急性心肌梗死患者血小板参数和血浆纤维蛋白原含量变化分析

目的探讨急性心肌梗死(AMI)患者血小板计数(PLT)、平均血小板体积(MPV)、血小板分布宽度(PDW)和纤维蛋白原(Fib)含量的变化及其对预后的意义。方法 AMI患者入院24h内抽取静脉血进行血小板系列参数和血浆FIB检测,同健康体检者80名的结果作对照。结果 AMI患者及其与健康对照组的上述各指标对比均出现不同程度的差异。结论联合PLT、MPV、PDW和Fib检测对AMI患者的病情监测和预后判断有重要意义。     

急性冠状动脉综合征患者纤维蛋白原和C反应蛋白的检测及其临床意义

目的：探讨急性冠状动脉综合征（ACS）患者血浆纤维蛋白原（fibrinogen。FIB）含量和血清C反应蛋白（C—reactive protein，CRP）水平的测定及其临床意义。方法：选择35例ACS患者（ACS组）、20俐稳定型心绞痛患者（SAP组）、25名健康体格检查者（对照组）作为研究对象，用免疫浊度法测定血清CRP水平、血浆FIB水平。并作比较。结果：ACS组血浆FIB水平、血清CRP水平[（4．6±1． 2）g／L，（32．12±6．3）mg／L]明显高于SAP组[（3．6±0．2）g／L，（6．20±4．5）mg／L]及对照组[（3．1±0． 3）g／L，（5．40±4．8）mg／L]（P〈0．05或P〈0．01）。ACS组血浆FIB水平与血清CRP水平间呈正相关（r=0．61，P 〈0．01）。结论：ACS患者血浆FIB水平与血清CRP水平明显升高。FIB与CRP可以作为早期预测ACS的生化指标．[著者文摘]     

冠心病和脑梗塞患者中纤维蛋白原的临床意义

目的：研究血浆纤维蛋白原浓度与冠心病和脑梗塞之间的关系。同时研究纤维蛋白原浓度与冠心病伴发心绞痛、心肌梗塞、心力衰竭的关系以及纤维蛋白原浓度与脑梗塞的梗塞面积大小的关系。方法：选择冠心病和脑梗塞病人共42例。作为观察组，30例无冠心病。脑梗塞者作为对照组。测定血浆纤维蛋白原水平。结果：(1)观察组中有39例纤维蛋白原高于正常。占92．8％。对照组中仅为4例。占13．3％。(2)纤维蛋白原浓度与冠心病伴发心绞痛。心力衰竭呈正相关。与脑梗塞时梗塞面积的大小呈正相关。     

去纤维蛋白原酶对急性心肌梗死尿激酶溶栓疗效增强作用的研究

目的 :观察联合应用去纤维蛋白原酶 (DEF)和小剂量尿激酶 (UK)对急性心肌梗死 (AMI)溶栓治疗的临床疗效及安全性。方法 :对 6 h内的 AMI患者分为联合用药组和单独用药组。联合用药组 U K剂量为单独用药组的一半 ,静脉滴注 U K前先静脉注射 DEF 5 U ,之后分别加用 3次 DEF 5 U静脉滴注。所有患者入院后均接受阿斯匹林治疗。观察判断冠状动脉再通率 ;记录出血并发症。溶栓治疗前及溶栓治疗后 6 h分别测定血浆纤维蛋白原 (Fg)及 D二聚体含量。结果 :两组患者的年龄、体质量、发病时间、再通率、再梗死率、次要出血并发症发生率和病死率相似 (P均 >0 .0 5 ) ,均无严重出血并发症发生。 U K+DEF组和 U K组再通率分别为6 9.5 6 %和 6 8.18% (P>0 .0 5 ) ;但联合用药组再通时间比单独用药组明显缩短 ,分别为 (6 2 .0 8± 32 .4 0 ) m in和(80 .0 0± 39.14 ) min。两组溶栓治疗后 D 二聚体水平相似 (P>0 .0 5 ) ,且均较溶栓前明显升高 (P均 <0 .0 5 )。UK+DEF组溶栓后 Fg含量下降 5 8.4 6 % ,其程度明显大于 U K组 (16 .78% ) ,P<0 .0 1。结论 :联合应用 DEF可以增强小剂量 UK的溶栓效力 ,加速血栓溶解 ,疗效相当于单独应用全剂量 UK,且不增加出血并发症。     

纤维蛋白原分子异常的临床意义

纤维蛋白原(Fg)的异常可分为质的缺陷(异常Fg血症)和量的异常(Fg缺乏症)，两者均可分为先天性和获得性。异常Fg血症的特征是Fg分子结构异常改变了其功能特性，先天性异常Fg大多是基因点突变导致的个别氨基酸被置换。Fg缺乏症则可分为低Fg血症和无Fg血症。先天性无Fg血症是一种罕见的常染色体隐性遗传病，特征是Fg合成不足或完全缺乏，而其代谢过程正常。迄今已发现30余种导致该病的基因突变。本文就先天性Fg分子异常的临床意义进行综述。     

纤维蛋白原分子异常的临床意义

纤维蛋白原(Fg)的异常可分为质的缺陷(异常Fg血症)和量的异常(Fg缺乏症),两者均可分为先天性和获得性。异常Fg血症的特征是Fg分子结构异常改变了其功能特性,先天性异常Fg大多是基因点突变导致的个别氨基酸被置换。Fg缺乏症则可分为低Fg血症和无Fg血症。先天性无Fg血症是一种罕见的常染色体隐性遗传病,特征是Fg合成不足或完全缺乏,而其代谢过程正常。迄今已发现30余种导致该病的基因突变。本文就先天性Fg分子异常的临床意义进行综述。     

抗凝血酶Ⅲ和纤维蛋白原测定与心肌梗死的相关性研究

目的探讨抗凝血酶Ⅲ（AT-Ⅲ）和纤维蛋白原（Fib-C）测定与心肌梗死的相关性。方法对23例急性ST段抬高型心肌梗死（STEMI）、29例非ST段抬高型心肌梗死（NSTEMI）和100例健康体检者（对照组）的血浆中的AT-Ⅲ活性与Fib-C浓度进行测定分析。结果 STEMI组与NSTEMI组的AT-Ⅲ活性及Fib-C浓度分别为（75.909±16.865）%与（3.784±0.527）g/L及（83.690±15.048）%与（3.488±0.933）g/L。经SPSS v17.0统计软件处理后,STEMI组与NSTEMI组的AT-Ⅲ活性均低于对照组（P〈0.05）;STEMI组与NSTEMI组的Fib-C浓度均高于对照组（P〈0.05）;STEMI组的AT-Ⅲ活性低于NSTEMI组（P〈0.05）;STEMI组的Fib-C浓度高于NSTEMI组（P〈0.05）。结论 AT-Ⅲ活性降低及Fib-C浓度升高与心肌梗死患者处于高凝状态或血栓形成密切相关;并通过测定有助于了解二者在不同类型的心肌梗死的发生、发展所起的作用,从而协助临床的诊断、治疗及预后的判断。     

急性心肌梗死与陈旧性心肌梗死患者纤维蛋白原和D-二聚体血测定含量对比

目的研究血浆纤维蛋白原(Fg)和D-二聚体(DD)在急性心肌梗死(AMI)和陈旧性心肌梗死(OMI)的临床意义。方法分别测定29例AMI和23例OMI的Fg和DD含量,进行Fg和DD比较。结果AMI组Fg、DD含量明显高OMI组(P<0.05)。结论Fg和DD的升高是AMI的重要依据。     

血浆纤维蛋白原与脑钠素在急性心肌梗死危险度评价中的研究

目的探究血浆纤维蛋白原(Fbg)和脑钠素(BNP)水平对急性心肌梗死(AMI)危险度的评价及与其之间的相互作用。方法以2016年10月至2017年10月该院心内科住院患者104例为研究对象,其中诊断为AMI患者为AMI组(n=64),其余为非AMI组(n=40),AMI组患者随访6个月,再根据是否发生不良事件分为事件组和对照组。采用化学发光法测定血浆中BNP水平;采用凝固法检测Fbg水平。分析血浆Fbg和BNP对AMI危险度的评价及与其之间的相互作用。结果 AMI组血浆Fbg、BNP水平高于非AMI组,差异有统计学意义(P0.05)。随冠状动脉危险程度逐渐加重,血浆Fbg与BNP水平均呈上升趋势,且冠状动脉病变严重程度与Fbg、BNP水平呈正相关(r=0.728,P0.001;r=0.824,P0.001)。6个月后随访AMI患者,事件组血浆Fbg、BNP水平高于对照组(P0.05),事件组心力衰竭血浆Fbg、BNP水平高于对照组,差异有统计学意义(P0.05)。Fbg诊断灵敏度为87.50%,特异度为62.50%,曲线下面积(AUC)为0.783;BNP诊断灵敏度为85.00%,特异度为54.68%,AUC为0.700;Fbg、BNP联合检测其诊断灵敏度为76.56%,特异度为80.00%,AUC为0.845。结论血浆Fbg、BNP水平能较好地反映患者心肌受损情况,预测病危程度与预后效果,有效指导AMI患者治疗方法的选择和改善患者预后评价。     

肺癌患者血浆纤维蛋白原的检测及其临床意义

[目的]通过检测肺癌患者血浆中的纤维蛋白原（FIB）含量，研究肺癌患者FIB与肺癌的病理分型、分化程度、临床分期、以及和转移与否的关系，评价其在肺癌辅助诊断及判断预后的临床意义。[方法]使用ACL200血凝分析仪检测277例初诊肺癌患者和37例肺良性疾病患者血浆FIB，之后进行统计学分析。[结果]肺癌患者血浆FIB明显高于肺良性疾病患者；鳞状细胞肺癌和其它细胞肺癌FIB明显高于腺癌；临床分期越高，FIB越高；存在转移者明显高于无转移者；分化程度越低，FIB水平越高。[结论]肺癌患者存在FIB异常，重症肺癌患者（高临床分期、低分化、远处转移等）血浆FIB升高。通过检测血浆中FIB含量对肺癌的辅助诊断及判断预后可能具有一定的意义。     

急性心肌梗死患者血浆sCD40L水平与细胞黏附分子改变的临床意义

目的观察急性心肌梗死患者可溶, CD40L水平变化及其与细胞性黏附分子之间的关系.方法采用酶联免疫吸附法测定血清可溶性CD40L、可溶性细胞间黏附分子-1浓度.结果急性心肌梗死患者可溶性CD40L、可溶性细胞间黏附分子-1水平显著高于对照组和稳定性冠心病患者(P＜0.01).结论急性心肌梗死患者外周血可溶性CD40L水平升高,可能与急性心肌梗死的发生有关,是动脉粥样硬化斑块不稳定的标志.CD40L可能通过上调黏附分子表达而促发急性心肌梗死.     

Soluble CD40 ligand and prolactin levels in migraine patients during interictal period

The relationship of migraine with cardiovascular diseases has been clarified by many studies, and currently, migraine is suggested to be a systematic vasculopathy. Inflammation, thrombosis and impaired vascular reactivity are the underlying pathophysiological mechanisms of the vasculopathy. In the present study, we aimed to investigate the relationship between prolactin levels and subclinical atherosclerosis risk factors such as soluble CD40 ligand (sCD40L) and high-sensitivity CRP (hsCRP) in migraine patients during interictal period. Fifty female migraine patients and age-matched 25 female control cases were enrolled in the study. Migraine diagnosis was settled according to the ICHD-II diagnostic criteria. A questionnaire was completed about the existence of vascular risk factors. Serum samples were used to measure sCD40L, hsCRP and prolactin levels. No difference was found between the prolactin levels of the migraine patients and the controls. The sCD40L levels were significantly higher in migraine patients (p < 0.001). High-sensitivity CRP levels showed no difference between the groups. There was no correlation between prolactin, sCD40L, and hs-CRP levels in migraine patients. We consider that the migraine patients are prone to subclinical atherosclerosis, but this tendency is independent of prolactin levels.     

急性冠脉综合征患者血清sCD40L、TNF-α的变化及相关性

目的探讨血清可溶性CD40配体(sCD40L)与肿瘤坏死因子-α(TNF-α)在急性冠脉综合征(ACS)中变化的意义及相关性。方法急性心肌梗死(AMI)患者45例,不稳定心绞痛(UAP)患者38例及健康体检者40例采用ELISA方法测定sCD40L及TNF-α的血清含量。结果急性冠脉综合征患者血清sCD40L在不稳定心绞痛(UAP)和急性心肌梗死组(AMI)分别为[(2.16±0.84)ng/ml,(2.93±0.99)ng/ml]显著高于健康对照组[(1.25±0.86)ng/ml(P<0.05)]。AMI组血清sCD40L水平高于UAP组,但无统计学意义。急性冠脉综合征患者血清TNF-α在AMI组为[(238.56±34.21)ng/ml]明显高于UAP组[(199.33±30.25)ng/ml(P<0.01)]和健康对照组[(132.25±29.28)ng/ml(P<0.01)]。sCD40L和TNF-α呈显著正相关(r=0.698,P<0.01)。结论急性冠脉综合征患者外周血清sCD40L和TNF-α水平升高,可能与急性冠脉综合征的发生有关,可能是动脉粥样硬化不稳定的标志,sCD40L可能通过促使TNF-α的表达而促发急性冠脉综合征。     

不同剂量辛伐他汀早期干预对非ST抬高型急性冠脉综合征sCD40L水平的影响

目的：探讨不同剂量辛伐他汀早期干预治疗对非ST抬高型急性冠脉综合征患者sCD40L水平的影响。方法：60例非ST抬高型急性冠脉综合征患者随机分为3组：A组为常规治疗组（20例）予以常规治疗但不用降脂药物；B组（20例）为20mg辛伐他汀治疗组；C组为40mg辛伐他汀治疗组（20例）；20例稳定性心绞痛患者为对照组。60例非ST抬高型急性冠脉综合征患者在治疗2周前后分别测定血清sCD40L及血脂水平。结果：60例非ST抬高型急性冠脉综合征患者的血清sCD40L水平明显高于稳定性冠心病患者（P＜0．05），B、C组治疗2周后血清sCD40L平均有明显下降（P〈0.05），而以C组作用更明显。结论：非ST抬高型急性冠脉综合征患者血清sCD40L水平增高，早期辛伐他汀治疗可降低非ST抬高型急性冠脉综合征患者的血清sCD40L水平，且呈剂量依赖性。早期他汀类药物强化治疗可能使非ST抬高型急性冠脉综合征患者获益更大。     

Soluble CD40 ligands sensitize the epithelial ovarian cancer cells to cisplatin treatment

ObjectiveCD154 (CD40L) is a protein that is primarily expressed on activated T cells and is a member of the TNF superfamily of molecules. It binds to CD40 on antigen-presenting cells (APC), which leads to many effects depending on the target cell type. Being an activator of immune cells, CD40L has also been shown to directly induce apoptosis in tumor cells by multiple mechanisms. To understand the role of sCD40L in regulating the proliferation of epithelial ovarian cancer cells treated or untreated with cisplatin.MethodsEpithelial ovarian cancer cells: SKOV3 and its cisplatin-resisitant strain SKOV3/DDP cells were used to test the effect of sCD40L and cisplatin. The proliferation of SKOV3 and SKOV3/DDP cells were measured by MTT. Cell cycle was assessed by flow cytometry. The mRNA expressions of targeted genes were detected by qRT-PCR. The protein expressions were detected by Western blotting.ResultssCD40L showed a significant dose-dependence inhibitory effect on the proliferation of ovarian cancer cell lines. sCD40L in combination with cisplatin could sensitized SKOV3/DDP cells to cisplatin treatment and reversed the drug resistance of SKOV3/DDP cells. The reversal ratios of 1 μg/ml sCD40L combined with cisplatin in SKOV3 and SKOV3/DDP cells were 2.11, 2.71, while the reversal ratios of 2 μg/ml sCD40L combined with cisplatin in SKOV3 and SKOV3/DDP cells were 3.78, 5.20, respectively. sCD40L or sCD40L combined cisplatin increased tumor cells in G0/G1 phase. sCD40L in combination with cisplatin decreased the expression levels of GST-π, LRP, Survivin, p53 and Bcl-2 in both epithelial ovarian cancer cell lines. The protein expression level of GST-π, LRP and P53 protein was also decreased upon sCD40L in combination with cisplatin although the expression level of Bcl-2 and survivin protein had no significant difference.ConclusionsCD40L inhibits the proliferation of SKOV3 and SKOV3/DDP cells. The combined application of sCD40L and cisplatin can strength the inhibitory effect of cisplatin, and to a certain extent, reversing the resistance to cisplatin in SKOV3/DDP cells. sCD40L could lead a cell block in G0/G1 phase and make the cell growth restrained. sCD40L could induce SKOV3 and SKOV3/DDP cells apoptosis and reverse drug resistance through cutting GST-π mRNA, LRP mRNA, survivin mRNA, p53 mRNA and Bcl-2 mRNA and decreasing the expression of GST-π, LRP and P53 protein in SKOV3 and SKOV3/DDP cells, which provides in-vivo experiment basis to the application of sCD40L as a drug improving ovarian cancer cells sensitivity to cisplatin.     

The CD40-CD40L system in cardiovascular disease

Abstract

The CD40-CD40L system is a pathway which is associated with both prothrombotic and proinflammatory effects. CD40 and its ligand were first discovered on the surface of activated T cells, but its presence on B cells, antigen-presenting cells, mast cells, and finally platelets, is evident. The soluble form of CD40L (sCD40L) is derived mainly from activated platelets and contributes to the pathophysiology of atherosclerosis and atherothrombosis. Indeed, sCD40L has autocrine, paracrine, and endocrine activities, and it enhances platelet activation, aggregation, and platelet-leucocyte conjugation that may lead to atherothrombosis. It has even been suggested that sCD40L may play a pathogenic role in triggering acute coronary syndromes. Conversely, blockade of this pathway with anti-CD40L antibodies may prevent or delay the progression of atherosclerosis. Concentrations of sCD40L also predict risk of future cardiovascular disease in healthy women and clinical outcomes in patients with acute coronary syndromes. However, there are controversial and uncertain points over the application of this biomarker to clinical cardiology. In this review, we provide an overview of potential implications of CD40-CD40L signalling and sCD40L as a biomarker in patients with atherosclerotic vascular diseases.     

Impact of residual renal function and HCV seropositivity on plasma CD40/CD40L system and oxidative status in haemodialysis patients

Objectives

We evaluated the impact of residual renal function (RRF) on oxidative stress (SOX) and CD40/CD40L system in haemodialysis (HD) patients.

Design and methods

We determined sCD40, sCD40L and SOX marker—Cu/Zn superoxide dismutase (Cu/Zn SOD) levels in HD patients with RRF, with anuria (A) and in healthy controls.

Results

sCD40 and Cu/Zn SOD plasma levels were higher in both groups of dialyzed patients compared to controls (all p < 0.001), and they were higher in A than in RRF patients (all p < 0.01). In RRF group, sCD40/sCD40L and Cu/Zn SOD were significantly higher in anti-HCV-seropositive (anti-HCV[+]) patients than in their anti-HCV[−] counterparts. This phenomenon was not observed in A group. Multiple regression analysis showed that Cu/Zn SOD, kt/V and low fibrinogen were the independent factors affecting sCD40 levels in the whole HD group.

Conclusions

The loss of RRF and HCV seropositivity increased plasma levels of sCD40/sCD40L and oxidative status in HD patients.     

Soluble CD40L in patients with morbid obesity: significant reduction after bariatric surgery

BACKGROUND: Morbid obesity is associated with increased cardiovascular morbidity and mortality. Recent studies suggest that soluble CD40 Ligand (sCD40L) may play a pathogenetic role in atherothrombotic complications in cardiovascular disease as well as in inflammation and thrombosis. As morbid obesity is closely associated with chronic inflammation and insulin resistance (IR), it was of interest to study sCD40L in patients with morbid obesity before and after massive weight loss induced by bariatric surgery. PATIENTS AND METHODS: A total of 34 patients (mean age 40 +/- 12 years) with morbid obesity were studied before and 27.2 months after bariatric surgery. High sensitivity assays were used to measure concentrations of fasting sCD40L, monocyte-chemoattractant-protein-1 (MCP-1) and high-sensitive C-reactive protein (hsCRP). To investigate the associations of concentration changes of the parameters studied, differences between pre- and post-operative data were assessed and tested by univariate and multivariate linear regression analysis. RESULTS: After a mean weight loss of 33.1 +/- 18.4 kg, circulating sCD40L decreased significantly from (3.7 +/- 1.5) ng mL(-1) to (2.2 +/- 0.7) ng mL(-1), (P < 0.001). The decline in sCD40L after weight loss correlated significantly with the decrease in fasting insulin, 2-h insulin, HOMA insulin resistance (HOMA-IR), triglycerides, and the inflammatory biomarkers MCP-1 and hsCRP. CONCLUSIONS: We have shown a marked decrease in circulating sCD40L in association with an improvement of both insulin resistance and chronic inflammation in morbidly obese patients after bariatric surgery. As high sCD40L was shown to predict cardiovascular death and myocardial infarction in several prospective studies, the observed marked lowering of sCD40L might be of clinical relevance in morbidly obese patients.     

Soluble CD40 ligand, high sensitive C-reactive protein and fetuin-A levels in patients with essential thrombocythemia

Background

CD40 ligand (CD40L) is expressed on the surface of activated platelets and activated T lymphocytes. Circulating soluble CD40 ligand (sCD40L) is formed from these molecules proteolytically. Fetuin-A is a potent antiinflammatory cytokine.

Aim of the study

In this study, we aim to investigate sCD40L levels to determine whether there is platelet activation and to measure high sensitive C-reactive protein (hs-CRP) levels to demonstrate if this leads to an inflammatory process and also to study fetuin-A levels to see if there is any concomitant antiinflammatory event in patients with essential thrombocythemia (ET).

Methods

We compared 30 patients with essential thrombocythemia with 30 control subjects and in these patients we measured levels of sCD40L, hs-CRP and fetuin-A.

Results

sCD40L levels were significantly higher in the ET group compared to the control group (30.6 ± 14.4 vs. 18.5 ± 8.9, p = 0.001). Although fetuin-A levels showed a slight trend to be increased in ET patients, the difference did not reach significance (4.5 ± 4.2 vs. 3.2 ± 2.1, p = 0.158). There were no statistically significant differences in hs-CRP levels (24.6 ± 4.9 vs. 25.0 ± 5.2, p = 0.750).

Conclusion

sCD40L was significantly higher in patients with an ET without any association with an inflammatory process and we believe this may be a marker of platelet regeneration.     

慢性肾衰竭患者血清sCD40L与动脉粥样硬化的关系

目的：研究慢性肾衰竭患者血清sCD40L水平与动脉粥样硬化的关系。方法：选择慢性肾衰竭患者60例和健康对照34例，采用酶联免疫吸附法测定血清sCD40L水平，用高分辨超声技术检测颈总动脉内膜一中层厚度（IMT）、粥样硬化斑块以及反应性充血后和舍服硝酸甘油后肱动脉内径的变化率。结果：慢性肾衰竭患者血清sCD40L水平高于正常对照组（P〈0．05）；慢性肾衰竭患者IMT和颈总动脉粥样斑块检出率均高于正常对照组（P〈0．05）；肱动脉反应性充血后内径增加率（Dh）、舍服硝酸甘油后内径增加率（Dn）均分别低于正常对照组Dh和Dn（P〈0．05）；按动脉粥样硬化严重程度分级，病变越严重者血清sCD40L水平越高。结论：慢性肾衰竭患者动脉粥样硬化与血清sCD40L水平有关，提示sCD40L是CRF患者动脉粥样硬化发生、发展的危险因素。