白细胞激活在下肢静脉性溃疡发病机制中的作用

慢性静脉性溃疡是慢性静脉功能不全(chronic venous insufficiency,CVI)最严重的并发症.在欧美国家,住院患者中静脉性溃疡发病率为1％～1.5％,总花费占年度卫生总预算的1％[1].我国的静脉疾病发病率既往要比西方国家低,静脉性溃疡的发病率在人群中约为0.4％～1.3％[2].但近年来有快速上升的趋势,因此静脉疾病的病因学研究就显得越来越重要.     

静脉高压对慢性静脉功能不全患者血小板活性的影响

目的 观察体位变化和压力对下肢慢性静脉功能不全(CVI)患者血小板活性的影响.方法 根据纳入和排除标准,选择24例CVI患者作为实验组和20例正常人作为对照组,采用酶联免疫吸附法(ELISA)测定两组人群在不同体位时下肢静脉血液、肘部静脉血液及在外在压力持续作用60 min后血小板P-选择素表达水平.结果 晨起平卧位及站立30 min后两组下肢静脉血液血小板P-选择素表达水平差异无统计学意义(P>0.05);在90～100mm Hg(1 mmHg=0.133 kPa)压力作用60 min后,CVI患者的下肢静脉血液和肘部静脉血液血小板P-选择素均明显高于对照组(P<0.01).结论 CVI患者血小板对压力具有高反应性,可能是CVI发病的重要机制之一.     

外科手术在治疗慢性静脉功能不全中的作用

下肢慢性静脉功能不全（chronic venous insufficiency,CVI）是外科临床的常见病和多发病,我国的发病率约为8％-13％。按1995年American Venous Forum所认同的概念及诊断和分类标准,多种血管疾病均可导致CVI的发生。按病因可分为原发性、继发性和先天性;按血流动力学可分为血液反流性病变和血液回流障碍性病变;按解剖学可涉及浅静脉、深静脉和交通静脉三个系统。外科手术主要针对原发性、血液反流性疾病,范围可涵盖浅静脉、深静脉和交通静脉。     

白细胞激活及炎症反应在慢性静脉功能不全中的作用

目的 探讨白细胞激活及炎症反应在慢性静脉功能不全中的作用。方法 查阅国内、外相关文献并进行综述。结果 白细胞激活及炎症反应参与静脉壁和瓣膜重塑，导致静脉瓣膜功能不全及静脉曲张的形成。结论 白细胞激活及由此引起的炎症反应在慢性静脉功能不全的发生、发展中起重要作用。     

Fractalkine在下肢静脉性溃疡发病中作用的研究

目的 探讨Fractalkine在下肢静脉性溃疡发病机制中的作用.方法 采用逆转录.聚合酶链反应(RT-PCR)和免疫组织化学技术对Fractalkine在慢性静脉功能不全患者、静脉性溃疡患者和正常人下肢静脉血中的mRNA表达水平进行半定量检测,对其在手术前后溃疡及其周围局部皮肤中的表达进行定性和定位检测.结果 Fractalkine mRNA表达在静脉性溃疡患者较单纯静脉功能不全患者和正常人明显增高(P<0.05);手术前溃疡边缘组织的Fractalkine的表达显著高于正常皮肤组织(P<0.05),手术后愈合中或愈合后的溃疡组织Fractalkine的表达显著低于手术前溃疡边缘组织(P<0.05).结论 Fraetalkine的表达与下肢静脉性溃疡的发病有密切关系,Frac-talkine的高表达可能是导致肢静脉性溃疡的发病的重要因素.     

透照下静脉切除术在下肢静脉曲张外科手术中的应用现状

静脉曲张是慢性静脉功能不全的主要临床表现,随着针对该症的外科手术技术的不断更新,透照下静脉切除术(TIPP)作为一种新型的微创手术受到重视,本文从TIPP的历史、操作技术、优势等方面对其在下肢静脉曲张外科手术的应用现状进行综述并对其未来进行展望.     

髂静脉压迫综合征诊治在下肢慢性静脉功能不全中的意义

目的:探讨髂静脉压迫综合征(IVCS)在下肢慢性静脉功能不全(CVI)诊治中的意义。方法:195例IVCS伴CVI患者采用介入球囊扩张、支架置入或联合浅静脉手术进行治疗,对其治疗成功率、疗效进行回顾性分析。结果:本组195例中浅静脉曲张治愈率95.7%,下肢肿胀缓解率78.7%,疼痛缓解率80.6%,溃疡愈合率77.8%。其中仅支架置入20例,下肢肿胀缓解率78.9%,疼痛缓解率88.9%,溃疡愈合率77.8%。结论:纠正IVCS或联合浅静脉手术能明显改善CVI病人的症状,IVCS可能是部分CVI的病变基础。     

白细胞激活对曲张静脉管壁的重塑作用

白细胞捕获学说和血管重塑概念的提出,对于静脉疾病的研究有着重要意义[1,2]。有研究表明,静脉曲张是静脉壁适应各种病理状态所引发的,以血管壁细胞和细胞外基质等有形成分变化为主的代偿性反应,其中血管内皮和白细胞的黏附与激活起到了一定的作用[3-5]。为探讨下肢静脉曲张血管壁重塑与细胞浸润的关系,本文着重就白细胞激活对下肢曲张静脉管壁的重塑作用综述如下。     

非血栓性髂静脉受压综合征在下肢慢性静脉功能不全中的诊治意义

目的 探讨非血栓性髂静脉受压综合征(NIVCS)在下肢慢性静脉功能不全中的诊治意义.方法 对210例下肢慢性静脉功能不全(CVI)伴NIVCS患者的治疗成功率、疗效及并发症进行分析.结果 本组男116例,女94例,左下肢192例,右下肢18例,平均年龄55.7岁.介入球囊扩张+支架植入或联合浅静脉手术共210例,技术成功率100.0％.浅静脉曲张治愈率95.8％,下肢肿胀缓解率76.9％,疼痛缓解率80.2％,溃疡愈合率75.0％.平均随访32.4个月,支架总通畅率100.0％.结论 纠正NIVCS或联合抗返流手术能明显改善CVI患者的症状,提出NIVCS可能是部分CVI的基础疾病.     

静脉顺行造影在下肢慢性静脉疾病诊断中的再认识

目的分析下肢静脉曲张患者静脉顺行造影表现,总结其对诊断下肢慢性静脉疾病尤其是髂静脉压迫综合征的临床意义。方法 282例下肢静脉曲张患者(329条下肢),左下肢185例,右下肢50例,双下肢47例,术前常规行下肢静脉顺行造影,分析其下肢及髂静脉影像学表现。结果 329条下肢静脉造影成功率100%,下肢深静脉血栓后遗症21例(6.38%),单纯性大隐静脉瓣膜功能不全57例(17.33%),下肢深静脉瓣膜功能不全182例(55.32%),交通支瓣膜功能不全66例(20.06%),先天静脉畸形3例(0.91%);同时发现有髂静脉狭窄大于50%者19例(5.78%),髂静脉狭窄小于50%者57例(17.33%)。结论下肢慢性静脉疾病患者术前静脉造影检查,能够明确原发病因尤其是髂静脉压迫综合征,对于选择个体化的治疗方案具有重要的临床意义和实用价值。     

The effect of s-nitroso-glutathione on platelet and leukocyte function during experimental extracorporeal circulation

Treatment with extracorporeal membrane oxygenation ECMO) is associated with side effects, e.g., blood cell consumption and activation. Our group has earlier shown that nitric oxide administered as a gas reduces platelet consumption and activation. In the present work we have studied the effect of the NO-donor S-nitroso-glutathione GSNO) on platelets and leukocytes in an in vitro extracorporeal circuit. Two complete ECMO circuits were perfused with fresh heparinized human blood for 24 hours. GSNO was administered as a continuous infusion to one circuit at a rate of 0.7 mg/hour in four paired experiments and at a rate of 3.5 mg/hour in another four paired experiments. The other circuit was used as a control. Blood samples were withdrawn from both circuits before the start of the experiments and at 0.5, 1, 3, 12, and 24 hours of perfusion. The samples were analyzed for red blood cell count, leukocyte count, platelet count, platelet membrane expression of glycoproteins GP) Ib and GPIIb/IIIa, leukocyte membrane expression of cluster of differentiation CD) 11b/CD18, as well as plasma concentration of tumor necrosis factor TNF)-alpha, interleukin IL)-1beta, and IL-8. No difference in these parameters between the GSNO and the control circuit at any time point was assayed. In this study, no significant effect of GSNO on circulating platelets or leukocytes during experimental extracorporeal circulation could be shown.     

The effect of protamine sulfate on platelet function

The adverse effects of protamine sulfate, used to neutralize the anticoagulant action of heparin, include systemic hypotension, pulmonary artery hypertension, thrombocytopenia and leukopenia. For further evaluation of protamine's mechanism of action, a three-part investigation was performed. In part I platelet-rich plasma (PRP) was prepared from canine blood samples (n = 6) taken before and 2 minutes after injection of protamine. In part II human PRP (n = 5) was preincubated with protamine or distilled water. Adenosine diphosphate-induced aggregation of protamine-treated platelets was unchanged, but thrombin-induced aggregation was inhibited in both canine and human preparations (p less than 0.05). In part III thrombocytopenia was produced in splenectomized dogs (n = 5), using microporous filters, to 4.5-8.4% of the initial platelet count. Protamine reversal of the heparinization caused hypotension (maximally -29 mmHg 90 s after protamine), but not pulmonary arterial hypertension. Leukopenia developed before additional thrombocytopenia appeared. Protamine-platelet interaction inhibits thrombin-induced platelet aggregation. Platelets may play an important role in the pulmonary pressure rise during protamine reversal, but do not mediate the systemic hypotension.     

The effect of halothane general anaesthesia on platelet function

Major craniofacial surgery has the potential for very large blood loss, frequently greater than one blood volume. In order that an assessment could be made of any deficiencies of platelet function or coagulation, tests were performed at intervals during the operation. None of the coagulation parameters showed variation below normal limits during the operation, but in vitro platelet aggregation showed significant decreases to several agonists.     

The effect of anaesthetic agents on platelet function.

This paper reviews studies which have investigated the effect of anaesthetic agents on platelet function. The results of these studies suggest that halothane is the only agent in current use which inhibits platelet function in concentrations used clinically. Nitrous oxide appears to cause only a modest inhibition, while enflurane and isoflurane appear to have minimal or negligible effects. There is no current evidence that intravenous induction agents, opiates, or muscle relaxants affect platelet function. Reports indicate that local anaesthetic agents inhibit platelet aggregation, but only at concentrations far greater than peak plasma concentrations found during clinical use. Epidural anaesthesia may be associated with a reduction in platelet aggregation through a mechanism unrelated to direct local anaesthetic inhibition. The clinical significance of the effect of halothane on platelet function is not known. However, it is possible that halothane may affect bleeding or thrombotic complications in a similar manner to other 'anti-platelet' drugs.     

The effect of denervation on leukocyte function in soft tissue infection

BACKGROUND: The present study was undertaken to investigate the effect of denervation on leukocyte function in soft-tissue infection in an isolated in vivo ovine flap model. METHODS: Fifteen adult ewes were divided into three groups. An island pedicle flap was raised on the right buttock. In group I (no denervation), the cutaneous nerve remained intact, whereas in group II (acute denervation) the nerve was divided acutely. In group III (prolonged denervation) the nerve was divided 7 days before flap elevation. All flaps received intradermal inoculation of 10(7) Staphylococcus aureus, and the animals were observed for 96 hours. RESULTS: In both groups II and III, the leukocyte chemiluminescence and chemotaxis were significantly decreased when compared with group I. Furthermore, there was profound impairment of leukocyte functions in group III compared with group II. Group III also had significantly higher bacterial counts, larger septic foci, lower viable leukocyte ratios, and decreased bacterial killing compared with group I. CONCLUSIONS: Denervation, particularly over a period of time, results in increased bacterial growth of soft-tissue septic foci. This appears to be due to decreased leukocyte function resulting in diminished bacterial killing.