终末期肾病患者肾移植后血液流变性之变化

研究终末期肾病肾移植后血液流变性的改变并探讨其临床意义。结果表明，肾移植后肾功能正常时，低切至高切变率时的全血粘度明显增高，甚至高于正常人。全血粘度的升高主要与红细胞比积、血浆粘度、红细胞聚集指数、Ｃａｓｓｏｎ粘度的增高有关，与红细胞的变形能力及血液屈服应力无明显关系。肾移植后肾功能失活时，红细胞比积及Ｃａｓｓｏｎ粘度降低，使低切至高切变率时的全血粘度降低，但血浆粘度仍明显高于正常对照组。提示，肾移植后肾功能正常时，血液的流变特性明显障碍，血液粘度尤其是血浆粘度升高，这可能是肾移植后肾功能失活的重要发病机理，也是血管栓塞性合并症发生的病理基础。     

血液透析对尿毒症患者血液流变性的影响

研究单次及长期维持血液透析时尿毒症患者血液流变性改变的影响。结果表明，单次血透后，红细胞比积明显升高，红细胞刚性明显降低；血浆粘度、红细胞聚集指数、Ｃａｓｓｏｎ粘度、血液屈服应力及低切至高切的全血粘度无明显改变。维持血透患者的红细胞比积、血浆粘度、红细胞聚集指数、Ｃａｓｓｏｎ粘度、血液屈服应力均无明显改变。进一步研究发现，单次血透后血浆渗透比明显降低．这可能是引起红细胞比积升高、红细胞刚性降低的原因之一。     

过敏性紫癜急性期血液流变性改变及其临床意义

为了研究过敏性紫癜（ＨＳＰ）急性期血液流变性改变及其临床意义，采用ＮＸＥ－Ｉ型锥板式粘度计，测定了２１例ＨＳＰ急性期血液流变学各项指标。结果表明，ＨＳＰ组全血粘度、血浆粘度、红细胞聚集性增多显著高于对照组；氧释放系数ＯＤ值较对照组明显降低；ＨＳＰ患儿红细胞压积、血小板计数、血清ＩｇＡ和ＩｇＭ呈明显升高。提示ＨＳＰ时存在明显的血液流变性异常，其发生与血液浓缩、高Ｉｇ血症等因素有关。及时治疗ＨＳＰ高粘滞血症对减轻症状、防止复发是十分有益的     

驻极体改善烫伤大鼠血液流变学指标的实验研究

本实验用自制模型造成大鼠局部烫伤，用锥板粘度计测定大鼠烫伤早期和应用驻极体治疗后全血表观粘度、血浆粘度及红细胞压积的变化，并对红细胞的聚集和变形性能等参量作了相应的讨论。结果表明，烫伤后大鼠的全血表现粘度、血浆粘度及红细胞压积均呈显著性升高（Ｐ＜０．００１），红细胞聚集程度增加，变形能力下降。应用驻极体治疗后，烫伤动物的血液粘度和红细胞压积均较烫伤后有明显下降（Ｐ＜０．００１），红细胞的变形能力和聚集性能得到改善，驻极体具有改善血液流变学指标的作用。     

脑脉宝对大鼠脑缺血再灌注后血液流变性及血小板形态的影响

采用四血管阻断法制成大鼠脑缺血３０ｍｉｎ再灌注３０ｍｉｎ模型后，大鼠全血粘度（２３ｓ－１、５．７５ｓ－１）、全血还原粘度（高切、中切）、红细胞聚集指数、内粘度、红细胞刚性系数、Ｃａｓｏｎ屈服应力等均较假手术组明显升高（Ｐ＜０．０１ ０．０５），其余指标也高于假手术组，但无统计学意义（Ｐ＞０．０５）。其血小板亦被激活，发生粘附、聚集反应。预先给予脑脉宝（由生黄芪、丹参、当归、川芎、地龙、水蛭、三七、牛磺酸等组成，具有“益气活血，豁痰，通络，补肾”功效）可显著改善其脑缺血再灌注后血液流变性异常，除１１５ｓ－１切变率下全血粘度、Ｃａｓｓｏｎ粘度、内粘度外，其余各指标均明显低于缺血再灌组（Ｐ＜０．０１０．０５），并可改善血小板形态和功能。提示该药可明显改善缺血再灌注后血液浓、粘、凝、聚等异常改变，促进血液循环正常运行，减轻脑损害。其机理可能与其使聚集的红细胞解聚及保持红细胞膜、增强红细胞变性等药理作用有关     

蝮蛇抗栓酶治疗急性脑梗死52例临床疗效与血液流变性分析

用蝮蛇抗栓酶治疗急性脑梗死５２例，有效率达９８％。并观察治疗前后血液流变性的变化，发现治疗前后的体外血栓长度、湿度、干重，血纤维蛋白原，还原比粘度，血浆比粘度，全血比粘度均有非常显著的差异（Ｐ＜０．０１）。临床疗效与血液流变性的改变相一致。因而认为血液流变性的观察对临床蝮蛇抗栓酶用药疗程和剂量有一定的指导意义。     

骨性关节炎患者血液流变学的变化及丹参疗效观察

探讨骨性关节炎患者血液流变学的变化及丹参注射液治疗效果。方法对１５例ＯＡ患者的血液流变学指标进行较全面的检测,并与正常人进行对照分析,同时观察丹参注射液治疗ＯＡ患者的对血液流变学的影响。结果ＯＡ组较对照组的全血粘度,血浆粘度,红细胞压积,血小板粘附率,红细胞聚集指数,纤维蛋白原均明显增加;应用丹参注射液治疗ＯＡ患者,治疗后血液流变学指标明显得到改善,有显著性差异（Ｐ值分别〈０．０１,０．０５）,以     

体外反搏对血液流变性和血小板聚集性的影响

观察４０例心脑血管疾病患者体外反搏前后血液流变性和血小板聚集性变化。结果表明，反搏后全血比及还原比粘度、血浆粘度有不同程度的下降（Ｐ＜０．０５～０．０１）。反搏治疗后，１～５ｍｉｎ血小板聚集率、最大聚集率和最大聚集速度较反搏前均明显降低（Ｐ＜０．０５～０．０１），而５ｍｉｎ解聚率则明显增加（Ｐ＜０．０５）。提示体外反搏治疗不仅影响血液动力学，而且明显降低血液粘度，对血小板聚集功能有明显抑制作用。     

糖尿病肾病与血液粘度

为研究糖尿病肾病患者血液粘度的改变，对不同病程度的糖尿病肾病患者血液粘度进行了观察。结果显示，大量白蛋白尿组患者高切变率（２４０ｓ－１）和低切变率（４８ｓ－１全血粘度增多明显低于正常白蛋白尿组（Ｐ＜００５，Ｐ＜００１），其红细胞压积也显著低于正常白蛋白尿组（Ｐ＜００１）。微量白蛋白尿组血液粘度和红细胞压积与正常白蛋白尿组比较均无显著差异。提示糖尿病肾病患者随病程进展出现肾性贫血而致红细胞压积减小，全血粘度降低。抗凝剂的使用也是影响血液粘度的因素之一     

紫外线照射充氧自血回输疗法对血液红细胞形态及流变学特性改变的研究

为探讨紫外线照射充氧自血回输疗法（ＵＢＩＯ）血液作用的机理，本文跟踪观察了经ＵＢＩＯ治疗后１５例男性视网膜色素变性（ＲＰ）患者的血液红细胞形态及流变学特性改变的情况。结果表明，ＲＰ患者经ＵＢＩＯ治疗后，血液中正常红细胞明显增多（ｐ＜０．０５）。全血高切和低切比粘度、红细胞刚性指数、聚集指数较治疗前都有明显降低（ｐ＜０．０５），患者症状明显好转，有效率达６６％。说明红细胞形态与血液流变学特性的改变是ＵＢＩＯ疗法对机体起作用的一个方面，也提示ＵＢＩＯ治疗ＲＰ患者是一种有效的物理疗法。     

慢性肾功能衰竭患者血液透析和肾移植前后凝血-血栓形成指标的变化

目的:观察慢性肾功能衰竭(CRF)患者血液透析(血透)和肾移植前后凝血-体外血栓形成指标的变化。方法:CRF病人53例,46例采用血透治疗,7例采用同种异体肾移植。分别于治疗前、血液透析10次后、肾移植18个月后检查血浆内皮素-1(ET-1)、抗凝血酶-Ⅲ(AT-Ⅲ)水平以及体外血栓形成的长度和重量。结果:CRF患者ET-1增加,AT-Ⅲ降低,体外血栓较长、较重,与健康对照组比较P均<0.01;血透治疗后ET-1有所降低,AT-Ⅲ有所增加,但体外血栓长度和重量无显著变化(P>0.05);肾移植治疗后血浆ET-1、AT-Ⅲ以及血栓长度和重量均较治疗前有非常显著性统计学差异,P均<0.01,接近健康对照组水平。结论:ET-1和AT-Ⅲ异常变化可促进CRF患者凝血功能增强和血栓形成,肾移植能改善凝血功能,防治血栓形成。     

Normalization of serum prolactin levels in hemodialysis patients on recombinant human erythropoietin

Correction of anemia in long-term hemodialysis patients by recombinant human erythropoietin (r-HuEPO) has been reported to improve sexual function. As elevated serum prolactin levels are believed to contribute to altered sexual function in uremia, we followed serum prolactin and testosterone levels during four months of r-HuEPO therapy. Within these four months, hematocrit values rose from 23.7 +/- 1.2 to 35.7 +/- 0.2% and hemoglobin from 7.3 +/- 0.3 to 11.3 +/- 0.4 g/100 ml. In parallel, serum prolactin values decreased significantly, from 66.9 +/- 9.3 to 9.6 +/- 2.6 ng/ml in females and from 39.5 +/- 10.5 to 10.3 +/- 1.0 ng/ml in male dialysis patients. Testosterone concentrations were in the lower normal range in male patients and remained unchanged during r-HuEPO therapy. Sexual function improved in four out of seven males, and five out of nine female patients started to have regular menstruations again. It appears that treatment of anemia in end-stage renal disease by r-HuEPO may improve sexual function by lowering elevated serum prolactin concentrations.     

A case of erythropoietin induced hypertension in a bilaterally nephrectomized patient

Recombinant human erythropoietin (r-HuEPO) is an established tool for correction of renal anemia. It is well known that chronic administration of r-HuEPO often causes hypertension in dialysis patients. However, the mechanism of the r-HuEPO induced hypertension has not been fully elucidated. We report a case of r-HuEPO induced hypertension in an anephric patient. In this case, hemodialysis was started after removal of both kidneys because of rupture of an angiomyolipoma. Although mean blood pressure (BP) did not change during the period of rapid correction of renal anemia by blood transfusion, treatment with r-HuEPO significantly increased mean BP. Also, discontinuation of r-HuEPO resulted in a decrease in mean BP. These results suggested that r-HuEPO caused an elevation in BP in the absence of kidneys, and the elevation in BP was thought to be independent of an increase in hematocrit level or hypervolemia. We also investigated the role of nitric oxide (NO) in r-HuEPO induced alteration of BP. A significant negative correlation was found between a decrease in serum NO level and an increase in mean BP during the period of r-HuEPO administration. The results suggest that an inhibitory effect of r-HuEPO on NO production might be, at least in part, related to the r-HuEPO induced hypertension in this case.     

Clinical effect of recombinant human erythropoietin on anemia associated with chronic renal failure. A multi-institutional study in Japan

Clinical effect and safety of recombinant human erythropoietin (r-HuEPO) were evaluated in 66 hemodialysis patients with intractable anemia. Initially, 50U/kg dry weight (DW) of r-HuEPO was administered intravenously at the end of every hemodialysis procedure for 4 weeks, then the dosage was increased to 100 and 200U/kg DW for poor responders. The patients' hematocrits rose from 19.8 +/- 2.3% (pretreatment) to 30.2 +/- 4.9% after 12 weeks. From 206 U of blood transfusion requirement in the 3-month period before the study, only 34 U were needed after treatment. Serum iron and ferritin levels fell significantly during the study, and iron storage was considered to be one of the decisive factors in the response to r-HuEPO. Blood pressure rose in the course of r-HuEPO administration, but uncontrollable hypertension was rarely observed. There was no significant adverse effect of r-HuEPO except for this mild hypertension. These results indicate that r-HuEPO is an excellent therapeutic aid for the anemia associated with chronic renal failure.     

Renal osteodystrophy in predialysis patients without stainable bone aluminum. A cross-sectional bone-histomorphometric study

Histomorphometry was performed on transiliac bone biopsies, double-labeled with tetracycline, from 60 consecutively admitted patients (20 women) at various stages of chronic renal failure (CRF). Eleven patients (1 woman) had normal bone resorption and formation indices. Bone resorption and osteoid formation increased with progression of renal failure, but abnormal values were seen even at slightly elevated creatinine levels. Mineralization lag time increased with CRF duration; prolonged values were only seen in patients with polycystic kidney disease or chronic pyelonephritis with advanced CRF. All patients with impaired mineralization also had increased bone resorption. Diabetes mellitus did not protect against skeletal lesions. The biochemical tests were too insensitive to predict type or severity of bone disease, and hand X-rays had no diagnostic value in early stages of renal osteodystrophy.     

Role of free hemoglobin in 8-iso prostaglandin F2-alpha synthesis in chronic renal failure and its impact on CD163-Hb scavenger receptor and on coronary artery endothelium

Free hemoglobin (Hb) during autoxidation increases 8-iso-prostaglandin-F2-alpha (8-isoprostane) formation in vitro. Because 8-isoprostane and plasma Hb are elevated in chronic renal failure (CRF), we evaluated the role of Hb in this isoprostane synthesis in vivo. By monitoring correlations between Hb, haptoglobin (Hp), CD163-Hb-scavenger receptor, and 8-isoprostane that is known to induce CD163 shedding, we examined whether 8-isoprostane blocks Hb catabolism in CRF. Additionally, by studying the effect of 8-isoprostane on human coronary artery endothelium (HCAEC) in vitro and its impact on intercellular adhesion molecule-1 (ICAM-1) in vivo, we tested its role in promotion of cardiovascular events in CRF. Twenty-two never-dialyzed CRF patients and 18 control patients were screened for renal function, plasma and urine 8-isoprostane, and plasma Hb, Hp, thiobarbituric-acid-reactants (TBARS), C-reactive-protein (CRP), and soluble (s) ICAM-1 and sCD163. HCAEC exposed to 8-isoprostane were tested for ICAM-1 and apoptosis. In CRF, urine 8-isoprostane was significantly elevated and correlated with free-Hb and TBARS. The increased free-Hb, Hp, and sCD163 in CRF suggested 8-isoprostane-mediated suppression of Hb catabolism through CD163 receptor shedding. 8-Isoprostane enhanced ICAM-1 expression and apoptosis in HCAEC. CRF patients showed elevated sICAM-1. In conclusion, free-Hb, via 8-isoprostane, paradoxically blocks its own catabolism. Free-Hb and/or 8-isoprostane may intensify cardiovascular events in CRF.     

Effect of recombinant human erythropoietin (r-HuEPO) therapy on plasma FT3, FT4, TSH, FSH, LH, free testosterone and prolactin levels in hemodialysis patients.

The aim of this study was to evaluate the effect of r-HuEPO treatment on free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), free testosterone and prolactin levels in uremic hemodialysis patients. Twenty-four uremic hemodialysis patients were given r-HuEPO with a dose 60 U/kg as intravenous bolus injection at the end of each dialysis session. Once the hematocrit value of the patient had reached a range of 30-35%, the dose was adjusted so as to keep the hematocrit levels constant. Twenty uremic dialysis patients were taken as control group. The above-mentioned hormone levels of patients and control group were determined before and 4 months after r-HuEPO treatment. After the treatment, serum prolactin levels significantly decreased in both sexes (36.8 +/- 7.8 vs 22.9 +/- 6.3 ng/ml and 78.3 +/- 13.3 vs 37.4 +/- 10.4 ng/ml male and female, respectively). FT3 and FT4 significantly increased (1.17 vs 1.67 pg/ml, p < 0.05, and 0.64 vs 0.084 ng/dl, p < 0.05, respectively). TSH levels increased but those changes were not significant. There was no change in the level of any hormone in the control group. Also, the sexual functions of eight male patients treated with r-HuEPO improved and menstruation started again in four female patients. We concluded that r-HuEPO treatment especially decreases prolactin level in uremic hemodialysis patients. It is conceivable that correction of elevated prolactin levels could improve sexual disorders in these patients.     

Hemostatic evaluation in bleeding disorders from native blood. Clinical experience with the hemostatometer

Primary hemostasis (PH), i.e., hemostatic platelet plug formation, and the subsequent coagulation were recorded and quantified from the same nonanticoagulated venous blood sample with the use of the Haemostatometer. In addition, platelet thrombus formation induced by interaction of flowing native blood with a collagen fiber under low shear rates (450 s-1) was simultaneously analyzed by this device. The effect of monoclonal antibodies (MoAbs) directed against von Willebrand's factor antigen (vWF:Ag), platelet glycoprotein Ib (GPIb) and the GPIIb/IIIa complex, and fibrinogen were studied. PH was significantly inhibited by MoAbs against vWF:Ag, GPIIb/IIIa, and fibrinogen but was unaffected by antibody against GPIb. Collagen-induced thrombosis was prevented by MoAbs against vWF:Ag and GPIb, slightly inhibited by antifibrinogen, and unaffected by blockage of platelet membrane GPIIb/IIIa. The effect of a single 600-mg dose of aspirin was monitored, and abnormal PH was still detectable five days later. From the 13 hemophiliacs tested, 7 showed significantly prolonged PH. In von Willebrand's disease, a characteristic defect of PH with significant inhibition or absence of collagen-platelet interaction was observed in all the 11 patients. PH was greatly prolonged in both of the two patients with storage pool deficiency. The technique detected improvement of platelet function, i.e., PH in all of six patients with bleeding disorders after replacement therapy or DDAVP infusion. The authors conclude that the Haemostatometer technique is a sensitive test for determining platelet dysfunction and monitoring efficacy of factor-replacement or DDAVP therapy.