糖尿病患者凝血、抗凝血及纤溶功能的变化

目的探讨糖尿病患者凝血、抗凝血、纤溶系统的变化及意义.方法纤维蛋白原(Fg)采用Clauss法,纤维蛋白A肽(FPA)、血管性血友病因子(vWF)、D-二聚体(D-dimer)、抗凝血酶-Ⅲ(AT-Ⅲ)、血浆血小板α-颗粒膜蛋白140(GMP-140)采用酶联免疫吸附试验(ELISA)法,组织型纤溶酶原激活物(t-PA)、纤溶酶原激活剂抑制物(PAI)采用发色底物法.结果与对照组比较,糖尿病无并发症组Fg、FPA、vWF、GMP-140水平显著增高(P<0.05),AT-Ⅲ、D-dimer、t-PA、PAI差异无显著性;糖尿病有并发症组Fg、FPA、vWF、D-dimer、PAI、GMP-140水平显著增高(P<0.01),AT-Ⅲ、t-PA水平显著降低(P<0.01).结论糖尿病时,凝血、抗凝血、血小板、纤溶等系统发生了显著变化,因此测定上述指标,对指导临床治疗、监测病情、预防血栓形成具有一定价值.     

非小细胞肺癌患者血浆纤维蛋白原检测的临床意义

目的探讨非小细胞肺癌(NSCLC)患者血浆纤维蛋白原水平与肺癌临床病理特征关系及预后的相关性。方法对55例NSCLC患者及20例健康人的血浆纤维蛋白原分别进行测定。结果NSCLC患者血浆纤维蛋白原水平显著高于健康对照组(P<0.01),肺癌患者血浆纤维蛋白原水平与患者的病理类型、TNM分期之间无明显关系。NSCLC患者血浆纤维蛋白原水平与其生存期之间有显著的负相关(r=-0.37,P<0.01)。结论NSCLC患者存在血浆纤维蛋白原水平增高,血液存在高凝状态;血浆纤维蛋白原水平与患者的生存期呈负相关,血浆纤维蛋白原是反映NSCLC患者预后的重要指标。     

厄贝沙坦和咪达普利对早期雄性自发性高血压大鼠凝血和纤溶系统的影响

背景 目前对于高血压凝血和纤溶系统的改变存在着争议 , 而凝血和纤溶系统在高血压血栓栓塞性和 /或出血性并发症的进程中具有关键性作用,因此,检测高血压患者的凝血和纤溶状态 ,并以此为依据合理选用能改善其凝血和纤溶状态的抗高血压药以及据此提出合理的康复介入方案,具有不容忽视的临床价值. 设计 随机对照的实验研究. 目的 探讨厄贝沙坦和咪达普利在降压的同时 , 对早期雄性自发性高血压大鼠( spontaneously hypertensive rats, SHR)血浆凝血酶原时间、纤维蛋白原含量、组织型纤溶酶原激活物活性( tissue-type plasminogen activator activity, t-PAA)、纤溶酶原激活物抑制剂活性( plasminogen activator inhibitor activity, PAIA)和α 2 纤溶酶抑制物活性(α 2 plasmin inhibitor activity,α 2-PIA)的影响. 地点、材料和干预本实验在武汉大学医院检验中心进行. 15周龄雄性 SHR 30只按随机数字表法分为 3组,咪达普利组给予含咪达普利的水 3 mg/( kg· d);厄贝沙坦组给含厄贝沙坦的水 50 mg/( kg· d); SHR对照组和同龄雄性 Wistar Kyoto( WKY)大鼠 (正常血压对照组 )10只以等量蒸馏水代替;采用一期法检测血浆凝血酶原时间,采用凝血酶法检测血浆纤维蛋白原含量,采用发色底物法检测血浆 t-PAA, PAIA和α 2-PIA. 主要观察指标厄贝沙坦和咪达普利对 SHR凝血、纤溶系统的作用结果并与正常血压对照组( WKY大鼠)进行比较. 结果 与 WKY组比较 SHR对照组血浆纤维蛋白原含量显著增高( P< 0.01), t-PAA显著增高( P< 0.05) ,α 2-PIA显著降低( P< 0.01) , 而凝血酶原时间和 PAIA无明显变化.与 SHR对照组比较咪达普利组和厄贝沙坦组经过 3个月治疗血压明显降低( P< 0.01),纤维蛋白原含量显著降低( P< 0.01),α 2-PIA显著增高( P< 0.01). 结论早期雄性 SHR血管内凝血与纤溶并存,厄贝沙坦和咪达普利对早期雄性 SHR的干预能逆转 SHR慢性隐性 DIC所致的血栓前状态和动脉粥样硬化,改善其已受损的凝血和纤溶系统,从而降低出血性和 /或血栓栓塞性并发症的危险性.     

心肌标志物检测在慢性阻塞性肺疾病患者低氧血症中的意义

目的探讨心肌标志物检测在慢性阻塞性肺疾病(COPD)患者低氧血症中的临床意义.方法对105例COPD急性发作期患者同时测定动脉血氧分压(PaO2)及血清肌钙蛋白I(cTnI)、肌钙蛋白T(cTnT)和肌酸激酶同工酶质量(CK-MB mass)水平.结果 COPD患者伴不同程度低氧血症,血清cTnI、cTnT和CK-MB mass水平均明显高于正常对照组(P<0.01),且重度低氧血症组患者血清中3项心肌标志物浓度均明显高于中度低氧血症组和轻度低氧血症组,相互比较差异有显著性(P<0.01);各患者组PaO2水平与相对应的血清cTnI、cTnT和CK-MB mass水平间呈负相关(分别为r=-0.812、P<0.01;r=-0.790、P<0.01和r=-0.705、P<0.05);血清cTnI、cTnT和CK-MB mass检测的阳性率分别为65.7%、58.1%、41.9%,以cTnI的阳性率最高,与cTnT和CK-MB mass比较差异有显著性(分别为P<0.05、P<0.01).结论 COPD患者低氧血症可导致血清中心肌标志物浓度增高,且与PaO2水平呈负相关,常规检测血清中心肌标志物浓度,尤其是cTnI,对及时了解COPD患者心肌损害程度、改善疗效有重要意义.     

系统性红斑狼疮患者CD5+B细胞与红细胞I型补体受体相关性研究

目的探讨外周血中CD5+B细胞水平和红细胞I型补体受体(CR1)表达在系统性红斑狼疮(SLE)活动中的作用及相关性.方法利用流式细胞分析法对36例SLE患者和20名正常人群外周血CD5+B细胞和红细胞CR1进行检测. 结果 SLE患者CD5+B细胞水平较正常人高(P<0.05),活动期较稳定期明显增高(P<0.01);SLE患者CR1表达显著低于正常人(P<0.001),活动期较稳定期明显降低(P<0.01);SLE患者CR1与狼疮活动积分呈负相关(P<0.05);CR1与CD5+B细胞呈显著负相关(P<0.01);CD5+B细胞与SLEDAI呈显著正相关(P<0.01).结论活动期SLE红细胞CR1明显降低,CD5+B细胞明显升高.两者存在明显相关性,并与SLE疾病活动有一定关系.     

强骨抗萎方对骨细胞代谢及血液流变学的影响

目的研究中药复方强骨抗萎方对尾吊大鼠血液流变学的影响. 方法 用大鼠尾吊- 30°21 d模拟失重,观察强骨抗萎方对大鼠血沉、血细胞比容、纤维蛋白原、血液黏度及红细胞变形性、聚集性等指标的作用. 结果 悬吊大鼠纤维蛋白原明显升高( P< 0.01),全血还原黏度及全血黏度明显增加( P< 0.01或 P< 0.05),红细胞刚性指数升高( P< 0.01),最大变形指数降低( P< 0.01),最大聚集指数增加( P< 0.01).该方不同剂量显示了不同的作用.低剂量组( 10 g/Kg)可降低各个切变率下的全血还原黏度和全血黏度( P< 0.01或 P< 0.05),以及异常的红细胞刚性指数和最大聚集指数( P< 0.01);中剂量组( 20 g/kg)可使纤维蛋白原含量减少( P< 0.01);高剂量组( 30 g/Kg)可降低高切变率下的全血还原黏度和全血黏度( P< 0.01或 P< 0.05),降低红细胞刚性指数( P< 0.01),并可升高红细胞最大变形指数( P< 0.01). 结论 该方具有改善尾吊大鼠血液流变学的作用,但无明显的量效关系.     

血浆神经肽Y水平与冠状动脉病变程度及左心室功能关系的探讨

目的探讨血浆神经肽Y水平与冠心病患者冠状动脉病变程度及左心室功能的关系.方法应用放射免疫法检测48例选择性冠状动脉造影主要分支狭窄程度大于50%的患者和10例冠状动脉造影正常者的血浆神经肽Y浓度,并作冠状动脉病变程度记分和测定左心室射血分数,研究血浆神经肽Y浓度与冠状动脉记分及左心室射血分数之间的关系.结果冠心病患者血浆神经肽Y水平(348.4±46.8)ng/L明显高于对照组(224.2±42.5)ng/L(P<0.01);血浆神经肽Y水平与冠状动脉狭窄程度记分呈显著正相关(r=0.64,P<0.01),而与左心室射血分数呈显著负相关(r=-0.59,P<0.01).结论冠心病患者血浆神经肽Y水平与冠状动脉病变严重程度和左心室功能均有一定关系,血浆神经肽Y水平升高的冠心病患者左心室功能随冠状动脉病变的加重而减退.神经肽Y可能参与了冠状动脉粥样硬化性心脏病的发生发展过程.     

风湿性心脏病合并心力衰竭患者内皮素及血管性血友病因子水平的变化

目的探讨风湿性心脏病合并充血性心力衰竭(RHD-CHF)患者内皮素(ET-1)及血管性血友病因子(vWF)的变化及其意义.方法检测31例CHF患者和30名正常人ET-1、vWF,并按心功能等级分组进行比较分析.结果 RHD-CHF患者血浆ET-1、vWF水平与对照组比较明显升高(P<0.01),且心功能越差,ET-1、vWF水平越高,心功能Ⅲ、Ⅳ级与Ⅱ级比较显著升高(P<0.05,P<0.01);患者血浆ET-1与vWF呈正相关(r=0.668,P<0.01).结论 RHD-CHF的发生、发展与细胞内皮损伤有关,检测血浆中vWF和ET-1可作为评价CHF病情严重程度的指标之一.     

海水浴中体操疗法对高血压患者血浆纤维蛋白原水平的影响

目的 探讨海水浴中体操疗法(体疗)对中、老年高血压康复疗养期患者，体内纤溶系统的调节作用。方法 采用涡流密度法，对30例中年、28例老年高血压患者海水浴体疗4个疗程(体疗组)前后作血浆纤维蛋白原浓度测定，并各与同年龄段非体疗组(对照组)作比较。结果 疗程结束后，两体疗组测值与疗养前比降低，差异有非常显著性意义(P&;lt;0．01)；各对照组疗养结束时与疗养前比，测值变化差异无显著性意义(P&;gt;0．05)；疗养后两体疗组与同年龄段对照组比，测值差异有显著、非常显著性意义(P&;lt;0．05～0．01)。结论 海水浴体疗可一定程度地降低中、老年高血压患者的血浆纤维蛋白原水平，有利于患者体内纤溶活性改善，减少血栓形成的危险因素。     

纤维蛋白原水平与先兆子痫发生的相关性分析

目的研究纤维蛋白原在先兆子痫发病机制中的作用及其临床意义。方法回顾性分析了85例正常孕妇、47例轻度先兆子痫、27例重度子痫患者和55名健康未孕女性的血浆纤维蛋白原水平。采用受试者工作特征(ROC)曲线分析纤维蛋白原水平对先兆子痫的预测价值、以Pearson法分析纤维蛋白原水平与先兆子痫发生时间的关系。结果先兆子痫患者血浆纤维蛋白原水平较正常孕妇和未孕健康女性增高(P0.01)。血浆纤维蛋白原预测轻度先兆子痫和重度先兆子痫的曲线下面积(95%可信区间)分别为0.70(0.62~0.78)和0.70(0.58~0.82)。血浆纤维蛋白原水平与发生先兆子痫的孕周呈负相关(R=-0.33,P0.01)。结论血浆纤维蛋白原水平对预测先兆子痫具有一定的帮助。     

脑梗死患者血浆D-二聚体、纤维蛋白原含量变化及临床意义

目的探讨脑梗死患者血浆中D-二聚体、纤维蛋白原含量（Fbg）变化与脑梗死发生的关系及其临床意义。方法测定40例脑梗死患者及3l例对照者血浆D-二聚体、Fbg量。结果与对照组相比,脑梗死患者血浆D-二聚体含量、Fbg水平显著增高（均P〈0．01）。结论血浆中的D-二聚体与脑梗死的发生、发展有密切关系;血浆Fbg水平的升高是脑血管病的重要危险因素,Fbg的增高与脑血管病变的发生发展密切相关。     

The relationship between the erythrocyte sedimentation rate (ESR) and plasma proteins in clinical materials and models

The relationship between the erythrocyte sedimentation rate (ESR) and plasma proteins was studied within homogenous clinical material and in in vitro models. In acute phase reactions, fibrinogen was the likely cause of the ESR-elevation, but there were significant associations between the ESR and the concentrations of α₁-antitrypsin, C₃, haptoglobin and albumin. In chronic diseases, the ESR-elevation was probably caused by fibrinogen, mono- or polyclonal increase of IgG, IgA, IgM alone or in combinations. In multiple myeloma of the IgG and IgA subtypes, significant correlations were found between the ESR and the monoclonal proteins or between the ESR and the percentage of plasma cells in bone marrow. Model studies showed that the ESR increased linearly with the concentrations of fibrinogen or gammaglobulin (IgG) when these exceeded normal thresholds. The ESR was slightly decreased by increasing concentrations of albumin. Albumin had a synergistic effect on the ESR together with gammaglobulin, but not together with fibrinogen.     

肛周脓肿患者血浆纤维蛋白原测定的临床意义

目的：评价肛周脓肿患者血浆纤维蛋白原（ FIB ）水平的临床意义。方法选取肛周脓肿患者326例,对患者手术治疗前进行血常规、血凝常规检测进行分析。结果血浆纤维蛋白原升高的140例患者均为肛周脓肿位置较深、感染范围重者,手术切口范围较大。纤维蛋白原无明显升高者,肛周脓肿病灶位置浅,手术处理相对简单。结论肛周脓肿患者纤维蛋白原水平不同,对评估感染位置的深浅、手术方式、麻醉方式的选择以及评估患者有无二次手术可能性具有临床参考意义。F IB 可作为肛周脓肿炎症反应及病情监测的指标之一。     

The relationship between the erythrocyte sedimentation rate (ESR) and plasma proteins in clinical materials and models

The relationship between the erythrocyte sedimentation rate (ESR) and plasma proteins was studied within homogenous clinical material and in vitro models. In acute phase reactions, fibrinogen was the likely cause of the ESR-elevation, but there were significant associations between the ESR and the concentrations of alpha 1-antitrypsin, C3, haptoglobin and albumin. In chronic diseases, the ESR-elevation was probably caused by fibrinogen, mono- or polyclonal increase of IgG, IgA, IgM alone or in combinations. In multiple myeloma of the IgG and IgA subtypes, significant correlations were found between the ESR and the monoclonal proteins or between the ESR and the percentage of plasma cells in bone marrow. Model studies showed that the ESR increased linearly with the concentrations of fibrinogen or gammaglobulin (IgG) when these exceeded normal thresholds. The ESR was slightly decreased by increasing concentrations of albumin. Albumin had a synergistic effect on the ESR together with gamma-globulin, but not together with fibrinogen.     

The acute phase reactant, fibrinogen, as a guide to plasma exchange therapy for acute Guillain-Barré syndrome

The Guillian Barré syndrome is an acute inflammatory disorder for which plasma exchange is effective treatment. Up to 10% relapse after plasma exchange suggesting that treatment sometimes finishes before disease activity has resolved. We studied whether plasma fibrinogen, an inflammatory marker, might be used to determine when to discontinue plasma exchange in patients with acute Guillain-Barré syndrome. We conducted a post-hoc analysis of apheresis database and hospital records of patients treated with plasma exchange for acute Guillain-Barré syndrome during 1999-2004. Data were analyzed from 28 patients who underwent a total of 29 courses of plasma exchange for acute Guillain-Barré syndrome. The mean (+/-SD) plasma fibrinogen concentration was 422.5 (+/-96.4) mg/dl at the time of presentation and, in 17 of the 29, it was above 400 mg/dl (reference range 200-400). Twenty of the 21 patients whose fibrinogen fell by more than 30% from baseline by the time of the final plasma exchange treatment had neurological improvement. There was improvement in only 3 of the 8 instances where fibrinogen decreased by less than 30% by the end of plasma exchange therapy. A > or =30% decrease in fibrinogen by the conclusion of plasma exchange was significantly associated with sustained neurological improvement (P = 0.0025). The plasma fibrinogen level appears to reflect disease activity in acute Guillain-Barré syndrome. A <30% fall in fibrinogen level despite plasma exchange may indicate the need to continue plasma exchange to maximize the benefit of treatment or minimize the risk of relapse. Therapeutic plasma exchange need not be extended when plasma fibrinogen remains > or =30% below its level at presentation by the time of the final planned plasma exchange procedure.     

慢性阻塞性肺疾病患者血气分析与血浆纤维蛋白原的相关性研究

目的：探讨慢性阻塞性肺疾病患者血浆纤维蛋白原（FIB）水平及与血气分析相关性。方法：对30例慢性阻塞性肺疾病患者治疗前后血气分析、血浆纤维蛋白原及30例对照组的血浆纤维蛋白原分别进行测定。结果：血浆纤维蛋白原水平在慢性阻塞性肺疾病加重期患者明显升高，与对照组相比有显著性差异；治疗后血浆纤维蛋白原明显下降，与对照组相比无显著性差异；血浆纤维蛋白原与动脉血氧分压（PaO2）呈负相关。血浆纤维蛋白原与动脉血二氧化碳分压（PaCO2）呈正相关。结论：慢性阻塞性肺疾病患者血浆纤维蛋白原增高，可导致血液高凝状态，并易导致肺小动脉血栓形成、低氧血症和高碳酸血症。临床应改善缺氧、通气及适当的抗凝治疗对控制病情有益。     

慢性阻塞性肺病急性加重期血浆纤维蛋白原水平的变化及临床意义

目的探讨血浆纤维蛋白原（plasma fibrinogen,Fbg）水平在慢性阻塞性肺病急性加重期（acute exacerbation ofchronic obstructive pulmonary disease,AECOPD）的变化及其临床意义。方法随机选择2009年1月至2010年6月确诊的AE-COPD住院患者（AECOPD组）和同期健康体检者（健康对照组）各43例,检测并比较AECOPD患者急性发作期、治疗缓解后及健康体检者血浆Fbg水平,同时检测并比较治疗前后动脉血气与肺功能相关指标,将AECOPD患者血浆Fbg水平相关的因素作直线相关分析。结果 AECOPD患者血浆Fbg水平治疗前高于治疗后,且均明显高于健康对照者（均P〈0.05）;与一秒钟用力呼气容积占用力肺活量的比值（the ratio of the forced expiratory volume in one second and the forced vital capacity,FEV1/FVC）、一秒钟用力呼气容积（forced expiratory volume in one second,FEV1）、动脉氧分压呈显著负相关（P〈0.05）,与二氧化碳分压呈显著正相关（P〈0.05）。结论 AECOPD患者血浆Fbg水平与病情严重程度具有密切相关性;检测血浆Fbg水平可反映AECOPD患者治疗效果。     

A common mutation (G-455--> A) in the beta-fibrinogen promoter is an independent predictor of plasma fibrinogen, but not of ischemic heart disease. A study of 9,127 individuals based on the Copenhagen City Heart Study.

A common mutation (G-455--> A) in the promoter region of the beta-fibrinogen gene has been associated with elevated plasma fibrinogen levels. Whether fibrinogen genotype affects plasma fibrinogen levels and risk of ischemic heart disease in the general population has not been studied. We investigated the association between fibrinogen genotype, plasma fibrinogen levels, and ischemic heart disease in a general population sample (n = 9,127). The A-allele (relative frequency, 0.20) was associated with elevated plasma fibrinogen levels in both genders (P < 0.001). While the effect of the A-allele on fibrinogen level was additive in men, the effect was dominant in postmenopausal women. The A-allele raising effect appeared to be two- to threefold greater in individuals with ischemic heart disease than in those without. An increase of 1 SD in plasma fibrinogen increased the odds ratio for ischemic heart disease by approximately 20% (P < 0.01 for women and < 0.005 for men). However, the frequency of the A-allele was similar in those with and without ischemic heart disease, and genotype was not a predictor of disease. These results demonstrate that the (G-455--> A) mutation in the promoter region of the beta-fibrinogen gene is associated with an increase in plasma fibrinogen in both genders in the general population. This increase does not appear to cause ischemic heart disease.     

Angiotensin-converting enzyme genotype, albuminuria and plasma fibrinogen in type 2 diabetes mellitus

AIMS: Increased fibrinogen level is considered an important atherosclerosis risk factor. Patients with type 2 diabetes frequently have increased fibrinogen levels. The aim of the present study was to examine the effect of angiotensin-converting enzyme (ACE) gene polymorphism and the effects of the diabetic environment on plasma fibrinogen in type 2 diabetes. PATIENTS AND METHODS: The study group included 125 patients with type 2 diabetes (40 men, 85 women). The average age of patients was 62 +/- 10 years. Fibrinogen concentration was determined with the thrombin coagulation test. ACE insertion/deletion (I/D) polymorphism was detected using polymerase chain reaction (PCR) assay. RESULTS: II homozygotes (n = 17) had the highest mean fibrinogen levels, ID heterozygotes (n = 75) had medium levels and DD homozygotes (n = 33) had the lowest (p = 0.054, ANOVA). II homozygotes also had significantly higher mean fibrinogen level than ID/DD carriers (4.3 +/- 1.7 vs. 3.5 +/- 1.3 g/l; p = 0.015). The indices of renal functions, i.e. albuminuria (r = 0.37; p < 0.0001) and serum creatinine (r = 0.22; p = 0.015), significantly correlated with fibrinogen levels. The correlation between albuminuria and fibrinogen was significant in the subgroups with genotypes II (r = 0.76; p = 0.001) and ID (r = 0.37, p = 0.002), whereas in the subgroup of DD homozygotes this relationship did not reach statistical significance. In the multivariate regression analysis with age, sex, BMI, creatinine, albuminuria and ACE genotype as independent variables, albuminuria was the only significant predictor of fibrinogen level (p < 0.0001). After interaction between the ACE genotype and albuminuria was included into multivariate analysis, the interaction became the only independent predictor of plasma fibrinogen level (p < 0.0001) in the model, and the model explained 25% of the plasma fibrinogen variance. CONCLUSION: ACE gene polymorphism is associated with plasma fibrinogen level in type 2 diabetes. This association is mediated by an interaction between ACE genotype and albuminuria. Diabetes patients with genotypes II or ID have increased plasma fibrinogen in the presence of albuminuria.     

急性脑梗死患者血浆D-二聚体与纤维蛋白原的变化

目的　观察急性脑梗死患者血浆中D 二聚体和纤维蛋白原的变化 ,并探讨其临床意义。方法　采集 5 3例发病 2 4h内急性脑梗死患者血液 ,测定其血浆中D 二聚体和纤维蛋白原含量 ,并与 4 0例健康对照组比较。结果　急性脑梗死患者血浆D 二聚体 ,纤维蛋白原含量明显高于对照组 (P <0 0 1) ,并与梗死灶大小及病情轻重明显相关。结论　急性脑梗死患者存在凝血纤溶系统异常 ,血浆D -二聚体及纤维蛋白原检测对脑梗死患者的诊断及病情判断、溶栓的效果评价及预后有重要的参考价值。