老年人高血压分期与血液流变学

本文通过对92例不同期老年高血压患者进行血液流变学各项指标的测定,并随机选择37例血压正常且无心脑血管疾病、糖尿病及血液病的老年患者作为对照,结果经统计学处理,发现:(1)三期高血压患者的红细胞电泳时间、全血粘度、还原粘度、血浆粘度、纤维蛋白原、体外血栓形成指标均明显高于对照组(P<0.05～0.001),红细胞电泳率明显低于对照组(P<0.001),(2)Ⅱ期和Ⅲ期高血压组的血小板粘附率、血球压积与对照组相比有明显差异(P<0.05),(3)各期高     

急性冠脉综合征患者血小板参数及血液流变学的研究

目的探讨急性冠脉综合征(ACS)患者血小板参数及血液流变学的变化及意义。方法分别应用全自动血细胞分析仪和全自动血粘度测试仪,测定正常对照组(NC)50例,稳定心绞痛(SA)40例,不稳定心绞痛(UA)40例,急性心肌梗死(AMI)30例的血小板参数及血液流变学值。结果(1)AMI及UA组与SA及NC组比较,血小板数目减少(P<0.05或P<0.01),SA与NC组相比无差异(P>0.05),血小板压积(PCT),平均血小板体积(MPV)和血小板宽度(PDW)均有不同程度增高(P<0.05或P<0.01),SA与NC相比无差异(P>0.05)。(2)AMI及UA组与SA及NC组比较,血液流变学检查示全血粘度低切,全血粘度中切,全血粘度高切,血浆粘度,红细胞压积,红细胞聚集指数,血沉,血沉议程K值均有不同程度增高(P<0.05或P<0.01),SA与NC组比较全血粘度低切增高(P<0.05),其余各项指标相比无差异(P>0.05)。结论血小板功能亢进及血液高粘滞状态在急性冠脉综合征的发生发展中起着重要作用,可能是急性冠脉综合征的活动性指标。     

肺结核进展期病人血液流变学变化及临床意义

35例肺结核进展期病人和36例健康人血液流变学指标的观察结果显示,肺结核进展期患者全血粘度、血浆粘度、体外血栓形成长度与重量增加和血沉均明显增快(P<0.01),血小板粘附率升高(P<0.05)、红细胞电泳时间延长(P<0.01)。提示肺结核进展期存在高粘滞血症和体外血栓易于形成。降低血液粘度、改善微循环可能是辅助治疗肺结核的一个环节。测定血液流变学指标对肺结核病情观察、活动性判定及疗效评价,可能有一定的价值。     

不同分期肺癌患者血液流变学变化的临床意义

目的探讨不同病期肺癌患者血液流变学变化及其临床意义。方法采用国产血液粘度计，在37C条件下，测定全血粘度、血浆粘度、红细胞压积、红细胞聚集指数、纤维蛋白元，并观察各期肺癌患者的血液流变学特性及参数间的差异。结果Ⅱ、Ⅲ期肺癌的血液流变学各参数，包括全血各粘度，血浆粘度等指标均显著高于正常人，其各个切变率、全血粘度和血浆粘度等指标均明显高于正常人，而Ⅰ、Ⅳ期肺癌各个血液流变学指标接近甚至低于正常。结论肺癌患者在病程的不同阶段，血液流变学有不同的变化，这种变化可能有其特定的临床意义。     

新疆阿图什市汉、维吾尔、柯尔克孜族健康中老年男性血液流变学调查报告

本文介绍了新疆阿图什市汉、维吾尔、柯尔克孜三个民族健康中老年男性血液流变值,维、柯族组间血液流变学各指标间均无显著差异(P>0.05);汉族组的全血粘度、红细胞压积低于维、柯族组(P<0.05);血浆粘度、红细胞电泳时间、血沉、血沉方程k值同维、柯族组无显著差异(P>0.05)。这表明随着居住地海拔增高,全血粘度、红细胞压积也增高。本文认为在不同地区,由于海拔、气候、饮食食谱不同、血液流变学的正常值也不同。     

血液系统疾病

652811 西安地区健康人七项血液流变学指标的正常值及其实用意义蒙秋镇等西安医学院学报6(1):45～47,1985 选健康的20～40岁成人30例,测得血液流变学结果为:红细胞压积(H)全血粘度(比)ηb男性高于女性;而血浆粘度(ηp)、全血还原粘度(比),ηb-1/H,红细胞沉降率(ESR)、血沉方程K值(K)女性高于男性,与献文报告基本相符,RBCEP(红细胞电泳时间)男20.14±2.86秒,女20.69±3.01秒,高于国内多数地区的水平。文章     

老年肺心病并发心衰和呼衰时血液粘度改变的探讨(附126例)

资料与方法 1985年11月～1987年4月间126例老年肺心病并发心衰和呼衰者进行血液粘度检测,同时期检测健康对照者62例。 结果 全血比粘度(ηb)在对照组、心衰Ⅱ度组及心衰Ⅰ度组,分别为4.27,6.90,     

高血压病患者血液流变学的分析

目的研究高血压病患者血液流变学改变。方法采用电子压力传感器式全自动血液流变学仪和血小板聚集仪检测152例高血压病患者(高血压病组)和148例非高血压病健康人(对照组)的血液流变学指标并进行对照比较。结果高血压组高切变、中切变及低切变全血粘度、红细胞压积、红细胞聚集指数、纤维蛋白原均明显高于对照组(P<0.05或P<0.01);血小板聚集率在男性ADP2.0μmol/L和Adr 5.56μmol/L均明显高于对照组(P<0.05);结论高血压病患者常伴有血液流变学异常,提示可能为其心脑血管并发症发生机理之一。     

依达拉奉联合胞磷胆碱钠治疗脑梗死的疗效及对血液流变学、氧化酶活性的影响

目的分析依达拉奉联合胞磷胆碱钠治疗脑梗死(CI)的疗效及对血液流变学、丙二醛(MDA)及超氧化物歧化酶(SOD)活性的影响。方法 CI患者86例随机分两组,各43例。对照组采用基础治疗,观察组采用依达拉奉联合胞磷胆碱钠,两组持续治疗1个月。对比疗效、血液流变学(红细胞聚集指数、全血高切粘度、全血低切粘度、红细胞压积)、MDA及SOD活性。结果观察组治疗有效率90.70%(39/43)高于对照组69.77%(30/43)(P0.05);红细胞聚集指数、全血高切粘度、全血低切粘度、红细胞压积均低于对照组(P0.05);MDA低于对照组,SOD高于对照组(P0.05)。结论依达拉奉联合胞磷胆碱钠治疗CI患者疗效显著,且可稳定血流动力学,降低MDA,提高SOD活性。     

急性心肌梗塞时白细胞增多与近期预后关系的探讨

对300例急性心肌梗塞(AMI)患者进行研究以探讨AMI早期白细胞计数增高与其近期预后关系。结果表明,AMI患者早期白细胞>15×10~9/L者其心衰、心律失常、心源性休克及住院病死率均较白细胞4×10~9～8.999×10~9/L为高(P<0.05～P<0.01),白细胞>15×10~9/L者较9×10~9～14.999×10~9/L者心衰、心源性休克、住院病死率高(P<0.01)。因此AMI早期外周血白细胞增高是估计近期预后的一个指标。     

Platelet aggregation and blood rheology in severe sepsis/septic shock: relation to the Sepsis-related Organ Failure Assessment (SOFA) score

Abnormalities in blood rheology and platelet dysfunction might play a role in the pathogenesis of multiple organ failure in septic patients by reducing microvascular blood flow. To determine whether alterations in blood rheology and in platelet function are related to the severity of organ dysfunction, we prospectively studied plasma fibrinogen, red cell aggregation, plasma viscosity, hematocrit, whole blood viscosity and platelet aggregation in relation to the Sepsis-related Organ Failure Assessment (SOFA) score in 34 consecutive patients with severe sepsis/septic shock. We found that patients had higher plasma fibrinogen, red cell aggregation and plasma viscosity (p < 0.01), but lower hematocrit, whole blood viscosity and ADP-induced platelet aggregation than controls (p < 0.01). Platelet aggregation (p < 0.01), but not other rheological variables, were inversely related to the SOFA score. Only platelet count was linked to poor clinical outcome (p < 0.05). We conclude that blood rheology and platelet function are severely altered in patients with severe sepsis/septic shock. Our findings suggest progressive platelet dysfunction with advancing severity of the disease. Platelet dysfunction might play a more important role in the pathogenesis of the multi organ dysfunction syndrome than abnormalities in blood rheology.     

冠心病患者纤维蛋白原、超敏C反应蛋白及总胆红素检测的意义

目的:探讨纤维蛋白原(Fg)、超敏C反应蛋白(hs-CRP)和总胆红素(TBIL)水平与冠心病的关系。方法:选择200例冠心病患者及200例健康对照者,进行Fg、hs-CRP和血清TBIL的定量测定。结果:与健康对照组比较,冠心病组Fg[(2.75±0.97)g/L∶(4.51±0.42)g/L]、hs-CRP[(1.64±0.57)mg/L∶(5.31±1.91)mg/L]水平明显升高(P均0.05),而血清TBIL[(26.71±3.72)μmol/L∶(14.26±2.44)μmol/L]水平明显降低(P0.01);按陈旧性心肌梗塞组、稳定型心绞痛组、不稳定型心绞痛组、急性心肌梗塞组的排列顺序,血浆hs-CRP和Fg水平呈上升趋势,而TBIL水平呈下降趋势,组间差异显著(P0.05~0.01)。结论:冠心病患者血液中存在高纤维蛋白原、超敏C反应蛋白和低总胆红素的现象,以急性心肌梗塞患者最为突出,提示纤维蛋白原和超敏C反应蛋白水平升高,总胆红素水平降低可能是冠心病发生、发展的重要危险因素之一。     

Altered blood rheology in obstructive sleep apnea as a mediator of cardiovascular risk

BACKGROUND: Cardiovascular complications are common in patients with obstructive sleep apnea (OSA). Blood rheology is a major determent of coagulation and an established risk factor for cardiovascular events. Since nocturnal hypoxemia could influence parameters of blood rheology, we hypothesized that OSA alters blood rheology independent of other cardiovascular risk factors. METHODS: One hundred and ten consecutive patients admitted to the sleep laboratory were included. The association of plasma fibrinogen and viscosity (as parameters of blood rheology) with OSA was evaluated. RESULTS: One hundred and ten patients aged 61.4+/-10.1 years (body mass index 28.4+/-4.1 kg/m2) were included. OSA was confirmed in 63 patients (57.2%) with an apnea-hypopnea index (AHI) of 28.7+/-14.9 events/hour. Patients with OSA showed higher levels of plasma viscosity (1.36+/-0.09 vs. 1.31+/-0.08 mPas, p=0.005). Nevertheless, hypertensive apneics have even higher levels of plasma viscosity than nonapneics (1.38+/-0.091 vs. 1.32+/-0.028 mPas, p=0.018). Similar results were found in patients with coronary artery disease, where OSA was associated with elevated plasma viscosity (1.36+/-0.076 vs. 1.31+/-0.081 mPas, p=0.007). Plasma fibrinogen was correlated with nocturnal minimal oxygen saturation (r=-0275, p=0.0036) and AHI (r=0.297, p=0.001). OSA was associated with higher plasma fibrinogen (353+/-83 vs. 317+/-62 mg/dl, p=0.015). These differences persist with control for cardiovascular risk factors. CONCLUSIONS: Patients with OSA have elevated morning fibrinogen levels and a higher plasma viscosity, which correlate positively with indices of sleep apnea severity. These changes in blood rheology are independent of cardiovascular risk factors, and therefore, might be specific mechanisms of OSA. This supports the pathophysiological concept that sleep apnea is a cardiovascular risk factor.     

Blood rheology after cardiac valve replacement with mechanical prostheses or bioprostheses

Arterial thromboembolism is a serious complication in patients after heart valve replacement. Abnormalities in blood rheology may contribute to this complication. Therefore, the aim of this study was to compare various determinants of blood rheology in patients with substitute heart valves with those in healthy controls; furthermore, differences between patients with mechanical valves and those with bioprostheses should be investigated. The hemorrheologic determinants--fibrinogen, plasma viscosity, red cell aggregation, hematocrit and platelet aggregation--were studied in 92 patients with mechanical bileaflet valves, in 28 patients with bioprostheses and in 29 control subjects; the time since valve replacement was greater than or equal to 9 months. Fibrinogen, plasma viscosity, red cell and spontaneous platelet aggregation were found to be increased in all patients after heart valve replacement compared with normal subjects (fibrinogen: 348 +/- 87 vs 267 +/- 66 mg/dl, p less than 0.01; plasma viscosity: 1.71 +/- 0.1 vs 1.66 +/- 0.1 mPas, p less than 0.05; red cell aggregation: 9.9 +/- 2 vs 7.8 +/- 2 U, p less than 0.01; platelet aggregation: 22 +/- 15 vs 13 +/- 13%, p less than 0.01); among patients, fibrinogen, plasma viscosity and spontaneous platelet aggregation were higher in mechanical valves than in bioprostheses (fibrinogen: 359 +/- 95 vs 314 +/- 41 mg/dl, p less than 0.01; plasma viscosity: 1.72 +/- 0.1 vs 1.68 +/- 0.1 mPas, p less than 0.1; platelet aggregation: 23 +/- 15 vs 16 +/- 11%; p less than 0.05), whereas no difference could be found for red cell aggregation (9.7 +/- 2 vs 10.5 +/- 2%, p greater than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

伴高血压的急性心肌梗塞临床特点

目的探讨高血压（ＨＴ）对急性心肌梗塞（ＡＭＩ）临床表现与预后的影响。方法对照分析了５３５例有ＨＴ病史和６１７例无高血压病史（ＮＨＴ）的ＡＭＩ临床资料。结果ＨＴ组吸烟、饮酒、家族史阳性者,既往有糖尿病、脑卒中、心绞痛和陈旧性心肌梗塞史者均多于ＮＨＴ组（Ｐ＜０．０５～０．００１）,心绞痛的病程也较长（Ｐ＜０．００１）。ＡＭＩ于睡眠中发病,因劳累诱发者均少于ＮＨＴ组（Ｐ＜０．０５～０．００１）。ＨＴ组合并心衰、休克、室速室颤者与住院病死率均高于ＮＨＴ组（Ｐ＜０．０５～０．００１）。结论伴高血压的ＡＭＩ具有更多的冠心病危险因素,严重心脏并发症较多,近期预后较差。     

幽门螺杆菌感染及其毒力与急性心肌梗死、血浆纤维蛋白原及血栓素B2的关系

目的　探讨幽门螺杆菌 (Hp)感染及其不同毒力与心肌梗死的关系。 方法　测定 5 1例急性心肌梗死 (AMI组 )和 42例陈旧性心肌梗死 (OMI组 )患者及 3 1例冠脉造影正常者 (对照组 )的Hp特异性抗体 (HpIgG、HpIgM )及其细胞毒素相关蛋白特异性抗体浓度 ,并同步观察血浆纤维蛋白原 (Fg)、血栓素B2 (TXB2 )变化及其与Hp感染的相关性。结果　AMI组HpIgG、HpIgM阳性率及平均浓度 (或OD值 )明显高于对照组 (P <0 .0 5 ) ;校正冠心病危险因素前、后 ,HpIgG阳性与AMI均具有相关关系。AMI组Fg、TXB2 明显高于对照组、OMI组。AMI组中Hp阳性者Fg、TXB2 明显高于Hp阴性者 (P <0 .0 5 )和OMI组中Hp阳性者 (P <0 .0 0 1) ;调整冠心病的危险因素前、后 ,IgG与Fg均呈正相关 (P <0 .0 5 )。 结论　Hp感染与AMI、Fg、TXB2 之间存在明显的相关性 ,不同毒力的Hp感染与冠心病心肌梗死的关系无显著性差异     

静息心率与急性心肌梗死关系的临床探讨

目的探讨静息心率(RHR)在急性心肌梗死(AMI)中的变化及临床意义。方法选择住院确诊的AMI患者110例进行RHR测定,以40例体检无异常发现者作为对照,分析RHR与AMI的梗死面积、并发症及预后之间的关系。结果AMI组RHR显著高于正常人(82.8±12.4次/分vs71.8±10.4次/分,P<0.001);不同梗死面积的患者间RHR差异显著(F=6.393,P<0.01),RHR随梗死面积的增加而增快;合并心力衰竭或休克的AMI患者RHR显著高于无合并症者(P<0.05或0.001);RHR增快(≥80次/分)的AMI患者射血分数低于RHR正常(<80次/分)者(P<0.01);住院期间死亡患者RHR亦显著高于病情好转及治愈者(t=3.995,P<0.001),其中RHR≥90次/分的AMI患者的住院病死率显著高于RHR<90次/分的AMI患者(χ2=25.521,P<0.005)。结论RHR与AMI的发生与发展有一定关系,可作为评估AMI病情和预后的指标之一。     

可溶性白介素2受体与急性心肌梗塞相关性的研究

本研究采取双抗体夹心ＥＬＩＳＡ法测定３２例急性心肌梗塞患者血清可溶性白介素２受体（ｓＩＬ－２Ｒ）和肌酸激酶（ＣＫ）结果显示：急性心肌梗塞的ｓＩＬ－２Ｒ和ＣＫ明显高于恢复期的患者及正常对照组（ｎ＝４０）（Ｐ＜０．００１，Ｐ＜０．００１），而恢复期与正常对照组无显著差异（Ｐ＞０．０５）；ｓＩＬ－２Ｒ水平与急性心肌梗塞的面积呈正相关（Ｐ＜０．００１，Ｐ＜０．０５）；无并发症的急性心肌梗塞与伴有并发症的急性心肌梗塞的ｓＩＬ－２Ｒ、ＣＫ有显著差异（Ｐ＜０．０５．Ｐ＜０．０１）．提示急性心肌梗塞患者存在免疫调节功能改变，显示ｓＩＬ－２Ｒ做为急性心肌梗塞患者病情监测、判断预后的指标。     

不同年龄老年急性心肌梗死住院患者近期预后的临床分析

目的 探讨年龄对老年住院急性心肌梗死(AMI)患者近期预后的影响.方法 对2535例老年AMI住院患者按年龄、预后分别分组.回顾性分析年龄、并存疾病对AMI患者预后的影响.结果 80v94岁组与65～79岁组、60～64岁组比较,住院病死率升高,分别为7.5%、14.2%和22.9%(χ2=46.378,P<0.01),30 d病死率亦升高(χ2=44.534,P<0.01);60～64岁AMI患者30 d死亡组陈旧性心肌梗死、肾功能不全、肺功能不全例数高于存活组,心绞痛例数低于存活组(P<0.05);65～79岁AMI患者30 d死亡组合并陈旧性心肌梗死、高血压、糖尿病,脑血管病、肾功能不全、肺功能不全例数均高于存活组;合并心绞痛例数低于存活组(P<0.05).80～94岁AMI患者30d死亡组陈旧性心肌梗死、糖尿病、脑血管病、肾功能不全、肺功能不全例数均高于存活组,心绞痛低于存活组(P<0.05);80～94岁以上30 d死亡组与60～64岁、65～79岁的死亡组比较,陈旧性心肌梗死、高血压、糖尿病、脑血管病、肺功能不全患者增加(P<0.05).结论 AMI患者病死率随增龄而升高,不典型心绞痛是80岁及以上AMI患者死亡的独立危险因素.     

Plasma viscosity, fibrinogen and haematocrit in the course of unstable angina

Plasma viscosity, fibrinogen and haematocrit were measured in 80 patients with unstable angina on the 1st, 2nd and 5th day of hospitalization. In the group of patients who developed acute myocardial infarction (AMI) during hospitalization (20 patients), plasma viscosity was elevated during the entire observation period (1.69 +/- 0.05 cp, normal range 1.38-1.48 cp), while in patients who did not develop AMI, plasma viscosity was only mildly elevated (1.59 +/- 0.05 cp, P less than 0.001 vs the group who developed AMI) and tended to normalize towards the 5th day of hospitalization. Fibrinogen and haematocrit showed similar variations between the two groups. In a group of 20 patients who received heparin, the studied parameters were similar to the group who did not develop AMI. The importance of haemorheological factors in the clinical course of unstable angina is thus emphasized.