综合征并发下肢深静脉血栓的治疗探讨

目的探讨尿激酶联合低分子肝素对肾病综合征并发下肢深静脉血栓的治疗作用。方法回顾性分析2002年3月至2009年12月在我院住院的42例肾病综合征并发下肢深静脉血栓形成的患者的临床资料,尿激酶联合低分子肝素治疗者27例,为A组,单纯普通肝素治疗者15例,为B组,比较2组疗效及不良反应。结果A组总有效率为88．9％,B组总有效率为53．3％,2组差异有统计学意义（P〈0．05）;2组出血发生率无差异（P〉0．05）;与B组相比,A组尿蛋白排泄量和血纤维蛋白原含量降低（P〈0．05）。结论尿激酶联合低分子肝素是肾病综合征并发下肢深静脉血栓的有效治疗方法之一,且出血发生率低。     

Coagulation status and the presence of postoperative deep vein thrombosis in patients undergoing laparoscopic cholecystectomy

Background Venous thromboembolism is a relevant social and health care problem because of its high incidence among patients who undergo surgery (20–30% after general surgical operations and 50–75% after orthopedic procedures), its pulmonary embolism-related mortality rate, and its long-term sequelae (postthrombotic syndrome and ulceration), which may be disabling. This study aimed to determine the coagulation status and the presence of postoperative deep vein thrombosis (DVT) in patients undergoing laparoscopic (LC) and open cholecystectomy (OC). Methods Prospectively, 114 patients were randomized into two groups. group 1 (58 patients undergoing LC) and group 2 (56 patients who are undergoing OC). The coagulation parameters (prothrombin time [PT], partial thromboplastin time [PTT], D-dimer, prothrombin F1 + 2, antithrombin III, and factor VII) were monitored preoperatively and during the operation, then 24 and 72 h after the operation. The patients in both groups underwent color duplex scan examination preoperatively, then 3 and 7 days after surgery to establish the presence of DVT. None of the patients in either group received thrombosis prophylaxis. Results In the LC group, postoperative DVT developed in four patients (6.9%; in the calf veins of 3 patients and in the popliteal vein of 1 patient). In the OC group, nine patients (16.07%) had postoperative DVT (in the calf veins of 7 patients and in the popliteal and femoral veins of 2 patients). The plasma levels of monitored parameters in the patients of both groups were altered, but the difference between the groups was not statistically significant. For the patients in both groups who experienced DVT, only the decrease of factor VII had statistical significance (p < 0.05). Conclusions The incidence of postoperative DVT among the patients who underwent OC was higher than among the patients who underwent LC (p < 0.05). The decrease in factor VII among the patients who underwent surgery could be a potentially useful parameter indicating the patients at high risk for developing DVT.     

下肢深静脉血栓形成患者P-选择素与血小板活化因子的变化及意义

目的 探讨下肢深静脉血栓形成(DVT)患者P-选择素与血小板活化因子(PAF)的变化及其临床药物干预后的变化.方法 用流式细胞术(FCM),以单克隆抗体为探针测定40例下肢DVT患者及20例健康人P-选择素阳性表达率,应用双抗体夹心ELISA免疫方法测定血小板活化因子(PAF)含量.结果 DVT组在发病的早期P-选择素阳性表达率与血小板活化因子含量均高于对照组(P＜0.05),溶栓抗凝等治疗后不同时间P-选择素阳性表达率与血小板活化因子含量呈降低趋势,其中应用奥扎格雷钠组与非奥扎格雷钠组比较P-选择素阳性表达率,血小板活化因子含量有显著差异.出院1个月后P-选择素阳性表达率与血小板活化因子含量明显降低,但P-选择素阳性表达率,血小板活化因子含量较正常人偏高.结论 急性DVT患者早期体内血小板活化;应用抗血小板活化药物能明显提高DVT的治疗效果;P-选择素、血小板活化因子可做为DVT诊断的指标之一;出院后DVT患者仍是血栓形成的高危人群,需要定期随访.     

患者血栓风险评估效果探讨及下肢深静脉血栓护理体会

目的总结下肢深静脉血栓(DVT)患者的护理经验,探索患者入院采用Wells评估表效果及DVT合理护理措施。方法收集我院近5年来482例DVT患者临床资料,前4年采用常规护理方法,2017年后采用Well′s评分表对入院患者行DVT风险预测以及统计患者DVT的实际符合率,对确诊DVT患者进行一系列沟通及日常重点检查工作,突出专科护理及必要的抢救准备。比较2017年与前4年DVT发病情况,探讨新的护理经验。结果实施规范VET防治、实行规范护理措施后,2017年的121例DVT患者只发生3例肺栓塞(PE),DVT并发PE的发生率为2.48%,与往年相比,PE并发率明显下降,其差异有统计学意义(P0.05)。结论 Wells评分系统能较准确预测DVT患者。对确诊DVT患者的做好护理沟通,完善DVT专科护理及必要的抢救准备,有助于降低并发PE的发生率及死亡率。