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1.
《内科》2013,(5):491-491
该项研究共纳入来自4所医院的350名ACS患者,所有患者均行支架植入手术并且具有血小板高反应性。受试者按照1:3:3的比例被随机分成三组,一组接受血小板双抗治疗(阿司匹林300mg/d联合氯吡格雷75mg/d,n=50);一组接受高剂量氯吡格雷维持治疗(阿司匹林300mg/d联合氯吡格雷150mg/d,n=150);  相似文献   

2.
病历摘要 患者女,27岁,汉族,无业.因血小板减少20年,突发胸痛34 h于2009年5月6日入院.患者20年前间断出现牙龈出血、皮肤黏膜瘀斑,查血小板9.0×109/L,外院诊断为血小板减少性紫癜,予以泼尼松40 mg/d治疗,效果不佳,自行减量至10 mg/d,血小板波动于(70~80)×109/L.17年前双侧面颊部出现对称性蝶形红斑,日晒后加重,伴脱发、反复口腔溃疡.  相似文献   

3.
目的:评价重组人血小板生成素(rhTPO)对特发性血小板减少性紫癜(ITP)的疗效和安全性。方法:21例ITP患者采用随机区组,分成试验组和对照组2组。试验组皮下注射rhTPO 1.0μg/kg,1次/d,疗程14 d。对照组在服用达那唑14 d后如血小板仍≤20×109/L,加用rhTPO皮下注射,1.0μg/kg,疗程14 d。2组在整个试验阶段均服用达那唑,0.2 g,每日3次。结果:试验组用药前血小板计数的中位数为8.0(4.0~15.0)×109/L,用rhTPO后血小板最高值为100.0(49.0~118.5)×109/L,与用药前相比P<0.01。停药后血小板计数逐渐回落,至开始治疗后28 d,血小板计数降至39.0(22.0~68.5)×109/L。对照组用药前血小板计数的中位数为6.0(4.0~10.0)×109/L,第1阶段(1~14 d)仅用达那唑治疗血小板最高值为33.0(23.0~72.0)×109/L。第2阶段(14~28 d)加用rhTPO,血小板计数最高值为111.5(60.0~152.0)×109/L,与用药前及第1阶段最高值相比均P<0.01。停药后血小板计数逐渐下降,至4...  相似文献   

4.
重组人白介素-11治疗特发性血小板减少性紫癜2例   总被引:2,自引:0,他引:2  
例1女,29岁。因“反复月经过多,皮肤出血点1年余”2005年11月收住我科。既往曾住院诊断特发性血小板减少性紫癜(ITP),诊断标准依照文献〔1〕。1年余来长期未间断服用泼尼松60mg/d,血小板可保持正常水平,低于该剂量则血小板在(2068)×109/L之间波动,入院前1个月左右,泼尼松20mg/d。入院体检:库欣面容,向心性肥胖,皮肤散在出血点,肝脾肋下未触及肿大。PLT22×109/L,Hb110g/L,WBC5.6×109/L,PLT抗体IgA、IgM正常,IgG升高,骨穿示增生活跃,粒红两系增生、形态及各阶段比例正常,全片见巨核细胞52个,产板巨1个。诊断为ITP。入院后在服用…  相似文献   

5.
目的 探讨强化抗血小板治疗对急性冠状动脉综合征患者冠状动脉支架术后血小板高反应性(HPR)的影响.方法 2009年3月至2011年2月在3家医院连续入选3316例置入药物洗脱支架的急性冠状动脉综合征患者,其中840例(25.3%)患者诊断为HPR.HPR定义为氯吡格雷300 mg和阿司匹林300 mg治疗24h后,20 μmol/L二磷酸腺苷诱导的血小板聚集率>55%.HPR患者按1:2的比例随机接受标准抗血小板治疗(标准组,n=280)及强化抗血小板治疗(强化组,n=560).标准组患者服用阿司匹林300 mg/d和氯吡格雷75 mg/d.强化组患者服用阿司匹林300 mg/d和双倍剂量氯吡格雷(150 mg/d),3d后如 HPR 未改善则加用西洛他唑(50~100 mg,每天2次).观察患者的HPR改善率及发生的临床事件.结果 强化组患者治疗3d后HRP改善率为54.3%(304/560);256例HRP未改善的患者接受西洛他唑治疗3d后,强化组的HRP改善率为81.1%(454/560).术后30 d,强化组HPR改善率显著高于标准组(69.9%比55.7%,P=0.000).两组患者均未发生死亡及卒中事件.强化组发生亚急性支架血栓形成1例(0.2%),标准组未发生支架血栓形成事件(P =1.000).两组均未发生死亡和主要及次要出血事件,轻度出血发生率两组之间差异无统计学意义(强化组为4.3%,标准组为2.1%,P=0.166).结论强化抗血小板治疗可显著改善急性冠状动脉综合征患者冠状动脉支架术后的HPR,且不增加出血风险,但其临床获益还需更长时间随访研究的证实.  相似文献   

6.
1临床资料 患者,男,47岁。三年前无明显诱因出现胸骨后憋闷,就诊当地医院,心电图示Ⅱ、Ⅲ、aVF导联ST段抬高,诊断为急性下壁心肌梗塞进行溶栓治疗,当时血小板1000×10^9/L,病情稳定出院后长期服用阿司匹林100mg/d。半月前劳累后再次出现胸骨后闷痛,心电图示V1~V5导联ST段抬高,诊断为前壁心肌梗塞。再次进行溶栓,病情稳定后转入我院。  相似文献   

7.
目的倾向值匹配法分析阿司匹林抗血小板作用是否对阿司匹林剂量存在依赖性。方法收集2008年4月~2010年7月驻京干休所530例老年患者资料,根据每日服用阿司匹林剂量分为3组:未用阿司匹林40例为空白对照组,25~50mg组24例,75~100mg组466例。用花生四烯酸诱导光比浊法检测血小板聚集率,血小板聚集率≥20%诊断为血小板高反应性。采用倾向值匹配法,将3组性别、年龄、体质量指数、吸烟、饮酒、基础疾病、服心血管病药物等14个协变量完全匹配分析。结果空白对照组,25~50mg组,75~100mg组的血小板高反应性发生率分别为72.50%,37.50%,13.73%,3组比较差异有统计学意义(χ2=87.25,P<0.01)。经倾向值匹配后,每组各17例患者临床基线完全匹配,空白对照组,25~50mg组,75~100mg组的血小板高反应性发生率分别为82.35%,47.06%,11.76%,3组比较差异有统计学意义(χ2=17.00,P<0.01)。结论服用阿司匹林剂量在0~100mg变动,抗血小板作用对阿司匹林剂量有依赖性,多数口服≤50mg/d的阿司匹林患者达不到抗血小板作用。  相似文献   

8.
目的:总结减低剂量的地西他滨治疗3例骨髓增生异常综合征-难治性血小板减少(MDS-RT)患者的诊疗体会。方法:起始3例患者均行减低剂量地西他滨治疗1疗程:20mg/m2,静脉滴注1h,qd×3d,之后患者2巩固3疗程,患者3转用免疫抑制剂治疗。结果:1疗程结束后,患者1血小板3×109/L升为50×109/L,患者2血小板5×109/L升为45×109/L,均脱离输注,患者3仍未脱离输注,免疫抑制剂治疗无效,后进展为急性单核细胞白血病。结论:减低剂量地西他滨治疗低危的MDS-RT可改善血小板减少、血小板输注依赖问题,且不良反应少,值得在大样本的临床实验中检验其疗效。  相似文献   

9.
1 病例资料 患者男性,82岁.因"发作性胸痛6个月,发热2d,突发咯血、呼吸困难1 d"于2012年6月4日入院.患者6个月前因急性ST段抬高型心肌梗死(下壁)行冠状动脉造影,结果为三支病变,并置入支架(Medtronic Resolute)两枚,术后规律服用阿司匹林100 mg/d及氯吡格雷75 mg/d.2d前患者中午进餐后(较油腻)突发寒战、发热、恶心、呕吐(有胆管结石病史),来急诊时血压140/100 mm Hg,心率135次/min,血红蛋白141 g/L,白细胞15.46×109/L,中性粒细胞87.3%,心电图检查见V2~ V6导联T波高尖,查心肌肌钙蛋白Ⅰ(TnI) 21.17 μg/L,诊断急性心肌梗死、胆道感染.  相似文献   

10.
血小板对阿司匹林治疗反应不好不一定是氧化应激增加的缘故,其原因可能是由于血小板数量多因而阿司匹林剂量不足。文献中关于阿司匹林抵抗的发生率差别很大,公认的测定方法金标准是光透射聚集仪,服用阿司匹林后尚残存20%聚集者即认为有阿司匹林聚集(Am Heart Association8th An-nual Conference of Arteriosclerosis Thrombosis,and Vascular Biology April19,2007,Chicago.Poster86)。该文研究200名稳定冠心病人服用阿司匹林,有一组用80mg/d,另一组用187mg/d,发现8例病人都发生在80mg/d组。该组血小板计数较高(318×109/L),而192例“…  相似文献   

11.
冠心病是心血管系统常见的疾病,其病理生理基础为冠状动脉粥样硬化,其发生发展直接影响冠心病的临床过程.骨桥蛋白(osteoprotein,OPN)最初由矿化的骨基质中分离,参与骨代谢,可介导骨组织细胞与骨基质的连接,因此得名.近年来发现骨桥蛋白作为一种重要的多功能糖蛋白,存在于细胞外基质中,由多种组织及细胞合成和分泌,如肺、骨、肾、肌肉、膀胱及血管平滑肌细胞、巨噬细胞、成纤维细胞、血管内皮细胞、血管上皮细胞等.至今国内外大量研究表明,在血管壁动脉粥样硬化处的内皮细胞和平滑肌细胞内OPN mRNA呈高表达状态,这引起了许多学者对骨桥蛋白在冠心病中作用的研究兴趣.  相似文献   

12.
Objectives To analyze risk factors and the relation between clinical, biochemical marker and the stenosis extent of coronary artery in patients below the age of 45 years with acute myocardial infarction (AMI). Methods A retrospective investigation was performed on 92 patients below the age of 45 with AMI at the First Affiliated Hospital of Medical School of Xi′an Jiaotong University in 2003-2007. The etiology, morbidity, risk factors, clinical features and results of coronary angiography were studied. Various clinical and biochemical markers were assessed to find out what were associated with the stenosis extent of coronary artery. Meanwhile, the differences between one-vessel disease (group A) and two-vessel or multi-vessel disease (group B) patients with AMI were comparatively analyzed. Results Risk factors analysis revealed that a history of cigarette smoking, metabolic disorders and abusive drinking were mainly found in young AMI patients below the age of 45 years, and metabolic disorder mainly consists of decreased high-density lipoprotein cholesterol (HDL-C) and hypertriglyceridemia. AMI in patients below the age of 45 years account for 10.3% of all AMI. Angiographically, the incidence of one-vessel affected was most frequent in the young adults (73.75 %). The most committed vessel was LAD (80.00 %). A higher incidence with history of hypertension and diabetes or impaired glucose tolerance was found in group B, but a history of preceding angina 1 month earlier was more frequently found in group A. Improved Genisi scores of coronary angiography was lower in group A than in group B(7.49±3.63 vs 15.08±6.08). Correlation analysis showed that log(LDL-C/HDL-C)(r= 0.238, P= 0.037), TC/HDL-C (r= 0.232, P= 0.046) were directly correlated with angiographic scores, and HDL-C(r= -0.202, P= 0.042)was inversely correlated. Multielement gradual linear regression analysis showed log(LDL-C/HDL-C), TC/HDL-C were associated with the extent of stenosis of coronary artery. Fur  相似文献   

13.
Objectives To investigate the effects of simvastatin on membrane ionic currents in left ventricular myocytes of rabbit heart suffering from acute myocardial infarction ( AMI), so as to explore the ionic mechanism of statin treatment for antiarrhythmia. Methods Forty-five New Zealand rabbits were randomly divided into three groups: AMI group, simvastatin intervention group ( Statin group) and sham-operated control group (CON). Rabbits were infarcted by ligation of the left anterior descending coronary artery after administration of oral simvastatin 5 mg · kg^-1·d^-1 (Statin group) or placebo (AMI group) for 3 days. Single ventricular myocytes were isolated enzymatically from the epicardial zone of the infracted region 72 h later. Whole cell patch clamp technique was used to record membrane ionic currents, including sodium current (INa), L-type calcium current (Ica-L) and transient outward potassium current (Ito). Results (1) There was not significant difference in serum cholesterol concentration among three groups. (2) The peak INa current density (at -30 mV) was significantly decreased in AMI group ( -25.26±5.28, n = 13 ), comparing with CON ( - 42. 78± 5.48, n = 16), P 〈 0. 05, while it was significantly increased in Statin group ( - 39.83 ±5.65 pA/pF, n = 12) comparing with AMI group, P 〈0. 01 ; The peak Ica-L current density ( at 0 mV) was significantly decreased in AMI group ( -3. 43 ±0. 92 pA/pF, n = 13) comparing with CON ( -4. 56 ±1.01 pA/pF, n = 15), P 〈0. 05, while it was significantly increased in Statin group ( -4. 18±0. 96 pA/pF, n = 12) comparing with AMI group, P 〈0. 05; The Ito current density ( at + 60 mV) was significantly decreased in AMI group ( 11.41 ± 1.94 pA/pF, n = 13 ) comparing with CON (17.41 ±3.13 pA/pF, n = 15), P 〈0. 01, while it was significantly increased in Statin group (16. 11 ± 2. 43 pA/pF, n = 14) comparing with AMI group, P 〈 0. 01. Conclusions AMI induces signific  相似文献   

14.
室间隔穿孔是急性心肌梗死少见但却非常严重的机械并发症之一,常发生于急性心梗的早期1~2周,占急性心梗患者1%~3%[1].其预后差,死亡率极高.主动脉内球囊反搏(IABP)是目前国内应用较多的心脏辅助装置,能够提高疗效,提高生存率.本病例在药物治疗基础上,早期植入IABP,使患者心功能得到一定的改善,度过危险期,赢得了最佳的抢救时机。  相似文献   

15.
Objectives To assess the prognostic value of B-type natriuretic peptide (BNP) in severe AMI patients treated with intra-aortic ballon counterpulsation(IABP). Methods A total of 42 AMI patients with cardiogenic shock were retrospectively studied. BNP plasma level was recorded in the 24th hour and 4th day after myocardial infarction. The different mortality were compared among patients with different BNP levels. Results With aggressive treatment, 20 patients survived short term hospitalization. Plasma concentration of BNP in dying patients is much higher than in survivals(1369 ± 353 vs 651 ± 302 pg/ml. P〈 0.01).Patients with BNP higher than 1474 pg/mL had a mortality of 92.9 %. Conclusions Elevated BNP level in AMI patients with cardiogenic shock treated with IABP is highly associated with poor prognosis.  相似文献   

16.
Objectives To study the effects of bradykinin (BK) B2 receptor blockade on infarct size and hemodynamics after myocardial infarction (MI) in rats with angiotensin-converting enzyme (ACE) inhibition therapy. Methods MI was produced by ligating the left coronary artery. The effects of enalapril ( 500 μg/kg·day), enalapril ( 500 μg/kg · day) with BK B2 receptor antagonist Hoe-140 (500 μg/kg · day), angiotensin Ⅱ (Ang Ⅱ) type 1 (AT1) receptor antagonist losartan (3 mg/kg · day) on infarct size, left ventricular systolic pressure ( LVSP), cardiac output index (CI) and stroke volume index (SVI) were observed in rats after MI. Treatments were started on the 2nd day after MI and continued for another 6 weeks. Results Enalapril reduced infarct size and improved CI and SVI compared with the untreated MI group ( P 〈 0. 05 ), and these effects of enalapril were significantly blunted by concomitant treatment with Hoe-140 (P 〈 0. 05). Losartan was less effective than enalapril. LVSP were unchanged in the three treatment groups. Conclusions BK can reduce infract size and improve hemodynamics in rats following MI. The cardioprotective effects of ACEI partly result from the action of BK exerted through the B2 receptor.  相似文献   

17.
Objectives To investigate changes of clinical features of aortic dissection (AD) in recent years in Guangzhou. Methods Retrospective analysis of consecutive patients with AD over 10 years in Guangdong Cardiovascular Institute. Demographic features and outcomes in cases presenting with acute dissection were compared between patients admitted in two five-year periods. Results 339 patients with AD were admitted during the recent ten years. Their mean age was 55.7 ± 11.2 years. Male verse female ratio was 4.8. Surgery was performed in 37 % of cases with acute type A and 7 % with acute type B dissection. Apart from a fast increase in number of patients admitted each year, there were no significant changes in demographic characteristics over these ten years. Survival of patients with acute dissection showed a trend of improvement, though it had not been statistically confirmed. Conclusions The number of admitted patients with AD has been fast increasing in Guangzhou. These patients were about ten years younger than previously reported by foreign researchers. Surgery was much less frequently performed than it was in western countries. Survival in acute cases showed a trend of improvement. These data support urgent improvement in prevention and management of aortic dissection.  相似文献   

18.
<正>1病历资料男性,患者,41岁,2007年因乙型肝炎肝硬化、食管胃底静脉曲张破裂出血于外院行内镜下食管静脉曲张硬化治疗术,术后患者出现化脓性胆囊炎,经保守治疗后病情缓解。该患者2013年8月因再次"呕血、黑便1 d"入住威海市立医院,本次住院前曾行B超检查:肝硬化,门静脉高压,脾静脉、肠系膜上静脉、下腔静脉肝后段栓塞,胆囊多发结石,胆囊壁厚。住院后随即行相关化验检查,血常规:白细胞(WBC)4.7×109/L,中性粒  相似文献   

19.
<正>心肌梗死属冠心病的严重类型,是因冠状动脉血供急性减少或中断,使相应的心肌严重而持久地急性缺血导致的心肌坏死。早期再灌注是挽救缺血心肌的唯一方法,恢复血流灌注可防止梗死面积扩大,保护心脏功能。目前心肌梗死的再灌注治疗主要有溶栓和冠状动脉介入治疗,但再灌注开始的几分钟内,由于细胞内钙超载、三磷酸腺苷(adenosine triphosphate,ATP)合成不足、氧自由基爆发及膜磷脂的缺失而产生不可逆的细胞损害,包括心肌细胞坏死、凋亡,心肌收  相似文献   

20.
目的:了解住院患者呼吸道疾病非典型病原体感染情况,重视非典型病原体感染和防治。方法:对慢性支气管炎、阻塞性肺气肿、慢性阻塞性肺疾病、社区获得性肺炎、支气管哮喘、支气管扩张、肺源性心脏病等呼吸道疾病患者,采用间接免疫荧光法(IFA),检测嗜肺军团菌(LP)、肺炎支原体(MP)、Q热立克次体(QFR)、肺炎衣原体(CP)、腺病毒(ADV)、呼吸道合胞病毒(RSV)、甲型流感病毒(INF A)、乙型流感病毒(INF B)、副流感病毒(PIVs)等9种病原体IgM。结果:569例慢性支气管炎、阻塞性肺气肿、慢性阻塞性肺疾病、社区获得性肺炎、支气管哮喘、支气管扩张、肺源性心脏病检出非典型病原体例数和感染率分别为:15例(17.0%)、7例(12.5%)、29例(20.0%)、34例(32.1%)、3例(5.2%)、5例(7.8%)、2例(3.8%)。各种呼吸道疾病皆有非典型病原体检出,位居前5位的病原体分别是INF B(28.2%)、MP(24.3%)、INF A(12.5%)、PIVs(10.4%)、LP(9.6%)。各种呼吸道疾病,单一非典型病原体感染61例,感染率64.2%;2种及2种以上混合感染34例,感染率35.8%。结论:各种呼吸道疾病,无论是感染因素所致,还是非感染因素所致,都存在不同种类非典型病原体感染,并且混合感染较多。因此,必须重视呼吸道疾病非典型病原体感染的诊断和治疗,才能有效防治呼吸道疾病。  相似文献   

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