含孕酮宫内节育器减少经血量机制的初步探讨——放置宫内节育器前后月经血及外周血纤溶活性、抗凝血酶Ⅲ和因子Ⅷ相关抗原的变化

本文观察了22例放置孕酮宫内节育器和19例放置不含孕酮的宫内节育器妇女上环前及上环后月经第一天之月经血及周围静脉血中纤溶活性、抗凝血酶Ⅲ(AT-Ⅲ)和因子Ⅷ相关抗原(ⅧR:Ag)的变化。以探讨放置孕酮宫内节育器后经血量减少的机制。结果表明:放置孕酮IUD妇女经血量减少的机制既不是AT-Ⅲ活力的变化,亦不是通过合成、释放ⅧR∶Ag的增加从而加强血小板的粘附作用。而经血中纤溶活性的降低则可能是置孕酮IUD者经血量减少的重要机制之一。     

腹腔镜全子宫切除术对凝血及纤溶活性的影响

目的:探讨妇科腹腔镜手术对患者凝血及纤溶活性的影响。方法:采用凝固法、酶联免疫法检测25例无血栓形成高危因素患者腹腔镜子宫全切除术后凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶原国际标准化值(INR)、纤维蛋白原(FG)、D-二聚体(D-D)的变化。结果:PT在手术结束时明显延长(P<0.05),术后24小时逐渐恢复至术前水平。FG在手术结束时变化不明显(P>0.05),术后24小时明显升高(P<0.01)。D-D在手术结束和术后24小时均明显升高,与术前比较差异有非常显著性(P<0.01)。APTT、PT、INR在手术结束及术后24小时均未发生明显变化(P>0.05)。结论:腹腔镜子宫全切除术可引起患者术后凝血及纤溶指标的改变,术后形成血液凝固性增加、凝血活性增强的高凝状态,故对有高危因素的患者,应加强围手术期管理,预防血栓性疾病发生。     

置释铜IUD妇女经血纤溶活性与宫颈粘液铜离子浓度相关性研究

本文以置不锈铜IUD妇女作为对照,测定置TCu-220 C IUD妇女于置器前后月经总量、经血纤溶活性,包括组织型纤溶酶原激活剂(t-PA)活性、纤溶酶原(PLG)含量和纤维蛋白(原)降解产物(FDP)含量、宫项粘液Cu~(++)浓度,以了解妇女置释铜IUD 后宫腔Cu~(++)浓度与局部纤溶活性改变的相关性。经检验发现Cu~(++)浓度的升高与t-PA 活性和FDP 含量呈正相关,而与PLG 含量呈负相关。实验初步表明释铜IUD 的应用使宫腔局部Cu~(++)浓度升高,并促进局部纤溶活性增加,从而使置器妇女月经过多的发生率增加。     

卵巢肿瘤患者血清尿激酶型纤溶酶原激活物及其抑制物1含量检测的临床意义

目的:探讨血清尿激酶型纤溶酶原激活物(uPA)及其抑制物1(PAI-1)含量的检测对卵巢恶性肿瘤浸润转移诊断的临床意义.方法:采用酶联免疫吸附反应(ELISA)检测49例卵巢恶性肿瘤,49例卵巢良性肿瘤和49例正常健康妇女血清中uPA和PAI-I含量.并对其中22例卵巢上皮性癌患者手术治疗前后外周血uPA和PAI-1含量进行动态观察,分析其与临床病理因素及预后关系和作为卵巢恶性肿瘤浸润转移诊断标志物的可能性.结果:①卵巢恶性肿瘤患者血清中uPA和PAI-1含量明显高于正常对照和良性肿瘤(P＜0.01).②卵巢恶性肿瘤患者术后血清uPA和PAI-1含量较术前有明显下降(P＜0.01).③低分化恶性肿瘤、Ⅲ～Ⅳ期、有淋巴结转移患者术前血清uPA和PAI-1含量均明显高于高中分化者(P＜0.05,P＜0.01)、Ⅰ～Ⅱ期患者(P＜0.05,P＜0.01)、无淋巴结转移者(P＜0.05,P＜0.01),大网膜转移者术前血清uPA含量高于无大网膜转移者(P＜0.05).④uPA或PAI-1阳性者和阴性者的中位生存时间相比较差异均无统计学意义(P＞0.05).结论:卵巢恶性肿瘤患者血清uPA和PAI-1含量高低与其疾病进展相关,血清uPA和PAI-1含量测定有助于判断卵巢恶性肿瘤浸润转移.     

放置不同材料IUD_s后兔子宫内膜纤溶活性的改变

本文介绍兔一侧子宫内分别放置铜、钢、磁性物质及铜加6-氨基己酸(EACA)制成的宫内节育器(IUD),观察子宫内膜的纤溶变化。发现实验侧纤溶活性均明显高于对照侧,以铜为最明显。比较对照试验,铜IUD侧纤溶活性高于钢及磁(P<0.05),钢与磁之间无差异(P>0.05)。置含EACA铜IUD组分别于置器后7,14,28天后观察纤溶活性。7及14天组实验侧与对照侧纤溶活性无差异。28天后实验侧明显高于对照侧。用含EACA铜与无EACA的铜IUD进行对比,7天组实验侧纤溶活性低于对照侧(0.05相似文献   

注射用纤溶酶治疗急性缺血性脑血管病疗效观察

目的：观察注射用纤溶酶治疗急性缺血性脑血管病的临床疗效及安全性。方法：随机选择62例患者,对用药前后神经功能缺损评分及凝血酶原时间、纤维蛋白原定量、血浆黏度比的测定,并与对照组40例进行对照。结果：神经功能缺损评分明显降低（P〈0．02）,治疗组纤维蛋白原明显降低（P〈0．01）。结论：注射用纤溶酶能明显改善神经功能缺损,降低纤维蛋白原及血浆黏度,是治疗急性缺血性脑血管病的理想药物,具有安全、有效的特点。     

GnRH-a对子宫内膜异位症腹膜纤溶相关因子tPA/PAI-1表达影响的研究

目的:探讨子宫内膜异位症(EM)腹膜组织纤溶相关因子表达水平及使用促性腺激素释放激素类似物(GnRH-a)后表达的变化。方法:应用免疫组织化学方法检测组织型纤溶酶原激活物(tPA)、纤溶酶原激活物抑制剂(PAI)-1、尿激酶纤溶酶原激活物(uPA)在内异症和正常对照组腹膜组织中的表达。分析GnRH-a对各种纤溶相关因子表达的影响。结果:内异症腹膜组织中纤溶相关因子tPA、PAI-1、uPA表达均高于对照组腹膜组织的相应表达,差异有统计学意义(P<0.01)。应用GnRH-a的EM组tPA表达水平明显升高,且PAI-1表达水平降低,差异有统计学意义(P<0.05),GnRH-a应用对uPA表达无明显影响。结论:与正常腹膜相比内异症腹膜组织纤溶相关因子tPA、PAI-1、uPA表达水平发生变化,纤溶活性的变化可能是腹膜对损伤发生的反应。GnRH-a应用使tPA表达升高、PAI-1表达降低,发挥促进纤溶作用,从而抑制腹膜粘连形成。     

选择性剖宫产对新生儿脐血纤溶酶活性及免疫因子的影响

目的探讨选择性剖宫产对新生儿脐动脉血纤溶酶活性,血清免疫球蛋白和补体含量的影响。方法中国医科大学附属二院于2001年1月至2004年10月分别采用发色底物法和速率散射比浊法,对122例选择性剖宫产儿脐动脉血纤溶酶活性和IgG、IgM、IgA、C3、C4进行检测,并以150例自然产儿脐动脉血作对照。结果(1)选择性剖宫产儿脐血纤溶酶的活性显著低于对照组(P<0.01)。(2)选择性剖宫产儿脐血IgG、IgM、C3、C4均显著低于对照组(P<0.01、P<0.05、P<0.01、P<0.05)。(3)两组脐血IgA含量差异无统计学意义(P>0.05)。结论(1)选择性剖宫产新生儿湿肺、肺透明膜病等的发生率上升。(2)选择性剖宫产儿对感染的抵抗力较自然产儿更为低下,易患感染性疾病。(3)选择性剖宫产与自然产均使子宫内膜受损,作为黏膜局部保护性抗体的IgA均发挥重要的作用。     

正常孕产妇血液纤溶系统部分指标的变化

正常孕产妇血液纤溶系统部分指标的变化刘燕儒马海梅孙丽芳张会英纤溶系统与凝血系统活性的动态平衡是维持血液在血管中正常流动的基础。纤溶系统由纤溶酶、纤溶酶原、纤溶酶原激活物（ＰＡ）和纤溶酶原激活物抑制剂（ＰＡＩ）组成。近年来大量研究揭示，纤溶系统损害及功...     

放置宫内节育器后子宫内膜和子宫液纤溶活性的变化

<正> 目前,在各种节育措施中,宫内节育器(IUD)的使用比较普遍,但由于存在某些副反应,特别是带IUD 后经量增多而因症取出,使IUD 的使用受到一定限制。IUD 引起经量增多的机理各国学者进行了大量的研究,但众说纷纭。很多学者认为是由于IUD 引起子宫内膜纤溶活性增加所致。在正常月经周期中,子宫内膜的纤溶活性存在着周期性变化,分泌期较增殖期高,于月经前期达最高值。这可能是预防大血块的形成及使子宫腔内已形成的血块重溶,以便经血流出宫腔,这是一种受激素调节的生理现象。人类子宫液的纤溶活性也有周期性的变化,但与子宫内膜不同,在增殖期纤维蛋白溶解活性     

The fibrinolytic enzyme system in normal menstruation and excessive uterine bleeding and the effect of tranexamic acid

The fibrinolytic enzyme system of menstrual and peripheral blood was studied in three groups of women: Group 1, 20 subjects (mean age 37.2 years) with normal menstrual loss; Group 2, 20 patients (mean age 39 years) with dysfunctional uterine bleeding studied before treatment, and Group 3, during treatment with a fibrinolytic inhibitor, tranexamic acid (AMCA) (1 g 8-hourly). The fibrinolytic activity (plasminogen activator and plasmin) of menstrual blood was significantly higher than that of peripheral blood in the three groups (p less than 0.001). Both plasminogen activator and plasmin were higher in the menstrual blood of patients with menorrhagia (Group 2) compared with the control subjects (Group 1) (p less than 0.001 and p less than 0.1 respectively). Treatment with AMCA significantly reduced both plasminogen activator (p less than 0.01) and plasmin (p less than 0.05) in the menstrual blood of patients with menorrhagia (Group 3). No significant differences in fibrinolytic activity were found in peripheral blood between Groups 1 and 2; however, both plasminogen activator and plasmin were significantly lower (p less than 0.01) in Group 3 than in Group 2. Plasmin activity was also significantly lower (p less than 0.05) in Group 3 compared to Group 1. These findings confirm the presence of increased fibrinolytic activity in the uterus in excessive (dysfunctional) bleeding.     

A Canadian,Multicentre Study Comparing the Efficacy of a Levonorgestrel-releasing Intrauterine System to an Oral Contraceptive in Women With Idiopathic Menorrhagia

ObjectivesTo evaluate the efficacy of a levonorgestrel-releasing intrauterine system (LNG-IUS) compared with a combined oral contraceptive containing 1 mg norethindrone acetate and 20 μg ethinyl estradiol (OC1/20) in reducing menstrual blood loss (MBL) in women with idiopathic menorrhagia.MethodsA prospective, randomized, open-label study was conducted in nine centres in Canada. Healthy women over 30 years of age suffering from idiopathic menorrhagia were treated either with LNG-IUS (n = 20) or with OC1/20 (n = 19) over 12 months. The primary endpoint was the change in MBL from baseline to 12 months. Secondary endpoints included treatment success (defined as a MBL score < 100 after 12 months), hemoglobin levels, and the menorrhagia severity score.ResultsIn both treatment groups, MBL decreased significantly from baseline to 12 months (P < 0.001). For the primary endpoint, the MBL score decreased significantly more in the LNG-IUS group (median from 228 to 13, mean percent change–83%) compared to the OC1/20 group (median from 290 to 72; mean percent change–68%) (P = 0.002) after 12 months.In the LNG-IUS group, 80% of subjects had treatment success compared with 36.8 % in the OC1/20 group (P < 0.009).Both treatments increased hemoglobin concentrations significantly between baseline and 12 months. The menorrhagia severity score was consistently lower in the LNG-IUS group at all study time points and was significantly lower (P = 0.045) at six months. Both treatments were well tolerated.ConclusionBoth the LNG-IUS and the combined oral contraceptive effectively decreased menstrual blood loss in women with idiopathic menorrhagia. The overall clinical benefit was more pronounced with LNG-IUS than with OC1/20.     

An objective evaluation of flurbiprofen and tranexamic acid in the treatment of idiopathic menorrhagia

The effect of flurbiprofen (100 mg x 2 for 5 days) was compared with tranexamic acid (1.5 g x 3 for 3 days, 1 g x 2 days 4 and 5) in the treatment of 15 women with idiopathic menorrhagia. The mean blood loss during two medication-free periods was 295 +/- 52 ml. A significant (p less than 0.01) reduction in menstrual blood loss was recorded during treatment with both flurbiprofen and tranexamic acid. The menstrual blood loss was significantly (p less than 0.01) lower during treatment with tranexamic acid (155 +/- 33 ml) than with flurbiprofen (223 +/- 44 ml). Various side effects were recorded by 7 of 15 women during treatment with tranexamic acid and by 4 women of 15 during treatment with flurbiprofen. Many women with menorrhagia suffer simultaneously from dysmenorrhea. Thus although tranexamic acid was generally more effective in reducing menstrual blood loss, flurbiprofen provides an important therapeutic alternative to antifibrinolytic agents, especially in patients with concomitant dysmenorrhea.     

Increased uterine prostaglandin E receptors in menorrhagic women

Summary. PGE receptor concentrations were measured in myometrial samples collected from 10 women at hysterectomy. Five women had normal measured menstrual blood loss (35–44 ml) and the remainder had unexplained menorrhagia occurring in the absence of any uterine, pelvic or general pathology, with losses ranging from 85 to 925 ml. Median PGE receptor concentrations were significantly higher in the women with menorrhagia (1077 fmol/mg protein) than in the women with normal menstrual blood loss (625 fmol/mg protein) and correlated with menstrual blood loss ( P <0·02). These findings suggest that unexplained menorrhagia may simply be a constitutional variant in some women and that specific and potent PGE uterine receptor antagonists would furnish effective non-surgical treatment for unexplained menorrhagia.     

正常妇女经血中FDP含量的测定

测量经血中纤维蛋白(原)降解产物(FDP)的含量能作为反映行经时子宫腔内纤溶活力的一种指标,从而间接地确定月经过多与纤溶活力之间的关系。本文报道了兔抗人纤维蛋白原特异性抗血清的制备及以免疫双扩散法测定了43名正常成年妇女经血中FDP含量,多数正常妇女经血上清液在稀释度为1:32或1:64时仍有阳性沉淀性可见,其中倍数是1:32相当于144毫克/100毫升的浓度。     

Increased uterine prostaglandin E receptors in menorrhagic women

PGE receptor concentrations were measured in myometrial samples collected from 10 women at hysterectomy. Five women had normal measured menstrual blood loss (35-44 ml) and the remainder had unexplained menorrhagia occurring in the absence of any uterine, pelvic or general pathology, with losses ranging from 85 to 925 ml. Median PGE receptor concentrations were significantly higher in the women with menorrhagia (1077 fmol/mg protein) than in the women with normal menstrual blood loss (625 fmol/mg protein) and correlated with menstrual blood loss (P less than 0.02). These findings suggest that unexplained menorrhagia may simply be a constitutional variant in some women and that specific and potent PGE uterine receptor antagonists would furnish effective non-surgical treatment for unexplained menorrhagia.     

Phospholipase activity in the endometrium of women with normal menstrual blood loss and women with proven ovulatory menorrhagia

The activity of phospholipase A2 types 1 and 2 and phospholipase C was measured in the endometrium of women with ovulatory menorrhagia and in those with normal menstrual blood loss. In both groups of subjects phospholipase A2 type 1 activity was significantly higher in the secretory phase than in the proliferative phase (P less than 0.001). The median activity (pmol/mg protein/min) for the proliferative phase was 27.6 in normal subjects and 40.4 in women with ovulatory menorrhagia and for the secretory phase the median activity was 144.5 in normal women and 138.1 in women with ovulatory menorrhagia. There was no difference between the two groups of women at either stage of the cycle. Phospholipase A2 type 2 activity was also higher in the secretory phase than in the proliferative phase (P less than 0.05 for normal subjects and P less than 0.001 for women with menorrhagia). The median activity (pmol/mg protein/min) for the proliferative phase was 94.4 (normal subjects) and 56.6 (women with menorrhagia) and for the secretory phase 148.3 (normal subjects) and 142.5 (women with menorrhagia). The activity of phospholipase A2 type 2 was significantly lower in the proliferative phase of women with ovulatory menorrhagia compared with normal subjects (P less than 0.05). Phospholipase C activity (nmol/mg protein/min) was significantly higher in women with ovulatory menorrhagia (median 8.2) compared with women with normal blood loss (median 5.5) (P less than 0.01).     

Comparison between mefenamic acid and danazol in the treatment of established menorrhagia

Summary. Forty women with established menorrhagia were treated with either mefenamic acid (500 mg thrice daily for 3–5 days in two cycles) or danazol (100 mg twice daily for 60 days) in an open parallel group randomized study. Mefenamic acid reduced mean menstrual blood loss from 160ml to 127ml (20%, P<0·01). Danazol reduced mean menstrual loss from 163 ml to 65 ml (60%, P<0·001). The percentage reduction in menstrual blood loss was significantly greater in the danazol group than in the mefenamic acid group, but the adverse sideeffects occurred significantly more often in the danazol group (75%) than in the mefenamic acid group (30%, P<0–005). Overall, approximately half the women in each group were prepared to continue with the treatment they received to reduce their menstrual bleeding.     

Treatment of menorrhagia with intrauterine release of progesterone

Summary. In 12 women with menorrhagia 80 ml per menstrual period) a progesterone-releasing device (Progestasert) was inserted. The women were followed by repeated measurements of the blood loss for 12 periods. The menstrual blood loss was significantly reduced after 1 month but the duration of bleeding was somewhat prolonged. Twelve months after insertion the menstrual blood loss amounted to 35% of the blood loss before the insertion. The Progestasert is a valuable treatment for menorrhagia.     

Phospholipase activity in the endometrium of women with normal menstrual blood loss and women with proven ovulatory menorrhagia

Summary. The activity of phospholipase A ₂ types 1 and 2 and phospholi-pase C was measured in the endometrium of women with ovulatory menorrhagia and in those with normal menstrual blood loss. In both groups of subjects phospholipase A ₂ type 1 activity was significantly higher in the secretory phase than in the proliferative phase (   P < 0.001  ). The median activity (pmol/mg protein/min) for the proliferative phase was 27–6 in normal subjects and 40–4 in women with ovulatory menorrhagia and for the secretory phase the median activity was 144–5 in normal women and 138–1 in women with ovulatory menorrhagia. There was no difference between the two groups of women at either stage of the cycle. Phospholipase A ₂ type 2 activity was also higher in the secretory phase than in the proliferative phase (   P < 0.05  for normal subjects and   P < 0.001  for women with menorrhagia). The median activity (pmol/mg protein/min) for the proliferative phase was 94–4 (normal subjects) and 56–6 (women with menorrhagia) and for the secretory phase 148–3 (normal subjects) and 142–5 (women with menorrhagia). The activity of phospholipase A ₂ type 2 was significantly lower in the proliferative phase of women with ovulatory menorrhagia compared with normal subjects (   P < 0.05  ). Phospholipase C activity (nmol/mg protein/min) was significantly higher in women with ovulatory menorrhagia (median 8-2) compared with women with normal blood loss (median 5–5) (   P < 0.01  ).