鼻咽癌患者前列环素及血栓素与外周血细胞免疫状况

应用间接免疫荧光法和放射免疫法分别检测了 34例鼻咽癌患者外周血中淋巴细胞的数量和血浆前列环素(PGI2 )及血栓素 (TXA2 )的含量 ,并与正常对照组对比研究。结果显示 :鼻咽癌患者外周血中 CD4细胞减少 (P<0 .0 1) ,而 CD8细胞则明显升高 (P<0 .0 5 )。同时鼻咽癌患者血浆中 PGI2 和 TXA2 的稳定代谢产物 6 - keto- PGF1α及 TXB2分别比对照组升高 ,以 TXB2 升高更明显 (P<0 .0 5 )。提示鼻咽癌患者体内前列腺素类物质 PGI2 和 TXA2 与鼻咽癌患者机体细胞免疫功能有关 ,并对其作为一种可能性抑制因素在鼻咽癌细胞免疫中的作用进行了讨论     

Prostacyclin and thromboxane in diabetes

Concentrations of the stable antiaggregatory prostacyclin metabolite 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha) and of the proaggregatory thromboxane A2 metabolite thromboxane B2 were measured by radioimmunoassay in plasma from 53 diabetics. In 33 of these patients the ability of platelets to produce thromboxane B2 during spontaneous clotting was also studied. Plasma 6-keto-PGF1 alpha concentrations were higher (p less than 0.05) in the diabetics (mean 107.7 +/- SE 7.6 ng/l) than in non-diabetic controls matched for age and sex (87.5 +/- 4.7 ng/l), and diabetics with microangiography (n = 28) and higher (p less than 0.01) concentrations (124.3 +/- 10.8 ng/l) than those without microangiography (n = 25; 89.2 +/- 9.3 ng/l). Plasma thromboxane B2 concentrations were also higher (p less than 0.01) in the diabetics (mean 218.5 +/- SE 25.3 ng/l) than in the controls (127.7 +/- 9.8 ng/l), but this increase was not related to microangiography. The ability of platelets to generate thromboxane B2 did not differ between the diabetics (181.4 +/- 16.4 microgram/l) and controls (195.8 +/- 11.8 microgram/l). Platelets of diabetics with microangiopathy or taking oral hypoglycaemic agents (n = 19), however, produced decreased amounts of thromboxane B2 during clotting. Plasma concentrations of 6-keto-PGF1 alpha and thromboxane B2 were not related to concentrations of glucose, haemoglobin A1, high-density lipoprotein cholesterol, cholesterol, triglycerides, magnesium, or creatinine. These results suggest that in diabetics with microangiopathy a balance between prostacyclin and thromboxane A2 is shifted to dominance by prostacyclin.     

9例血栓性血小板减少性紫癜的临床分析

目的分析血栓性血小板减少性紫癜（TTP）的临床特征和治疗方法选择的价值。方法对9例TTP患者的临床资料进行分析。结果9例患者6例为女性，男：女=1：3；其中系统性的红斑狼疮5例，严重感染、败血症3例，尿毒症1例。临床表现以血小板减少性出血、微血管病性溶血性贫血和神经系统症状的“三联症”起病的5例；三联症伴发热和肾脏病变“五联症”起病的2例；三联症伴发热起病2例。4例及时进行血浆置换为主治疗后均有效；其余5例未给予血浆置换的3例死亡。结论TTP多见于年轻女性，病因以系统性红斑狼疮最多见，感染次之。临床表现以三联征表现最多，以后多表现为四联征或五联征。及时给予血浆置换为主的治疗抢救成功率较高。     

Purification and some properties of platelet aggregating protein (PAP) from the plasma of a patient with thrombotic thrombocytopenic purpura

A new platelet aggregating protein (PAP) was purified from the plasma of a patient with acute thrombotic thrombocytopenic purpura (TTP) using A1 (OH)3 adsorption, PEG fractionation, DEAE cellulose chromatography, lentil lectin Sepharose 4B chromatography and gel filtration HPLC. The M. W. of this PAP was estimated to be 59,000. It induced the aggregation of washed platelets from normal subjects and the same patient after recovery. The antigenic material was present in 2 out of 6 other TTP patients but was absent in 7 normal subjects, two patients with DIC and two patients with ITP. The aggregation of washed platelets by PAP was concentration dependent and required energy metabolism, Ca2+ and fibrinogen. PAP was present in the plasma of a subset of TTP patients and was likely the cause of platelet thrombi in the microvessels in these patients.     

血浆置换治疗血栓性血小板减少性紫癜患者的临床分析

目的观察血浆置换治疗血栓性血小板减少性紫癜（TTP）的疗效。方法以新鲜血浆为置换液进行血浆置换。结果 7例患者中1例死亡,6例好转出院。结论血浆置换是TTP的首选治疗方法,它能够降低患者的病死率,效果肯定。     

特发性血小板减少性紫癜外周血B1细胞水平变化与病情和预后的关系

目的:研究特发性血小板减少性紫癜外周血B1细胞水平变化与病情和预后的关系。方法:收集在我院就诊的特发性血小板减少性紫癜患者的临床资料,检测患者体内B淋巴细胞总数、CD5+淋巴细胞、外周血中血小板计数,并用SPSS软件进行统计学分析。结果:ITP患者外周血中PLT计数明显少于健康者、B1淋巴细胞百分比明显高于健康者(P<0.05)。初治组ITP患者中有效者在治疗后PLT计数明显升高、B1淋巴细胞百分比明显下降(P<0.05)。难治组ITP患者经过抗H.pylori治疗后血小板计数有一定程度升高、B1淋巴细胞百分比略有降低(P<0.05)。结论:B1淋巴细胞水平的升高和ITP的发生密切相关,特别是pylori感染引起的B1淋巴细胞水平升高会导致难治性ITP的发生。     

血栓性血小板减少性紫癜6例临床分析

目的：探讨血栓性血小板减少性紫癜(TTP)的早期诊断及治疗方法,提高对本病的认识。方法：回顾性分析6例TTP患者住院病历资料。结果：6例患者均有血小板减少、徼血管病性溶血性贫血(MAHA)、明显精神神经症状。6例患者均采用血浆置换(PE),联用肾上腺糖皮质激素和抗血小板药物等综合治疗。4例存活,2例死亡。结论：TTP临...     

当归注射液对冠心病患者血超氧化物歧化酶活性和脂质过氧化物的影响

２４例冠心病患者静脉滴注当归注射液治疗后，血超氧化物歧化酶（ＳＯＤ）、６－酮前列腺素Ｆ１α（６－Ｋ）和６－Ｋ／血栓素Ｂ２（ＴＸＢ２）均升高，丙二醛（ＭＤＡ）、ＴＸＢ２和血小板最大聚集率均降低（Ｐ均＜０．０５～０．０１）。结果表明，当归注射液有增加ＳＯＤ活性，清除氧自由基，抗脂质过氧化反应，减低ＭＤＡ水平，升高ＰＧＩ２，降低ＴＸＡ２，调整ＰＧＩ２／ＴＸＡ２平衡和抑制血小板聚集的作用。     

干扰素诱发自身免疫性血小板减少性紫癜

21岁女性,主因＂乙肝表面抗原阳性15年余,牙龈出血1周余＂入院。2年前确诊为e抗原（HBe Ag）阳性慢性乙型肝炎,予干扰素联合核苷（酸）类似物拉米夫定（LAM）长期抗病毒治疗。治疗过程中定期监测,无明显不良反应。治疗第20个月获HBe Ag血清学转换,表面抗原（HBs Ag）滴度进行性下降。1周前血小板骤然下降至8×109/L。血小板严重下降的原因考虑为自身免疫性血小板减少性紫癜（AITP）,依据为：1聚乙二醇干扰素α-2a相对LAM容易引起血象改变;2抗血小板抗体阳性、抗核抗体滴度急剧上升,抗SSA抗体（＋）,而以往为阴性;3骨髓穿刺结果考虑AITP可能性大;4其他（如肿瘤、非甾体类药物等）病因引起的血小板减少可被排除;5血栓性血小板减少性紫癜可除外;6应用糖皮质激素和丙种球蛋白效果好。提示在干扰素治疗的全程中均应密切注意血常规的变化。出现血小板严重减少者,应先甄别病因,对症处理。     

Thrombotic thrombocytopenic purpura-like syndrome associated with infective endocarditis. A possible immune complex disorder.

A thrombotic thrombocytopenic purpura (TTP)-like syndrome was the chief presenting feature in two patients with infective endocarditis. Clinical and laboratory aberrations of the syndrome were rapidly reversed by specific antimicrobial therapy. Hypocomplementemia and high levels of circulating immune complexes were detected initially in both patients. Because these returned to normal as the TTP syndrome abated, an immunopathologic mechanism may have been operative.     

静脉盐负荷对高血压盐敏感者肾脏PGI2及TXA2的影响及盐敏感性高血压的胰岛素抵抗

OBJECTIVE: To investigate insulin resistance and the effects of intravenous acute saline load on renal production of prostaglandin I(2) (PGI(2)) and thromboxane A(2) (TXA(2)) in salt-sensitive hypertensive patients. METHODS: The 24-hour excretion of urinary 6-keto-prostaglandin F (PGF) 1alpha and thromboxane B(2) were measured before and after intravenous acute saline load in 53 hypertensive patients whose salt sensitivity had been determined. Oral glucose tolerance test and insulin release test were performed in all the subjects. RESULTS: after intravenous acute saline load, the 24-hour excretions of urinary 6-keto PGF 1alpha were significantly lower in salt-sensitive (SS) hypertensive patients than that in non-salt-sensitive (NSS) ones (316+/-57 pg/min vs 371+/-68 pg/min, P<0.01), and the decrease from baseline was much greater in SS group than that in NSS group (197+/-99 pg/min vs 136+/-101 pg/min, P<0.01). Both 24 hour urinary excretion of TXA(2) and the increase in urinary excretion of TXA(2) were significantly greater in SS hypertensive patients than those in NSS ones after salt loading (394+/-32 pg/min vs 359+/-44 pg/min, P<0.01, and 80+/-47 pg/min vs 47+/-45 pg/min, P<0.01, respectively). The plasma glucose and insulin concentrations in every time point were much higher in SS hypertensive subjects than that in NSS ones, and the former group had lower insulin sensitivity index than the latter (0.013+/-0.003 vs 0.018+/-0.004, P<0.01) CONCLUSION: Saline load produces significantly different effects on renal production of PGI(2) and TXA(2) in SS and NSS hypertensive patients, and these changes may be related to the pathophysiology of SS hypertensive patients after acute salt loading. Insulin resistance is greater in SS hypertensive patients than in NSS ones.     

肺心病患者血维生素E测定及其与GSH－Px／LPO和TXA_2／PGI_2平衡

分别测定２０名健康人、２９例慢性肺心病患者的急性期和缓解或血清维生素Ｅ（ＶＥ）、血浆ＬＰＯ、ＴＸＡ２、ＰＧ－Ｉ２、ＧＳＨ－Ｐｘ值，进行对比，结果急性或血ＶＥ含量减低，缓解期上升．ＧＳＨ－Ｐｘ、ＧＳＨ－Ｐｘ／ＬＰＯ比值与ＶＥ呈正相关，ＬＰＯ和ＴＸＢ２／６－Ｋ－ＰＧＦ１ａ比值与ＶＥ均呈负相关．提示心病急性期机体抗氧化潜力下降，并有ＴＸＡ２／ＰＧＩ２失衡，维持血ＶＥ正常水平有利于提高机体抗氧化能力和维持ＴＸＡ２／ＰＧＩ２平衡．     

Thrombotic thrombocytopenic purpura with terminal pancytopenia

A 27 year old housewife developed thrombotic thrombocytopenic purpura during the twelfth week of pregnancy. She had partial response to initial plasma infusion and subsequent plasmapheresis. However, her clinical course was complicated by the development of severe pancytopenia the consequence of a hypocellular marrow. She succumbed to septicaemic shock one month after diagnosis. The development of hypocellular marrow in thrombotic thrombocytopenic purpura has not been reported before.     

光量子氧疗对脑梗死患者TXA2-PGI2平衡及脑血流的影响

目的旨在观察光量子氧疗对脑梗死患者血栓素A2 前列腺素I2 平衡及脑血流的影响。方法将脑梗死后 3～ 10周患者 10 8例随机分为两组。A组予丹参液静脉滴注 ,B组予充氧光量子化丹参液静脉滴注 2周。治疗前、后分别做神经功能缺损程度评分、测定血浆血栓素B2 (thromboxaneB2 ,TXB2 )和 6 酮 前列腺素F1α(6 k PGF1α)含量、经颅血流多普勒超声测定大脑中动脉血流的平均峰流速 (meanvelocity ,Vm )并计算两侧的非对称指数。结果治疗前后两组的神经功能缺损程度评分均显著降低 ,但B组降低的幅度显著大于A组。B组的总有效率显著高于A组。两组血浆TXB2 和TXB2 / 6 k PGF1α比值在治疗后均显著降低 ,但B组降低的幅度显著大于A组。而且B组在治疗后 6 k PGF1α显著上升 ,而A组变化不显著。两组患侧Vm治疗后均显著增加 ,但B组增加的幅度显著大于A组。而且B组在治疗后Vm的非对称指数显著降低 ,非对称性病例显著减少 ,而A组变化不显著。血浆TXB2 、TXB2 / 6 k PGF1α比值与患侧Vm之间均呈显著负相关。结论光量子氧疗可显著促进纠正脑梗死患者恢复期的TXA2 PGI2 失衡 ,并加速患侧大脑中动脉血流的恢复 ,光量子氧疗的临床疗效可能与这些作用有关     

Thrombotic thrombocytopenic purpura: a syndrome of intravascular platelet consumption.

In four of five patients with thrombotic thrombocytopenic purpura (TTP) in whom serial tests of hemostatic function were performed, severe thrombocytopenia, normal plasma fibrinogen concentrations and mildly increased concentrations of fibrinogen/fibrin degradation products were observed. Widespread platelet thrombi were found in arterioles and capillaries. Fibrin could be seen around some of the platelet clumps and was the main component in a small number of the thrombi in two patients. The observations show that TTP is a disorder in which intravascular platelet consumption results in disseminated platelet thrombosis. The coagulation system is apparently activated secondarily to platelet aggregation and variable quantities of fibrin are incorporated into the thrombi. Clinical improvement resulted from combined therapy with corticosteroids, heparin and drugs that suppress platelet function.     

Infections with Escherichia coli O157:H7 in Washington State. The first year of statewide disease surveillance

In 1987, Washington became the first state to require that infection with Escherichia coli serotype O157:H7 be reported. In the first year of surveillance, 93 cases were reported, yielding an annual incidence of 2.1 cases per 100,000 population. The median age of case patients was 14 years (range, 11 months to 78 years), with the highest attack rate among children younger than 5 years (6.1 cases per 100,000 population per year). Bloody diarrhea was present in 95% of reported cases, 12% of patients developed either hemolytic-uremic syndrome or thrombotic thrombocytopenic purpura, and one patient died. Suspected secondary cases were seen in 5% of households. Fifty-six (60%) cases occurred during June through September, as did 73% of the cases of hemolytic-uremic syndrome or thrombotic thrombocytopenic purpura. Cases reported during the summer months were more likely than cases reported at other times of the year to be in children younger than 10 years. Medications, including antimicrobial medications, did not influence the duration of symptoms, nor did they appear to alter the risk of developing hemolytic-uremic syndrome or thrombotic thrombocytopenic purpura. This newly established surveillance system in Washington demonstrates that E coli O157:H7 is an important and common cause of bloody diarrhea in the United States.     

血浆置换治疗血栓性血小板减少性紫癜的临床研究

目的 研究血浆置换(PE)治疗血栓性血小板减少性紫癜(TTP)的疗效.方法 对12例患者进行血浆置换治疗,并结合免疫抑制剂及抗血小板、改善微循环治疗.结果 治疗总有效率为91.7%(11/12),1例患者死亡.结论 血浆置换治疗结合免疫抑制剂及抗血小板、改善微循环治疗是TTP的有效治疗方法.     

Elevated platelet-associated IgG in thrombotic thrombocytopenic purpura

A 41-year--old woman with thrombotic thrombocytopenic purpura (TTP) was treated with prednisone and splenectomy with complete recovery from her illness. Analysis of the patient's platelets for immunoglobulins showed abnormally elevated levels in the range of those seen in thrombocytopenic patients with systemic lupus erythematosus, immune vasculitis, and infectious mononucleosis. This finding is consistent with the concept that the immune system may play a role in the pathogenesis of TTP.     

血栓性血小板减少性紫癜的临床诊治体会

目的 对临床病例行回顾性分析,了解血栓性血小板减少性紫癜(TTP)的临床特征及治疗方法,以加深对本病的认识,提高对TTP的诊疗水平.方法 对我院2003年5月～2010年9月诊断的8例TTP的临床表现、治疗及预后进行回顾性分析.结果 8例TTP患者中,1例为男性,7例为女性,其中1例为妊娠期者.7例临床症状缓解,外周血...     

Plasma infusions in thrombotic thrombocytopenic purpura complicating systemic lupus erythematosus��a successful outcome

A severe form of acute thrombotic thrombocytopenic purpura (TTP) developed in a patient with systemic lupus erythematosus (SLE). Infusions of large amounts of fresh frozen plasma (FFP) were added to steroid therapy and resulted in a rapid improvement and remission. Further episodes of thrombocytopenia and abdominal pains during a two-year follow-up were successfully treated with plasma alone and this indicates the important role of FFP infusions in the recovery of this patient.