正常妊娠及妊高征孕妇凝血功能检测的临床意义

目的 研究抗凝血酶 -Ⅲ (AT-Ⅲ )、凝血因子Ⅷ活性 (Ⅷ :C)、纤维蛋白原 (FIB)、D -二聚体 (D -D)四项血凝指标在妊娠中的变化 ,探讨其在妊高征诊断和预防中的价值。方法 血浆抗凝血酶 -Ⅲ活性 (AT-Ⅲ :A)、凝血因子Ⅷ活性 (Ⅷ :C)、纤维蛋白原含量(FIB)、血浆D -二聚体 (D -D)测定共77例 (妊高征者21例 ,正常孕妇36例 ,正常非孕妇女20例 )。结果 妊高征者和正常孕妇AT -Ⅲ :AT-Ⅲ明显低于正常非孕妇女 (P<0.001或P<0.01) ,并妊高征者比正常孕妇降低更甚 (P<0.001) ;Ⅷ :C、FIB、D -D妊高征者和正常孕妇均明显高于正常非孕妇女 (P<0.001) ,并且妊高征者也明显高于正常孕妇 (P<0.001)。结论 产前做凝血功能检测对预防和治疗妊高征的发生和发展有重要意义     

Posttrauma coagulation and fibrinolysis.

OBJECTIVE: To determine the effects of disseminated intravascular coagulation (DIC) and head injury on posttrauma coagulation and fibrinolysis. DESIGN: Case-control study. SETTING: General ICU (tertiary care center) in a city hospital serving a population of 150 million people. PATIENTS: Forty trauma victims: 15 with DIC; 25 without DIC. INTERVENTIONS: Measurement of six types of coagulation and fibrinolytic molecular markers (fibrinopeptide A, fibrinopeptide B beta 15-42, plasmin antiplasmin complex, D-dimer, tissue plasminogen activator antigen concentration, tissue plasminogen activator activity) immediately after trauma, 3 days later, and 6 days later. Anticoagulant treatment with gabexate mesilate at 1.45 +/- 0.06 mg/kg/hr. MEASUREMENTS AND MAIN RESULTS: Fibrinopeptide A, fibrinopeptide B beta 15-42, plasmin antiplasmin complex, and D-dimer showed high values immediately after trauma and exceeded normal activity for the first 6 days. When trauma was complicated with DIC, the molecular markers showed significantly higher values than those for non-DIC patients on all days. In the head-injured patients, such effect was not noted. Tissue plasminogen activator antigen concentration and tissue plasminogen activator activity were within a normal physiologic range of variation. By contrast, tissue plasminogen activator antigen concentration increased significantly after trauma in patients with DIC. When anticoagulant treatment was found effective, it caused a reduction in fibrinopeptide A. CONCLUSIONS: a) Fibrinolytic shut-down and its reactivation cannot be confirmed after trauma. b) Head injury does not lead to an increase in posttrauma coagulation or fibrinolytic activity. c) DIC enhances posttrauma coagulation and fibrinolytic activity and plasminogen activator inhibitor activity can be inferred in DIC patients. d) Increase in tissue plasminogen activator antigen concentration without tissue plasminogen activator activation may be a prognostic factor indicative of DIC and its chances of improvement, and fibrinopeptide A as an assessment criterion for the effectiveness of anticoagulant treatment.     

Vagus nerve stimulation inhibits activation of coagulation and fibrinolysis during endotoxemia in rats

BACKGROUND: Sepsis and endotoxemia are associated with concurrent activation of inflammation and the hemostatic mechanism, which both contribute to organ dysfunction and death. Electrical vagus nerve stimulation (VNS) has been found to inhibit tumor necrosis factor (TNF)-alpha release during endotoxemia in rodents. OBJECTIVE: To determine the effect of VNS on activation of coagulation and fibrinolysis. METHODS: Rats received a sublethal i.v. dose of lipopolysaccharide (LPS) after electrical VNS or sham stimulation. Activation of coagulation and fibrinolysis, as well as cytokine release, was measured before LPS injection and 2, 4 and 6 h thereafter. Results: LPS induced activation of the coagulation system (increases in the plasma concentrations of thrombin-antithrombin complexes and D-dimer, and a decrease in antithrombin) and biphasic changes in the fibrinolytic system [early rises of plasminogen activator activity and tissue-type plasminogen activator, followed by a delayed increase in plasminogen activator inhibitor type 1 (PAI-1)]. VNS strongly inhibited all LPS-induced procoagulant responses and more modestly attenuated the fibrinolytic response. In addition, VNS attenuated the LPS-induced increases in plasma and splenic concentrations of the proinflammatory cytokines TNF-alpha and interleukin-6 (IL-6), while not influencing the release of the anti-inflammatory cytokine IL-10. CONCLUSION: These data illustrate a thus far unrecognized effect of VNS and suggest that the cholinergic anti-inflammatory pathway not only impacts on inflammation but also on the coagulant-anticoagulant balance.     

Sonoclot signature during normal pregnancy

Objective: The Sonoclot analyser provides global measurement of haemostasis, including plasma coagulation, platelet function and fibrinolysis. Benefits of its use in cardiovascular and hepatic surgery are well-documented and it may be useful in managing obstetric complications. The aim of this study was to determine ranges of the Sonoclot variables for normal pregnancy.¶Design: Prospective and longitudinal study.¶Setting: Antenatal outpatient clinic, university hospital.¶Patients: Forty-seven healthy women were studied; forty-two completed normal pregnancies and gave birth to healthy infants.¶Interventions: None.¶Measurements and results: Sonoclot signatures were performed at 10–15, 32–34 and 38–40 weeks of gestation and at 8 weeks postpartum. Haemoglobin concentration, haematocrit, platelet count, fibrinogen and activated partial thromboplastin time (APTT) were analysed with normal results. Sonact time and peak time were significantly decreased and clot rate and secondary rate were significantly increased during pregnancy compared with 8 weeks postpartum, indicating hypercoagulability. There were no significant changes in these variables during pregnancy. There were no changes in peak amplitude and downward rate. A significant correlation was found between sonact time and APTT, and between clot rate and APTT.¶Conclusions: We found the Sonoclot analyser simple to handle and the signatures easy to interpret. The ranges for the Sonoclot variables apply throughout pregnancy. The ranges for sonact time, clot rate, secondary rate and peak time during pregnancy differed from the ranges at 8 weeks postpartum.     

Biochemistry and physiology of blood coagulation and fibrinolysis

The principles of initiator and amplification reactions of blood coagulation and fibrinolysis will be presented and discussed in relation to various regulatory pathways of haemostasis. In particular, cell surface-dependent activation and inhibition reactions are characteristics of multi-component enzyme complexes that also allow the endogenous physiological control of the haemostasis system. The understanding of these relationships in complications of haemostasis has led to different available strategies for the therapeutic intervention with pro- and anticoagulant substances.     

Cardiorespiratory alterations during normal pregnancy.

Maternal cardiorespiratory changes can hinder satisfactory evaluation of gravid women. Alterations in the maternal cardiorespiratory system may be further modified by pain, labor, surgery, maternal posture, and gestational age. Critical illness during pregnancy demands an aggressive multidisciplinary approach by health care professionals who are familiar with these changes. This article reviews pertinent issues that should assist physicians treating complex medical complications during pregnancy.     

Platelets, coagulation, and fibrinolysis in atherosclerosis formation

Atherosclerosis is thought to be a chronic inflammatory disease, and many studies show platelets play important role in atherosclerosis formation. Activated platelets adhere to endothelial cells and make leukocyte arrest on endothelial cells. Platelets can interact with both leukocytes and with endothelial cells. Leykocytes or endothelial cells adhere to platelets secrete various inflammatory factors and promote inflammation. On the other hand, inflammation inhibits anti-thrombotic effect on endothelial cells. Annexin A2 is a co-receptor of tissue plasminogen activator and plasminogen and facilitates plasmin generation. We showed annexin A2 can inhibit formation of thrombus in injured blood vessel. Thus, platelets, coagulation, and fibrinolysis may be key factors in inflamed blood wall.     

肺部感染时凝血和纤溶系统的变化

现已明确多器官功能障碍综合征( MODS)的发生与过度的炎症反应有密切的关系 ,它可以引起广泛的微血管内血栓形成和毛细血管通透性增高。曾有文献报道了感染性疾病中凝血和纤溶系统的变化 ,但彼此间有一定的分歧〔1 3〕。本研究即观察肺部感染合并 MODS时凝血和纤溶系统的变化。1　资料与方法1.1　对象 :随机选择 2 0 0 0年 11月—2 0 0 1年 11月收治入院的肺部感染患者5 1例 ,其中男 46例 ,女 5例 ;平均年龄( 79± 11)岁 ;均无肝、肾、血液系统、免疫系统等疾病及肿瘤 ,也无药物因素。根据肺部感染的严重程度及临床转归 ,将5 1例患者分…     

Pre-eclampsia: relationship between coagulation, fibrinolysis and inflammation

Pre-eclampsia (PE) is a multi-system disorder of human pregnancy, characterised by hypertension and proteinuria. Although the pathogenesis of PE is not fully understood, predisposition to endothelial dysfunction is thought to play a crucial part. Despite intensive research there is no reliable test for screening purposes or to inform decision making towards effective treatment for PE. Understanding the link between PE, abnormal haemostatic activation and inflammation may help to elucidate some of the patho-physiology of the disease; primary preventative measures and targeted therapies at an early stage of the disease could then be considered. In the present paper we discuss potential causal links between PE, haemostasis and inflammation. The potential implications of such interaction on the pathogenesis of PE are also addressed.