多发伤合并脓毒症患者血浆s-CD62P水平与炎症因子、凝血指标的相关性研究

目的探讨多发伤合并脓毒症患者血浆可溶性颗粒膜蛋白CD62P(s-CD62P)、炎症因子、凝血指标的表达特征,并分析三者的关系。方法选取2017年1月—2019年12月南通大学附属医院ICU收治的多发伤合并脓毒症患者102例为观察组,同期100例健康体检者为对照组。采集空腹静脉血,检测血浆s-CD62P,炎症因子[肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、降钙素(PCT)]及凝血指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血小板计数(PLT)D-二聚体(D-D)]水平。比较两组的血浆s-CD62P、炎症因子及凝血指标水平,采用Pearson相关性分析s-CD62P与炎症因子、凝血指标的关系。结果观察组的血浆s-CD62P水平为(223.05±69.14)ng/mL,对照组为(96.25±31.54)ng/mL。观察组的血浆s-CD62P水平高于对照组(P <0.05)。观察组的TNF-α、hs-CRP、PCT、IL-6、PT、APTT、D-D水平高于对照组(均P <0.05),PLT水平低于对照组(P <...     

乌司他丁血必净联合治疗对脓毒血症凝血功能及全身炎性反应影响研究

目的研究乌司他丁、血必净联合治疗对脓毒血症凝血功能及全身炎性反应的影响。方法选取该院2010年2月‐2012年2月脓毒血症患者80例,随机抽签分为观察组与对照组,每组40例,对照组患者给予常规静脉滴注血必净注射液,观察组在对照组治疗的基础上给予乌司他丁治疗,比较两组患者治疗前后活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)及血小板(PLT)等凝血功能指标变化情况,比较治疗前后肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及白细胞介素-8(IL-8)等炎性因子水平。结果观察组APTT、PT水平较对照组显著较低(P0.05),FIB、PLT水平较对照组显著较高(P0.05);观察组TNF-α、IL-6、IL-8炎性因子水平较对照组显著较低(P0.05)。结论乌司他丁与血必净联合应用治疗脓毒血症患者效果显著,患者凝血功能得到有效改善,全身炎性反应显著降低,对患者的器官有较好的保护作用,应予以临床应用推广。     

不同抗凝方案在接受连续肾脏替代疗法的急诊脓毒症患者中的应用效果

目的 对比不同抗凝方案在连续肾脏替代疗法(CRRT)的急诊脓毒症患者中的应用效果,并分析其对患者炎症状态及出血风险的影响。方法 回顾性分析2020年1月至2022年12月医院收治的接受CRRT治疗的110例急诊脓毒症患者的资料,将接受低分子肝素抗凝的58例患者纳入对照组,将接受局部枸橼酸抗凝的52例患者纳入观察组。比较两组患者治疗前后炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]与凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)]水平,并采用房颤抗凝治疗出血评分系统评估两组患者治疗后的出血风险。结果 治疗后,两组患者血清TNF-α、IL-6水平均降低,且观察组水平低于对照组(P<0.05);两组患者PT、APTT降低,Fib水平升高,且观察组PT、APTT低于对照组,Fib高于对照组(P<0.05)。观察组房颤抗凝治疗出血评分系统评分低于对照组(P<0.05)。结论 与低分子肝素抗凝相比,采用局部枸橼酸抗凝方式可更好地减轻急诊脓毒症CRRT治疗患者炎症反应,改善凝血功能,降低出血风险。     

血必净对乙型肝炎慢加急性肝功能衰竭早期患者炎症因子、肝功能及凝血功能的影响

目的 探究血必净注射液对乙型肝炎慢加急性肝功能衰竭早期患者炎症因子、肝功能及凝血功能的影响。方法 选取中国人民解放军空军总医院感染科2013年6月—2015年4月收治的78例乙型肝炎慢加急性肝衰竭早期患者,随机分为对照组和研究组。对照组39例,采用内科常规综合治疗;研究组39例,在内科常规综合治疗基础上加用血必净注射液。治疗7天后,检测两组患者治疗前后的血清中炎症因子TNF-α、IL-6、IL-1、IL-10及内毒素LPS的水平,同时检测两组患者治疗前后的肝功能：TBIL、ALT、AST及凝血功能：凝血酶原时间(PT)、部分凝血酶原时间(APTT)、凝血酶原活动度(PTA)、D-二聚体(D-D)、血小板(PLT)计数。结果 观察组患者治疗后血清中TNF-α、IL-6、IL-1、LPS低于对照组, 而血清中的IL-10的水平则明显高于对照组(P均＜0.05)。 治疗后对照组和研究组TBIL、ALT、AST及PT、APTT、PTA、D-D、PLT 计数均较治疗前得到改善(P均＜0.05),其中研究组中各指标均显著优于对照组(P均＜0.05)。 结论 血必净联合常规内科综合治疗能降低乙型肝炎慢加急性肝衰竭早期患者的炎症反应, 同时能改善患者的肝功能及凝血功能。     

血必净注射液对脓毒症患者的炎性反应和凝血功能的影响

目的：对比分析血必净注射液对脓毒症患者炎性反应和凝血功能的影响,以指导临床治疗。方法：纳入 ICU 住院治疗的脓毒症患者80例,随机均分为两组各40例：对照组予常规综合治疗,观察组加用血必净注射液。持续治疗1周后,对比两组治疗前后外周血炎性反应指标,包括肿瘤坏死因子-α（TNF-α）、白细胞介素（IL）-8、IL-10、淋巴细胞亚群比例（CD4+/CD8+）、NK 细胞水平;凝血功能指标,包括血小板计数（PLT）、凝血酶原时间（PT）、纤维蛋白原（FIB）、活化部分凝血活酶时间（APTT）。结果：治疗前两组患者外周血炎性反应指标及凝血功能接近,差异无显著意义。治疗后所有患者 IL-10、CD4+/CD8+、PLT、FIB 均有上升;TNF-α、IL-6、APTT、PT 均有下降;对照组 NK 细胞水平出现下降,观察组出现上升,上述指标与治疗前相比,差异有显著性意义;治疗后观察组上述指标均优于对照组,差异有显著性意义。结论：血必净注射液有助于下调脓毒症患者促炎因子水平、提升抗炎因子水平、提升免疫功能、纠正凝血功能紊乱,这对改善脓毒症患者预后有积极意义。     

氯吡格雷联合拜阿司匹林对老年急性脑梗死病人疗效及对细胞炎症因子、凝血功能的影响

目的探讨氯吡格雷联合拜阿司匹林对老年急性脑梗死病人疗效及对细胞炎症因子、凝血功能的影响。方法将105例老年急性脑梗死病人随机分为2组,观察组（52例）采用氯吡格雷联合拜阿司匹林治疗,对照组（53例）采用拜阿司匹林治疗。观察2组疗效以及治疗前后炎症因子[高敏C-反应蛋白（hs-CRP）、肿瘤坏死因子-α（TNF-α）、白细胞介素-33（IL-33）]、凝血功能[凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血因子ⅩⅢ（FⅩⅢ）]的变化和差异。结果观察组有效率高于对照组（P < 0.05）。治疗后观察组血清Hs-CRP、TNF-α、IL-33均低于对照组（P < 0.05）,血清PT、APTT均高于对照组（P < 0.05）,FⅩⅢ低于对照组（P < 0.05）。结论氯吡格雷联合拜阿司匹林可提高急性脑梗死病人治疗疗效,降低炎症反应,改善凝血功能,效果优于单独拜阿司匹林。     

低分子肝素钙联合血液净化治疗重症脓毒血症的临床研究

目的探讨低分子肝素钙联合血液净化治疗重症脓毒血症的临床效果。方法用随机数字分表法将该院收治的80例重症脓毒血症患者分为对照组与观察组各40例,其中对照组采用普通肝素(HP)联合血液净化治疗,观察组采用低分子肝素钙(LMWHC)联合血液净化治疗。比较治疗前后两组患者凝血功能指标[凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fbg)、血小板含量(PLT)]、血清炎症因子指标[白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)、血浆降钙素原(PCT)、血栓前体蛋白(TpP)]、肾功能指标[血肌酐(SCr)、血尿素氮(BUN)]及不良反应发生率(滤器凝血、管路凝血)的结果变化。结果治疗1周后,两组患者PT、TT、APTT水平均高于治疗前(P<0.05),且观察组均高于对照组(P<0.05);Fbg、PLT、IL-6、TNF-α、CRP、PCT、TpP、SCr、BUN水平均低于治疗前(P<0.05),且观察组均低于对照组(P<0.05);观察组不良反应发生率低于对照组(P<0.05)。结论LMWHC联合血液净化治疗重症脓毒血症可有效改善患者凝血功能与炎症反应,促进器官功能恢复。     

体外冲击波治疗腰椎间盘突出症的疗效及凝血功能、血小板参数的影响

目的 研究体外冲击波治疗腰椎间盘突出症的疗效及凝血功能、血小板参数的影响。方法 以2021年12月至2022年12月我院收治的113例腰椎间盘突出症为研究对象,采用随机数字表法将患者分为对照组(56例)和观察组(57例)。对照组采用常规治疗,观察组在常规治疗基础上加用体外冲击波治疗。比较两组临床疗效、治疗前、治疗10d后日本骨科科学会(JOA)、视觉模拟疼痛评分法(VAS)、Oswestry功能障碍指数问卷表(ODI)评分、血小板参数[血小板计数(PLT)、平均血小板体积(MPV)、血小板压积(PCT)]、凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)]、血清炎症介质[肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)、CXC趋化因子配体10(CXCL10)、α-颗粒膜糖蛋白(CD62P)]水平。结果 观察组临床总有效率96.49%(55/57)高于对照组83.93%(47/56,P＜0.05)；治疗10d后观察组VAS、ODI评分低于对照组,JOA评分高于对照组(P＜0.05)；治疗10d后观察组PLT、MPV、PCT低于对照组,血清PT、APTT高于对照组(P＜0.05)；治疗10d后观察组血清TNF-α、IL-8、CXCL10、CD62P水平低于对照组(P＜0.05)。结论 体外冲击波治疗腰椎间盘突出症患者疗效显著,可有效改善临床症状,调节血小板参数及凝血功能,缓解炎症反应。     

产褥期深静脉血栓发生的危险因素及血清CD40L水平与凝血、血小板功能及炎症反应的相关性

目的:探讨产褥期深静脉血栓(DVT)发生的危险因素及血清CD40配体(CD40L)水平与凝血、血小板功能及炎症反应的相关性。方法:选取298名产褥期产妇为研究对象,依据是否并发DVT分为观察组(n=178)和对照组(n=120)。比较两组对象剖宫产率、血清CD40L水平与凝血指标[部分活化凝血酶时间(APTT)、凝血酶原时间(PT)、D二聚体(D-D)、纤维蛋白原(FIB)]、血小板功能指标[血小板活化因子(PAF)、P-选择素(P-selectin)、血管性血友病因子(vWF)]及炎症因子指标[肿瘤坏死因子-α(TNF-α)、白细胞介素-10 (IL-10)、C反应蛋白(CRP)]; Logistic多因素回归分析产褥期并发DVT的危险因素;pearson分析血清CD40水平与APTT、PT、DD、FIB、PAF、P-selectin、vWF、TNF-α、IL-10、CRP水平的关系。结果:观察组剖宫产率及血清CD40L、DD、FIB、PAF、P-selectin、vWF、TNF-α、IL-10、CRP水平高于对照组(P<0.05),APTT、PT水平低于对照组(P<0....     

小剂量肝素治疗脓毒症30例临床分析

目的 观察低分子肝素对脓毒症患者的治疗效果.方法 52例脓毒症患者随机分为对照组(22例)和低分子肝素组(以下简称治疗组,30例).观察两组患者治疗前后急性生理学慢性健康状况Ⅱ(APACHEⅡ)评分、肿瘤坏死因子(TNF-α)、白细胞介素-6(IL-6)、乳酸、D-二聚体、凝血酶原时间(PT)、凝血活酶时间(APTT)...     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.