颅脑外伤患者去骨瓣减压术后早期颅内血肿进展的影响因素

目的 分析颅脑外伤患者早期颅内血肿进展的相关因素。方法 分析2018年6月—2022年6月期间鹤壁市人民医院采用去骨瓣减压术治疗的180例颅脑外伤患者,依据是否出现早期颅内血肿进展分为进展组（n=54）和对照组（n=126）,采用多因素Logistic回归分析这些患者早期颅内血肿进展的影响因素。结果 分析结果显示,多发性血肿、术前血肿量≥20 cm³、纤维蛋白原＜2 g/L为颅脑外伤患者早期颅内血肿进展的危险因素（P＜0.05）。结论 多发性血肿、术前血肿量≥20 cm³、纤维蛋白原＜2 g/L为颅脑外伤患者去骨瓣减压术后早期颅内血肿进展的危险因素,临床中应对高危患者加强监测。     

纤维蛋白原、纤维蛋白及其降解产物对共培养血管平滑肌细胞表型转换的影响

目的：研究不同浓度纤维蛋白原（Fg）、纤维蛋白（Fb）及其降解产物（FDPs）对共培养血管平滑肌细胞（SMCs）表型转换的影响。方法：建立兔主动脉内皮细胞（ECs）-SMCs共培养体系，分别观察在正常增殖和不同浓度Fg、Fb和FDPs干预后共培养SMCs表型转换标志物——α-SM-actin mRNA的表达。结果：在共培养条件下从第3天开始SMCs呈增殖表型的形态特征，第6天后，呈收缩表型的形态特征；较高浓度（3.0-6.0mg·mL^-1）的Fg、Fb和FDPs均可显著下调α-SM-actin mRNA的表达，抑制SMCs向收缩表型转换。结论：增殖过程中SMCs表型发生有规律的转换；Fg、Fb和FDPs通过影响SMCs的异常表型转换，参与了动脉粥样硬化进程。     

阿司匹林与氯吡格雷双联对TIA患者凝血功能的影响

目的探讨阿司匹林与氯吡格雷双联对短暂性脑缺血发作(TIA)患者血小板聚集率和纤维蛋白原的影响。方法100例短暂性脑缺血发作患者随机分为2组,在常规控制血压、血糖、血脂等基础上,治疗组给予阿司匹林联合氯吡格雷治疗,对照组给予阿司匹林,其中阿司匹林100mg/d,氯吡格雷75mg/d。观察2组血小板聚集率与纤维蛋白原相关指标及临床疗效。结果治疗7~14d后,与对照组比较,治疗组血小板聚集率显著改善(P0.05),纤维蛋白原水平下降更显著(P0.05);治疗组临床疗效显著优于对照组(P0.05)。2组均未出现严重出血并发症。结论阿司匹林与氯吡格雷双联治疗短暂性脑缺血发作可改善患者血小板聚集率,降低纤维蛋白原水平,临床疗效显著。     

脑再梗死患者的D-二聚体、纤维蛋白原及血液流变学改变研究

目的探讨脑再梗死患者与初次脑梗死患者的血浆D-二聚体、纤维蛋白原及血液流变学的改变。方法分别对60例初次脑梗死患者及60例脑再梗死患者的血浆D-二聚体、纤维蛋白原及血液流变学进行测定,并对患者进行临床神经功能缺损评分和进行组间比较。结果再次脑梗死组血浆D-二聚体、纤维蛋白原及血浆粘度值、红细胞聚集指数均高于初次脑梗死组(P<0.05);在再次脑梗死组血浆D-二聚体与患者临床神经功能缺损评分呈显著相关(P<0.05)。结论血浆D-二聚体、纤维蛋白原及血液流变学的改变与脑再梗死的发生及预后有一定的关系,是再发脑梗死事件的重要危险因素。     

RDW TGF-β1 FIB与创伤性脑损伤后脑积水患者术后神经功能缺损的关系及预测预后的ROC分析

目的 探讨红细胞分布宽度(RDW)、转化生长因子-β1(TGF-β1)、纤维蛋白原(FIB)与创伤性脑损伤后脑积水脑室-腹腔分流术患者神经功能缺损的关系及联合预测预后的价值.方法 选取2016-10—2020-06上海市第六人民医院收治的108例创伤性脑损伤后脑积水患者,均行脑室-腹腔分流术,统计患者手术情况,根据3个...     

急性脑梗死患者血浆血管性血友病因子抗原、D-二聚体和纤维蛋白原降解产物的改变及临床意义

目的 观察急性脑梗死患者血浆血管性血友病因子抗原(vWF:Ag)、D-二聚体(DD)和纤维蛋白原降解产物(FDP)的改变及临床意义.方法 采用免疫比浊法测定vWF:Ag、DD和FDP的水平.分析急性脑梗死组与对照组间vWF:Ag、DD和FDP水平的差异,随访脑梗死组1年后vWF:Ag、DD和FDP的水平.结果 共纳入94例急性脑梗死患者,其中男56例(59.6%),女38例(40.4%).对照组为120名健康体检者,其中男68名(56.7%),女52名(43.3%).急性脑梗死组血浆vWF:Ag和DD水平高于对照组(P<0.01).Logistic回归分析显示,vWF:Ag、DD水平升高是急性脑梗死的危险因素.vWF:Ag、DD与NIHSS评分呈正相关(r=0.625、0.582,P<0.01),vWF:Ag与DD呈正相关(r=0.320,P<0.01).出院一年后,预后差的脑梗死患者血浆vWF:Ag、DD、FDP水平高于预后良好的患者(P<0.05).结论 急性脑梗死患者血浆中vWF:Ag、DD水平明显增高,且与病情严重程度相关.检测急性脑梗死患者的vWF:Ag、DD水平,有助于对病情严重程度及预后的判断.     

酒环境线索暴露对酒依赖者停止饮酒后心理渴求及生理活动的影响

目的 探讨酒环境暴露对酒依赖者心理渴求及生理活动的影响.方法 选择停止饮酒40 d的64例酒依赖患者和32名正常受试者(正常对照组)为研究对象,将患者分为试验组(暴露于酒环境)和患者对照组(暴露于牛奶环境),每组各32例,分别暴露于相关环境线索,于暴露前、暴露后的第1天、第1周和第4周测试三组的心理渴求以及心率、血压、血氢化可的松水平的变化.结果 (1)患者试验组和患者对照组的血浆氢化可的松水平于暴露前[分别为(77±40)μg/L和(75±40)μg/L]、暴露后第1天[分别为(123±56)μg/L和(77±40)μg/L]均高于正常对照组[(47±26)μg/L和(47±31)μg/L;P＜0.05].(2)患者试验组暴露于酒环境后,第1天的心理渴求程度及心率、收缩压、舒张压及血氢化可的松水平均较暴露前增高(P＜0.05),而第1周和第4周与暴露前比较的差异无统计学意义(P＞0.05).结论 酒环境暴露后酒依赖者的心理渴求及心率、血压、血氢化可的松水平增高,减少酒环境线索的暴露是降低复饮的重要因素.     

银杏达莫注射液治疗急性脑梗死的疗效及对血液流变学和纤维蛋白原含量的影响

目的探讨银杏达莫注射液治疗急性脑梗死的临床疗效及对血液流变学和纤维蛋白原含量的影响。方法将92例急性脑梗死患者采用随机数字表法分为2组各46例,均采取对症治疗,另外对照组给予丹参注射液,观察组给予银杏达莫注射液,比较2组临床疗效、治疗前后血液流变学指标、纤维蛋白原含量变化及不良反应发生情况。结果观察组总有效率为91.30%,显著高于对照组的73.91%(P0.05);观察组治疗后全血高切黏度、低切黏度、血浆黏度、红细胞压积和纤维蛋白原含量分别为(4.13±0.56)mPa/s、(6.23±0.72)mPa/s、(1.60±0.21)mPa/s、(43.11±3.29)%和(3.61±0.45)g/L,均显著低于对照组的(4.50±0.60)mPa/s、(7.84±0.75)mPa/s、(1.88±0.20)mPa/s、(47.03±3.39)%和(3.98±0.44)g/L(P0.05);2组不良反应发生率比较差异无统计学意义(P0.05)。结论银杏达莫注射液治疗急性脑梗死疗效显著,可明显改善患者血液流变学指标,降低纤维蛋白原含量,值得临床推广应用。     

去铁酮对大鼠脑出血后铁超载、活性氧含量及神经功能的影响

目的研究去铁酮(Dfp)对大鼠脑出血后铁超载情况下总铁含量、活性氧含量及神经功能缺损的影响。方法采用大鼠Ⅳ型胶原酶定位注射到大鼠右侧基底节区来制造脑出血模型,用原子吸收光谱法测定脑组织中的总铁含量,通过化学荧光法测定活性氧含量,并观察各组大鼠的神经功能缺损体征。结果 (1)脑出血(ICH)组及Dfp处理组各组较同期假手术(SH)组总铁含量显著增多,且ICH组以7 d最多(P<0.05);Dfp组与ICH组相比脑组织总铁含量显著减少(P<0.05)。(2)ICH组及Dfp组各组较同期SH组相比活性氧含量显著增多,以7 d最多(P<0.05);Dfp组与ICH组相比,活性氧含量各组之间没有统计学意义(P>0.05)。(3)ICH组和Dfp组各时间点神经功能评分均显著增高,以1 d~3 d最高,之后逐渐下降,差异无统计学意义(P>0.05)。结论数据显示大鼠脑出血后总铁含量显著增加,活性氧含量明显升高,并且有明显的神经功能缺损;Dfp可明显降低脑出血后脑组织中的总铁含量,但活性氧含量未发生明显变化,且不能改善神经功能缺损。     

FgBβ-1420G/A、-993C/T、1689T/G、BsmAIG/C、I6I/D、345C/T、HinfIA/C基因多态性对血浆Fg浓度和分子功能的影响

目的分析人群纤维蛋白原(fibrinogen,Fg)Bβ-1420G/A、-993C/T、1689T/G、BsmAIG/C、I6I/D、345C/T、HinfIA/C基因分布特征及其与血浆Fg浓度和分子活性功能的关系。方法采用整群抽样的方法选取开滦集团离退休职工940人,均留取清晨空腹静脉血测定血糖、尿酸等生化指标;应用PCR-RFLP、AS-PCR和基因测序方法检测FgBβ链7位点的基因型;采用微机辅助血浆Fg功能自动监测系统测定血浆Fg浓度和纤维蛋白单体聚合反应速率(FMPV)、最大光密度(Amax)、FMPV/Amax等反映Fg分子聚合功能的参数。结果仅FgBβ链-1420基因多态性位点变异基因型的分布频率高于其野生型的分布频率,达61.5%,而其余6位点则均以野生基因型分布占优势。Fg 7个多态性位点各基因型人群之间的血浆Fg浓度、FMPV、Amax及FMPV/Amax均无统计学差异(P>0.05)。依据多因素分析结果进行分层分析,以尿酸分层时可见高尿酸组与尿酸正常组FMPV/Amax比较有统计学差异(P<0.05)。结论 FgBβ链5′端启动子区-1420G/A、-993C/T,转录区外显子345C/T和内含子1689T/G、BsmAIG/C、I6I/D及3′端Hinf IA/C基因多态性位点对血浆Fg浓度和分子活性功能的表达没有直接明显影响,但其形成的特殊基因连锁板块对血浆Fg功能表达的影响尚需进一步研究。     

Evidence that plasma fibrinogen and platelet membrane GPIIb-IIIa are involved in the adhesion of platelets to an artificial surface exposed to plasma

We investigated the molecular mechanism(s) by which platelets adhere to an artificial surface exposed to plasma, using polystyrene microtiter plates pretreated with plasma. Washed platelets labelled with ⁵¹Cr were incubated with the plates under static conditions. Prostaglandin E₁(PGE₁) was added to the platelets to prevent platelet-platelet interactions. Adhesion required the presence of a divalent cation such as Mg⁺⁺ or Ca⁺⁺. Polyclonal anti-fibrinogen antibody inhibited adhesion by 70%. Polyclonal antibodies against fibronectin, vitronectin, von Willebrand's Factor, and the Fc portion of human IgG, had no effect on adhesion. Platelets adhered normally to a surface pretreated with plasma from a patient with severe von Willebrand's disease. No platelet adhesion occurred when the surface was pretreated with an afibrinogenemic plasma. Monoclonal antibodies against platelet membrane GPIIb-IIIa, potent inhibitors of ADP-induced fibrinogen binding to platelets, completely inhibited adhesion. Monoclonal antibodies against the GPIb subunit and GPIc(VLA ₅) showed no inhibitory effects on adhesion. Platelets from a patient with Glanzmann's thrombasthenia (type 1) did not adhere to the surface pretreated with normal plasma. These results suggest that plasma fibrinogen adsorbed onto the surface and that platelet membrane glycoprotein(GP)IIb-IIIa were responsible for adhesion in an activation-independent manner.     

Effects of extracorporeal circulation and heparin on the phenotype of platelet surface antigens following heart surgery

In this prospective study, the time-dependent effects of extracorporeal circulation and heparin-mediated effects on platelet surface antigens in vitro were investigated using whole blood flow cytometry. Blood samples were drawn prior to and following extracorporeal circulation in 89 patients. The response of surface antigen expression (glycoprotein IIb/IIIa, P-selectin, and glycoprotein Ib) with and without in vitro stimulation was measured. A significant correlation of the duration of extracorporeal circulation with the postoperative response of glycoprotein IIb/IIIa, glycoprotein Ib, and P-selectin to in vitro activation was found. Postoperative P-selectin and glycoprotein Ib expression stimulated with ADP correlated to blood loss. Heparin in vitro significantly reduced glycoprotein Ib expression. Heparin, as well as the duration of extracorporeal circulation, independently correlated to phenotypic changes of platelets following extracorporeal circulation. The significant correlation of these variables to postoperative blood loss demonstrates their relevance to platelet function in vivo.     

比较静脉溶栓与双抗治疗脑梗死后PLT、凝血指标、D-二聚体变化

目的静脉应用rt-PA(阿替普酶)和口服应用阿司匹林联合氯吡格雷治疗急性脑梗死后,了解24h内的PLT、凝血指标、D-二聚体的变化。方法收集发病在4.5 h以内的急性脑梗死患者,一组静脉应用rt-PA,另一组口服阿司匹林联合氯吡格雷,24 h内取血化验血小板计数、凝血指标、D-二聚体,比较两组差异。结果溶栓后24 h内,D-二聚体、PLT增高,Fib降低,TT、PT、APTT延长,分别与溶栓前和双抗组比较,有统计学意义。结论在治疗后24 h内阿替普酶静脉溶栓比双重抗血小板治疗更好的溶解血栓,对血栓作用更强,并且不增加继发脑出血的病死率,给急性脑梗死后选择溶栓治疗还是双抗治疗提供参考。     

No apparent effect of surgery for temporal lobe epilepsy on heart rate variability

BACKGROUND: Impaired cardiac autonomic function may contribute to the risk of sudden unexpected death in epilepsy (SUDEP). Clinical observations indicate that successful epilepsy surgery is associated with a reduced risk of SUDEP. However, in a previous study we found impaired cardiac control pre-surgically in patients with poor outcome of surgery, indicating an a priori lower risk in responders to epilepsy surgery. We have now examined the effect of surgery on cardiac autonomic control in the same patients. METHODS: We used 24 h EKG recordings to assess heart rate variability (HRV) by spectral analysis in 21 consecutive patients after temporal lobe epilepsy surgery. The HRV was compared with healthy controls, with pre-surgical HRV in the same patients, and analyzed in relation to seizure control 1 year after surgery. RESULTS: The patients with poor outcome after surgery had significantly lower SD of RR-intervals, total power, very low frequency power and low frequency power than matched healthy controls. The patients with favorable outcome did not differ from the controls, and the postoperative HRV was not different from HRV before surgery in any of the patient groups. CONCLUSION: We could not demonstrate any effect on HRV of temporal lobe epilepsy surgery in these patients. The observed lower HRV in the poor outcome group was present already before epilepsy surgery as previously reported. Although our results need confirmation in a larger study, the observations suggest that the increased risk of SUDEP in patients failing epilepsy surgery may be due to a common factor predisposing to surgical failure, impaired HRV as well as to an increased risk of SUDEP.     

The effect of albumin concentration and storage time on the adhesion of washed porcine platelets to glass

The effect of storing platelet suspensions at room temperature before assessing platelet adhesiveness to glass was investigated. Changes found in adhesiveness depended on the albumin concentration of the suspension medium. The initial rate of platelet adhesion was inversely related to albumin concentration. Thereafter, during a 4-hr period, platelet adhesion decreased in suspensions with low (0–0.35%) albumin concentrations, whereas at higher concentrations, the adhesion was either not affected (1% albumin) or increased (2% albumin). These observations are explained by the different and opposite effects of albumin which adsorbs to glass more quickly than the platelets and improves the viability of the platelets during storage.     

Plasma fibrinogen level on admission to the intensive care unit is a powerful predictor of postoperative bleeding after cardiac surgery with cardiopulmonary bypass

Introduction

Evidence regarding the behavior of fibrinogen levels and the relation between fibrinogen levels and postoperative bleeding is limited in cardiac surgery under cardiopulmonary bypass (CPB). To evaluate perioperative fibrinogen levels as a predictor of postoperative bleeding in patients undergoing cardiac surgery with CPB.

Materials and Methods

In this prospective, single-center, observational cohort study of 1956 patients following cardiac surgery with CPB, fibrinogen level was measured perioperatively. Excessive bleeding group was defined as patients with a 24-h chest tube output (CTO) exceeded the 90th percentile of distribution.

Results

The median 24-h CTO was 728.6 ± 431.1 ml. A total of 189 patients (9.7%) were identified as having excessive bleeding. At admission to the intensive care (Day 0), the fibrinogen levels were 2.5 ± 0.8 g/l and 2.1 ± 0.8 g/l in the control and excessive bleeding groups, respectively (P < 0.0001). The fibrinogen level on Day 0 was significantly correlated with the 24-h CTO (rho = -0.237; P < 0.0001). Multivariate analysis demonstrated that the fibrinogen level at Day 0 was the best perioperative standard laboratory test to predict excessive bleeding (P = 0.0001; odds ratio, 0.5), whereas preoperative fibrinogen level was not a predictor. Using receiver operating characteristics curve analyses, the best Day 0 fibrinogen level cutoff to predict postoperative bleeding was 2.2 g/l.

Conclusions

In this large prospective study, the fibrinogen level upon admission to the intensive care unit after CPB predicted the risk of postoperative bleeding. Our data add to the concern regarding the fibrinogen level threshold that might require fibrinogen concentrate infusion to reduce postoperative blood loss.     

养血清脑颗粒与罗痛定治疗紧张性头痛及对血小板聚合的影响

目的 研究养血清颗粒治疗紧张性头痛的疗效，探讨对血小板聚集的影响及紧张性头痛可能的发病机制。方法 对紧张性头痛患者随机分组，治疗组用养血清脑颗粒，对照组用罗痛定片，2周为一疗程，分别判定治疗前后2组患者疗效。测定血小板聚集率的变化。结果 养血清脑颗粒治疗紧张性头痛的有效率95．5％，对血小板聚集率有明显的影响。结论 养血清脑颗粒治疗紧张性头痛有效，其发病机制有待进一步探讨。     

养血清脑颗粒与罗痛定治疗紧张性头痛及对血小板聚合的影响

目的 研究养血清颗粒治疗紧张性头痛的疗效,探讨对血小板聚集的影响及紧张性头痛可能的发病机制.方法 对紧张性头痛患者随机分组,治疗组用养血清脑颗粒,对照组用罗痛定片,2周为一疗程,分别判定治疗前后2组患者疗效.测定血小板聚集率的变化.结果 养血清脑颗粒治疗紧张性头痛的有效率95.5%,对血小板聚集率有明显的影响.结论 养血清脑颗粒治疗紧张性头痛有效,其发病机制有待进一步探讨.     

Comparison of the effect of homocysteine in the reduced form, its thiolactone and protein homocysteinylation on hemostatic properties of plasma

Mechanisms involved in the relationship between hyperhomocysteinemia and hemostatic process are still unclear. In the literature there are few papers describing studies on the effects of homocysteine (Hcys) on proteins that participate in blood coagulation and fibrinolysis in human. The aim of our study was to establish and compare the influence of a reduced form of Hcys (at final doses of 0.01 - 1 mM) and the most reactive form of Hcys - its cyclic thioester, homocysteine thiolactone (HTL, 0.1 - 1 μM) on the clot formation (using whole human plasma and purified fibrinogen) and the fibrin lysis. Moreover, the aim of our study was to explain the effect of plasma protein modifications (S- and N-homocysteinylation) on selected parameters of hemostasis. We observed that HTL, like its precursor, a reduced form of Hcys stimulated polymerization of fibrinogen, but this process was not dose-dependent. In the presence of HTL (at the lowest tested concentration - 0.1 μM) the increase was about 55%. Our present results also demonstrated that Hcys in the reduced form (0.01 - 1 mM) and HTL at lower doses than Hcys (0.1 - 1 μM) reduced the fibrin lysis in whole human plasma. Our results reported that HTL, like the reduced form of Hcys (at concentrations corresponding to concentrations in plasma during hyperhomocysteinemia) induced modifications of hemostatic plasma proteins, and the consequence of these modifications may be alteration in protein structure associated with changes of hemostatic functions.