幽门螺杆菌对脑梗死患者血小板活化及凝血功能的影响

目的:观察幽门螺杆菌(Helicobacter pylori,Hp)感染对急性脑梗死患者血小板活化水平及凝血功能的影响,探讨其参与脑梗死发病的可能机制。方法:检测66例初发急性脑梗死患者(脑梗死组)和50例非脑血管病患者(对照组)Hp抗体浓度,全血血小板表面活化依赖的膜糖蛋白CD62p的表达和各凝血指标的水平,比较脑梗死组与对照组幽门螺杆菌感染情况、CD62p表达水平和凝血功能。结果:①脑梗死组Hp-IgG和Hp-CagA阳性率均高于对照组(P<0.05)。②脑梗死组Hp阳性患者血小板表面CD62p阳性率高于脑梗死组Hp阴性患者及对照组(P<0.05)。③脑梗死组Hp阳性患者PT、PTR及INR与Hp阴性组患者无明显差异(P>0.05),但两组间APTT、TT及FIB差异显著(P<0.05),其中Hp阳性患者APTT、TT较Hp阴性患者缩短,而FIB含量高于Hp阴性患者。结论:Hp感染可能通过增强急性脑梗死患者的血小板活化水平影响其凝血功能,参与脑梗死的发生与发展。     

综合性护理在伴Hp感染急性脑梗死患者治疗中的应用

目的探讨综合性护理在伴幽门螺杆菌(Hp)感染急性脑梗死患者治疗中的应用价值。方法 72例伴Hp感染的急性脑梗死(ACI)患者随机分为综合性护理组(n=36)和常规护理组(n=36),均给予抗Hp的三联疗法和溶栓抗凝、抗血小板聚集等脑梗死常规综合治疗,对照组给予常规护理,观察组给予综合性强化护理干预,比较两组Hp根除率及神经功能缺损评分(NIHSS),检测两组护理前后凝血功能指标及血小板活化率,并统计治疗依从性和护理满意度等。结果强化护理组Hp根除率88.89%明显高于对照组69.44%,护理后NIHSS评分显著低于对照组(P0.05)。两组护理前各项凝血功能指标及血小板活化百分率比较无统计学意义(P0.05),护理后与对照组比较,强化护理组凝血酶原时间(PT)、活化部分凝血活酶时间(a PTT)、凝血酶时间(TT)明显较长,纤维蛋白原(Fbg)、D二聚体(D-D)、CD62p血小板百分率显著较低(P0.05)。强化护理组治疗依从性、护理满意度明显高于对照组,合并症发生率11.11%明显低于对照组30.55%(P0.05)。结论综合性强化护理干预对改善伴Hp感染急性脑梗死患者的临床治疗疗效和凝血功能有积极作用。     

凝血功能检测对子宫腺肌病患者临床意义

目的 探讨凝血功能检测对子宫腺肌病患者临床意义。方法 以80例子宫腺肌病患者为对象,以同期80例接受子宫全切除治疗的子宫肌瘤的患者为对照组。检测两组凝血功能指标,分析其临床意义。结果 观察组活化部分凝血酶原时间(aPTT)水平高于对照组,凝血酶时间(TT)水平低于对照组(P<0.05);两组凝血酶原时间(PT)、纤维蛋白原定量(Fbg)、国际标准化比值(INR)及血小板计数(PLT)水平比较无差异(P> 0.05)。贫血组患者PLT水平高于非贫血组(P<0.05);两组a PTT、PT、TT、Fbg、INR水平比较无差异(P> 0.05)。Paerson相关性分析显示,子宫腺肌病组患者Fbg、PT与子宫体积呈正相关(P<0.05)。结论 子宫腺肌病患者凝血功能存在异常,贫血可能参与凝血功能的紊乱过程。     

急性白血病凝血指标的分析

目的探讨急性白血病(AL)凝血指标的变化及其临床意义。方法应用法国Stago-compact全自动血凝仪及其配套试剂,检测80例急性白血病的凝血酶原时间(PT)、活化部分凝血活酶时间(aPTT)、纤维蛋白原(Fbg)含量、凝血酶时间(TT)。结果与正常对照组比较,急性白血病组Fbg差异有显著性(P0.01),PT、aPTT差异均有显著性(P0.05),TT差异无显著性(P(0.05)。结论检测急性白血病的凝血指标能为有效应对急性白血病并发出血提供实验依据。     

标本因素对凝血五项检测结果的影响

目的探析标本因素对凝血五项检测结果的影响。方法选取本院2016年9月至2018年5月本院检验科583例不同因素的凝血标本,通过全自动血凝分析仪检测凝血指标活化部分凝血活酶时间(aPTT)、凝血酶原时间(TT)、凝血酶时间(TT)、纤维蛋白原(Fbg)以及国际标准化比值(INR)。结果采血量大于和小于2.0 ml标本检测PT、aPTT、TT、INR结果均大于重新取样合格样本,Fbg检测结果小于重新取样合格样本,差异有统计学意义(P0.05);标本经3000 r/min转速下离心15 min与4000 r/min转速下离心5 min条件下PT、aPTT、TT、Fbg、INR指标比较差异无统计学意义(P0.05);标本经3000 r/min转速下离心5 min、10 min、15 min后PT、aPTT、TT、Fbg、INR比较差异无统计学意义(P0.05);不同标本储存时间PT、Fbg、INR指标比较差异无统计学意义(P0.05);储存时间为4 h时,aPTT结果大于0 h和2 h,TT结果小于0 h和2 h,差异有统计学意义(P0.05);溶血标本检测PT、aPTT、INR结果均小于未溶血样本,TT结果大于未溶血标本,Fbg检测结果小于未溶血标本,差异有统计学意义(P0.05)。结论标本采集量、储存时间及标本溶血情况因素影响凝血指标检测结果的准确性。     

STA-campact全自动血凝仪检测PT、aPTT、Fbg、TT的参考值调查

目的探讨凝血酶原时间（PT）、活化部分凝血酶时间（aPTT）、纤维蛋白原（Fbg）、凝血酶时间（TT）在健康人群中的分布,并对不同的年龄、性别组分别进行比较分析.方法选择健康人535名在法国STA-compact全自动血液凝固仪上采用原装配套试剂测定PT、aPTT、Fbg、TT.结果535名健康人参考值范围：PT11.74～14.74 s;PTR 0.90～1.14;INR 0.86～1.20;aPTT 32.16～46.03 s;Fbg 1.69～4.10g/L;TT 13.85～21.75 s.男、女性别之间PT、PTR、INR、Fbg差异有显著性（P＜0.05）.各年龄组之间Ⅳ组（大于60岁）与各组PT差异有显著性（P＜0.05）,Ⅱ组（21～40岁）与Ⅲ组（41～60岁）aPPT差异有显著性（P＜0.05）.Ⅱ组与Ⅲ组、Ⅳ组Fbg差异有显著性（P＜0.05）.结论除TT测定无统计学意义外,PT、PTR、INR、Fbg在不同性别和年龄组均有不同程度差异,aPTT在Ⅱ、Ⅲ组有显著性差异.各实验室应建立自己的参考值为临床诊断提供最可靠的依据.     

孕妇血栓前状态与新生儿结局的关系分析

目的探讨分析孕妇血栓前状态与新生儿结局的关系。方法选取我院2016年1月至2017年1月收治的50例存在胎儿受限情况的产妇作为研究组,采用随机数字法分为研究组A(25例)和研究组B(25例),研究组B予以低相对分子质量肝素(LMWH)治疗,同时选取同期我院收治的50例正常分娩产妇作为对照组,比较三组的凝血功能[纤维蛋白原(Fbg)、活化部分凝血活酶时间(aPTT)、血浆凝血酶原时间(PT)、凝血酶时间(TT)]及血小板相关参数[血小板计数(BPC)、血小板平均体积(MPV)、血红蛋白(HB)、红细胞比积(HCT)],分娩后比较三组新生儿出生质量及新生儿Apgar评分。结果研究组A的Fbg显著高于研究组B和对照组(P0.05),aPTT、PT、TT显著低于研究组B和对照组(P0.05),研究组B的Fbg显著高于对照组(P0.05),aPTT、PT、TT显著低于对照组(P0.05);研究组A的MPV、HCT显著高于研究组B和对照组(P0.05),研究组B的MPV、HCT显著高于对照组(P0.05);研究组A的显著低于研究组B和对照组(P0.05),研究组B的新生儿质量及新生儿Apgar评分显著低于对照组(P0.05)。结论孕妇血栓前状态与新生儿结局密切相关,临床需加强孕妇凝血功能及血小板相关参数的监测,并予以针对性治疗,可改善妊娠结局。     

严重创伤患者大量输血治疗对凝血功能的临床研究

目的 探讨严重创伤患者大量输血治疗对凝血功能的影响.方法 以140例需输血治疗的患者为对象,分为对照组与观察组.比较两组凝血功能指标水平.结果 两组治疗前血小板计数(PLT)、活化部分凝血酶原时间(aPTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(Fbg)水平比较无差异(P>0.05);两组治疗后aPT...     

棚替佐米方案诱导治疗对多发性骨髓瘤患者凝血四项及血栓相关事件发生率的影响

目的观察棚替佐米方案(PAD)诱导治疗对多发性骨髓瘤患者凝血四项及血栓相关事件发生率的影响。方法选取我院2012年3月至2015年3月110例多发性骨髓瘤患者为研究对象,将患者抽签随机分为观察组与对照组,每组55例。比较两组凝血四项包括凝血酶原时间(PT)、活化部分凝血活酶时间(aPTT)、凝血酶时间(TT)、纤维蛋白原(Fbg),血小板聚集率,血栓事件及不良反应发生率。结果观察组PT、TT、aPTT、Fbg、血小板聚集率均低于对照组(P0.05)。观察组血栓事件发生率3.64%低于对照组16.36%(P0.05)。两组不良反应发生率比较无统计学意义(P0.05)。结论 PAD诱导治疗对多发性骨髓瘤,可纠正患者凝血功能障碍,抑制血小板聚集,降低血栓相关事件发生率。     

急性进展性脑梗死与凝血功能、纤溶功能、血脂的相关性分析

目的分析急性进展性脑梗死与凝血功能、纤溶功能、血脂的相关性。方法回顾性分析2014年5月至2017年5月在我院确诊为急性进展性脑梗死患者85例(进展组),急性非展性脑梗死患者85例(非进展组)及健康体检85例(对照组)的凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血活酶时间(a PTT)、纤维蛋白原(Fbg)、凝血酶时间(TT)、D二聚体(D-D)、甘油三酯(TG)、总胆固醇(TC)。分析三组的标检测结果差异,并分析凝血功能、纤溶功能、血脂与急性进展性脑梗死的相关性。结果患者发病48 h内,进展组与非进展组患者PT、INR、a PTT、TT无显著变化,但Fbg、D-D均升高(P0.05);进展组Fbg、D-D升高较非进展组明显(P0.05)。进展组与非进展组TG、TC较对照组均有升高,但无统计学差异(P0.05)。Logistic回归分析显示Fbg、D-D为急性进展性脑梗死独立危险因素,结论急性进展性脑梗死患者Fbg、D-D与脑梗死损坏程度成正相关,加强对Fbg、D-D水平的监测,对患者的预后判断有参考价值。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.