急性下肢深静脉血栓形成P-选择素与D-二聚体的变化及意义

目的 探讨下肢深静脉血栓形成(DVT)患者P-选择素与D-二聚体变化及其临床药物干预后的变化.方法 用流式细胞术(FCM),以单克隆抗体为探针测定40例下肢DVT患者及20例健康人P-选择素阳性表达率,应用免疫方法测定D-二聚体(D-dimer)含量.结果 DVT组在发病的早期P-选择素与D-二聚体阳性表达率均高于对照组(P均＜0.05),溶栓抗凝等治疗后不同时间P-选择素与D-二聚体阳性表达率呈降低趋势,其中应用奥扎格雷钠组与非奥扎格雷钠组比较P-选择素阳性表达率有显著差异.D-二聚体的变化无显著差异.出院1个月后P-选择素与D-二聚体含量明显降低,但P-选择素阳性表达率较正常人偏高.结论 急性DVT患者早期体内血小板活化,纤维蛋白溶解处于亢进状态;奥扎格雷钠能降低血小板活化;P-选择素,D-二聚体可做为DVT诊断的指标之一;出院后DVT患者仍是血栓形成的高危人群,需要定期随访.     

奥扎格雷钠注射液预防骨科手术后下肢深静脉血栓形成的临床观察

下肢深静脉血栓形成(lower extremity deep venous thrombosis,DVT)是骨科严重并发症,我们自2003年3月-2003年11月应用海南碧凯药业有限公司生产的奥扎格雷钠注射液(商品名晴尔)预防骨科手术后深静脉血栓形成,获得满意疗效.     

纤溶酶联合奥扎格雷钠治疗进展性脑梗死的疗效观察

目的:评估纤溶酶联合奥扎格雷钠治疗进展性脑梗死的临床疗效及安全性.方法:选择进展性脑梗死患者120例,随机分为2组(n=60):对照组(奥扎格雷钠80mg静滴,每日2次)、实验组(奥扎格雷钠基础上加用注射用纤溶酶200U静滴,每天1次),疗程均为14天,其他常规治疗方法一致.结果:实验组患者临床神经功能缺损评分较对照组显著降低,差异有统计学意义,两组均无出血倾向.结论:纤溶酶联合奥扎格雷钠治疗进展性脑梗死疗效优于单用奥扎格雷钠,且安全有效.     

静脉高压对慢性静脉功能不全患者血小板活性的影响

目的 观察体位变化和压力对下肢慢性静脉功能不全(CVI)患者血小板活性的影响.方法 根据纳入和排除标准,选择24例CVI患者作为实验组和20例正常人作为对照组,采用酶联免疫吸附法(ELISA)测定两组人群在不同体位时下肢静脉血液、肘部静脉血液及在外在压力持续作用60 min后血小板P-选择素表达水平.结果 晨起平卧位及站立30 min后两组下肢静脉血液血小板P-选择素表达水平差异无统计学意义(P>0.05);在90～100mm Hg(1 mmHg=0.133 kPa)压力作用60 min后,CVI患者的下肢静脉血液和肘部静脉血液血小板P-选择素均明显高于对照组(P<0.01).结论 CVI患者血小板对压力具有高反应性,可能是CVI发病的重要机制之一.     

奥扎格雷钠联合灯盏花素治疗急性脑梗死的临床观察

目的 观察奥扎格雷钠联合灯盏花素治疗急性脑梗死的疗效.方法 将60例经CT确诊的急性脑梗死患者随机分为观察组及对照组各30例,两组均根据病情给予脱水剂、脑细胞保护剂及降压、降糖、降血脂等常规对症处理,观察组在此基础上给予奥扎格雷钠联合灯盏花素治疗,14d为1个疗程,比较两组的疗效.结果 治疗14d后对两组的疗效进行比较,观察组的总有效率为93.33%,明显高于对照组的总有效率（76.67%）,差异有统计学意义（P ＜0.05）.结论 奥扎格雷钠联合灯盏花素治疗急性脑梗死疗效显著,值得推广和应用.     

P-选择素对腹腔镜脾切除术后门静脉血栓形成的早期预测价值

目的:探讨P-选择素对腹腔镜脾切除术后门静脉血栓形成的早期预测价值。方法:收集2009年～2017年因肝硬化门静脉高压症而行腹腔镜脾切除术的48例患者的临床资料,术后根据多普勒血管彩超诊断结果分为血栓组与非血栓组。动态监测两组患者术前第1天及术后第1天、第3天、第5天、第7天、第14天的P-选择素、血栓前体蛋白、血小板及D-二聚体值,并进行统计学分析。结果:术前两组患者四项指标水平差异无统计学意义(P>0.05)。血栓组P-选择素、D-二聚体、血栓前体蛋白于第1天即出现峰值,且明显高于非血栓组,差异有统计学意义(P<0.05),之后开始缓慢下降。相较其他指标,P-选择素于术后第5天P值仍小于0.001,维持时间最长。术后第1天,四项指标中P-选择素的门静脉血栓形成阳性预测值及诊断率均高于D-二聚体、血小板、血栓前体蛋白,且误诊率及漏诊率最低。结论:P-选择素对腹腔镜脾切除术后门静脉血栓的形成具有早期预测价值,可作为临床监测的有效指标。     

P-选择素与下肢深静脉血栓形成的相关性

目的:探讨P-选择素在下肢深静脉血栓形成中的临床意义。方法:选择下肢深静脉血栓形成患者32例,健康对照组20例,比较两组血浆P-选择素水平(ELISA方法)、血小板计数。结果:深静脉血栓形成组血浆P-选择素水平明显高于对照组,有显著性差异(P0.05);血小板计数略高于对照组,但无显著性差异(P0.05)。结论:P-选择素与下肢深静脉血栓形成密切相关,可以作为其早期诊断的标志物。     

奥扎格雷钠联合依达拉奉注射液治疗急性脑梗死的临床疗效研究

目的:分析探讨奥扎格雷钠联合依达拉奉注射液治疗急性脑梗死的临床疗效及安全性。方法:120例脑梗死患者随机分为观察组和对照组各60例,观察组采用奥扎格雷钠联合依达拉奉治疗,对照组单用奥扎格雷钠治疗,观察治疗前及治疗2周、4周后神经功能缺损评分。结果:观察组总有效率显著高于对照组(P<0.05);治疗前两组患者神经功能缺损评分无显著差异(P>0.05);治疗2和4周后两组较治疗前均有所改善,且观察组明显优于对照组,差异有统计学意义(P<0.05);两组患者均无明显不良反应发生。结论:奥扎格雷钠联合依达拉奉治疗急性脑梗死疗效显著且不良反应少,是较理想的安全有效的药物,值得临床推广应用。     

奥扎格雷钠联合血塞通治疗脑梗死

目的:观察奥扎格雷钠联合血塞通治疗脑梗死的治疗效果.方法:将80例脑梗死患者随机分为2组,2组均给予常规对症治疗,并予血塞通静点.在此基础上,治疗组给予奥扎格雷钠静点,对照组给予阿司匹林顿服,14d后观察2组疗效.结果:治疗组总有效率97.5%,对照组总有效率80.0%.两组相比有显著性差异(P<0.05),神经功能缺损程度评分均较治疗前降低,且治疗组减少程度优于对照组(P<0.01).结论:奥扎格雷钠与血塞通联合治疗脑梗死疗效好,且用药安全.     

低分子肝素钙预防下肢静脉曲张术后深静脉血栓的价值

目的:评价下肢静脉曲张行大隐静脉高位结扎加分段剥脱术后早期应用低分子肝素钙(LMWHC)预防下肢深静脉血栓形成(DVT)的临床效果。方法:回顾性分析2009年5月―2014年5月因单纯下肢静脉曲张行大隐静脉高位结扎加分段剥脱术治疗的320例患者临床资料,依据术后是否应用LMWHC分为对照组(158例)和观察组(162例)。对照组术后给予加压包扎及常规护理治疗预防血栓,观察组在此基础上加用LMWHC(2 500 IU皮下注射,1次/12 h,连用7 d)。通过B超检查患者双下肢静脉确定DVT发生情况,同时记录皮下瘀斑/切口淤血、下肢肿胀和疼痛、肝素诱导的血小板减少症(HIT)及活化的部分凝血活酶时间(APTT)和血小板计数(PLT)。结果:两组患者术前基本资料具有可比性。与对照组比较,观察组术后DVT发生率明显降低(0.6%vs.7.6%,χ~2=307.2,P0.05),APTT时间延长(29.6 s vs.52.2 s,t=22.8,P0.05);两组患者皮下瘀斑/切口淤血、下肢肿胀和疼痛等不良反应发生率均无统计学差异(均P0.05)。两组患者PLT差异无统计学意义(P0.05),所有患者均未出现HIT。结论:下肢静脉曲张行大隐静脉高位结扎加分段剥脱术后给予低分子肝素钙治疗可以安全有效的预防下肢深静脉血栓形成。     

Early diagnosis of deep vein thrombosis in female patients who undergo total knee arthroplasty with measurement of P-selectin activation

BACKGROUND: Deep vein thrombosis (DVT) remains a leading cause of postoperative morbidity and mortality in patients who undergo total knee arthroplasty (TKA). Although patients with previous thrombotic episodes are inherently at a higher risk for subsequent episodes of DVT, it remains difficult to predict such an occurrence and to make a diagnosis in early stages. One potentially useful assay that can be used in the determination of changes of coagulation among patients who undergo arthroplasty is platelet activation. The goal of this study was to establish a predictive value for DVT with measurement of P-selectin levels that could help in planning appropriate perioperative management strategies for patients at high risk for DVT. METHODS: A total of 52 patients who underwent TKA with general anesthesia underwent contrast venography on the 5th postoperative day. Platelet activation before and after operation was measured with platelet surface expression of P-selectin with flow cytometry in these two groups of patients for TKA. None of the patients underwent any anticoagulation therapy. RESULTS: Nineteen of the 52 patients for TKA showed radiologic evidence of DVT, whereas 33 patients for TKA had no radiologic signs of DVT. There was no difference in platelet activation at baseline, which was 1 hour before induction of anesthesia, between the two groups (P >.05) as measured with P-selectin assays. Differences were noted between the two groups on the 5th day after operation, wherein P-selectin was expressed in only 2.72% +/- 0.9% (mean +/- standard deviation) of platelets in patients for TKA with healthy venogram results. This differed significantly from platelets in patients for TKA with DVT, who had P-selectin expression of 6.56% +/- 3.1% (mean +/- standard deviation; P <.01). Sensitivity for the diagnosis of DVT with P-selectin assay was calculated to be 74%, and specificity was found to be 94%. CONCLUSION: The findings showed that radiologically confirmed DVT in patients for TKA surgery with general anesthesia is associated with an elevated number of activated platelets. Perioperative assessment of P-selectin may predict the early onset of DVT in patients who undergo high risk surgical procedures like TKA. This laboratory assay may help prevent the occurrence of the fatal events caused by DVT with use of early therapeutic intervention, such as heparinization.     

Differential effect of aspirin on platelet aggregation in IDDM.

Diabetes mellitus is associated with a high incidence of cardiovascular diseases not directly attributable to hyperlipidemia, smoking, or hypertension, but which in part may be explained by an enhanced tendency to thrombosis due to increased platelet activity. The aim of this study was to evaluate platelet function and compare the effectiveness of the antiplatelet drug aspirin on platelet aggregation in diabetic and nondiabetic subjects. Platelet aggregation and composition were examined in 20 male insulin-dependent diabetes mellitus (IDDM) patients and 20 nondiabetic control subjects matched for age and body mass index. All were normotensive with serum total cholesterol less than 6.5 mM. Although within the clinically acceptable normal range, blood pressure was significantly higher in diabetic patients (130/75 mmHg) than in control subjects (123/70 mmHg) (P less than 0.05). Serum thromboxane B2 and ex vivo aggregation of platelets in response to two doses of the agonists collagen and platelet-activating factor (PAF) were similar to nondiabetic subjects. However, after taking 100 mg/day aspirin for 5 days, platelet aggregation to collagen was reduced by 76% in control subjects compared to 56% in IDDM patients (P less than 0.001). Aspirin treatment also reduced the slope of the aggregation curve and increased the lag time (the period between the addition of collagen and the start of irreversible aggregation) significantly more in control than in diabetic platelets. This difference in platelet aggregation could not be attributed to differences in platelet serotonin or thromboxane A2 secretion, the latter being almost completely suppressed by aspirin in each group. Platelet aggregation to PAF was similar in both groups and was not affected by aspirin.(ABSTRACT TRUNCATED AT 250 WORDS)     

P选择素在肾病综合征并发深静脉血栓中的作用及犬血栓模型磁共振分子成像观察

目的 观察P选择素在肾病综合征（NS）并发深静脉血栓形成（DVT）中作用，探讨P选择素靶向对比剂及分子磁共振成像（MRI）在DVT犬模型早期诊断应用的可行性。 方法 （1）选择我院2005年至2006年间住院NS患者41例，根据核素深静脉造影检查有无伴发DVT，再分为DVT组和无DVT组，检测患者血中P选择素含量。（2）选择健康成年毕格犬，建立DVT模型，并按造模即刻、1 h、3 h采血并取静脉损伤节段，行血管组织和血中P选择素含量检测。（3）利用研制的抗P选择素单抗，制成P选择素靶向对比剂，结合体外犬静脉损伤节段血管MRI，进行犬活体内观察。 结果 （1）NS患者血P选择素水平较健康组显著增高（P < 0.01），DVT组又较无伴DVT组明显增高（P < 0.01）。（2）模型犬血P选择素水平较对照犬显著增高（P < 0.05），且于受损血管内膜及血栓形成部位明显表达。（3）制备的MRI对比剂，体外可明显增强犬离体受损血管与血栓部位显像信号。体内于犬静脉损伤局部注射对比剂30 min，MRI即显示高于周围肌肉显影的血管信号；1 h可见附壁血栓增强信号；至3 h随血栓形成增大而持续强化，实验组对比度噪声比 （CNR）值与对照组比较，差异有统计学意义（11.51±2.32比2.71±0.86，P < 0.01），且显示了与P选择素表达一致的信号强化效果。另从犬损伤部位远心端注射对比剂30 min至1 h，也显示了上述成像效果；2 h至4 h血栓信号由明显上升渐见趋缓，延迟24 h信号强度减弱，实验组CNR值与对照组间差异也有统计学意义（10.40±2.15比1.93±0.57，P < 0.01）。此外，该对比剂对实验犬的生命体征及心、肺、肝、肾等脏器均无明显影响。 结论 P选择素参与NS合并DVT。利用P选择素单抗MRI对比剂，可在活体内早期定位显像及反映血栓形成状态，为DVT早期诊断提供了一种可行方法。     

Defective platelet aggregation in response to platelet-activating factor in uremia associated with low platelet thromboxane A2 generation.

The bleeding tendency associated with uremia is likely due to a qualitative platelet dysfunction. So far the data available on platelet aggregation are conflicting. Since platelet-activating factor (PAF) plays a role in primary hemostasis, we studied platelet aggregation in response to PAF in 40 patients with chronic uremia on regular hemodialysis and 12 control subjects. Our results showed that in 28 of 40 uremics, platelet aggregation response to PAF was normal, whereas in the remaining 12 it was defective in that no second wave of aggregation was elicited even if the PAF concentrations were increased by a factor of 10,000. This abnormal response was peculiar to PAF and only partially related to factor(s) of plasma origin. The number of platelet PAF receptors and their affinity for the agonist were comparable in controls and "PAF-unresponsive" patients. The defective platelet aggregation in response to PAF was associated with a statistically significant reduction (P less than 0.01) in thromboxane A2 (TxA2) generation in platelet-rich plasma (PRP) challenged with PAF (10 and 100 nmol/L). When PRPs from PAF-unresponsive patients were preincubated with a stable analogue of prostaglandin endoperoxides/TxA2 U-46619, an irreversible platelet aggregation in response to PAF was obtained. Thus in a subpopulation of uremics, platelet aggregation in response to PAF is selectively abnormal as a consequence of a reduced TxA2 generation.     

血小板活化因子乙酰水解酶基因多态性与缺血性脑卒中患者血小板活化和预后关系的研究

目的探讨血小板活化因子乙酰水解酶（PAF—AH）基因多态性与缺血性脑卒中的关系。方法应用PCR技术,分析205例缺血性脑卒中患者（脑卒中组）及114例健康体检者（对照组）的基因型。并测定血浆血小板活化因子（PAF）、α颗粒膜糖蛋白140（GMP-140）、β-血小板球蛋白（β-TG）和血小板第4因子（PF4）水平。结果脑卒中组PAF-AH基因突变率和血浆PAF、GMP-140、β—TG和PF4水平[分别为42．44％、（91．08±39．10）ng／L、（36．46±13．10）μg／L、（41．75±11．18）μg／L、（29．05±9．16）μg／L]均显著高于对照组[分别为21．05％、（64．30±18．81）ng/L、（18．27±7．68）μg／L、（30．94±8．47）μg/L、（18．75±6．06）μg／L]（P＜0．01）。脑卒中组基因突变者血浆PAF、GMP．140水平显著高于无基因突变者（P＜0．01）。结论缺血性脑卒中患者急性期血小板活化增强,且与PAF。AH基因多态性相关。PAF-AH基因突变可能是缺血性脑卒中的一种遗传危险标志。     

Determinants of enhanced thromboxane biosynthesis in renal transplantation

BACKGROUND: Despite great improvement in patient and graft survival, the long-term morbidity and mortality in renal transplant recipients (RTRs) are still significant, with a high incidence of cardiovascular disease-related deaths. METHODS: We investigated thromboxane (TXA2) biosynthesis and endothelial and coagulative activation in 65 patients who received a renal transplant. RESULTS: The rate of TXA2 biosynthesis (urinary 11-dehydro-TXB2 excretion largely reflects platelet TXA2 production in vivo) was significantly (P < 0.0001) higher in RTRs than in healthy subjects. Plasma von Willebrand factor (vWF) and thrombin-antithrombin (TAT) complexes were significantly higher (P < 0.001) in RTRs compared with controls. Urinary 11-dehydro-TXB2 directly correlated with plasma vWF and cholesterol. We next examined the relative influence of cyclosporine A (CsA) on TXA2 biosynthesis and endothelial activation, comparing a group of RTRs not receiving CsA with an age- and sex-matched group of patients treated with CsA. Urinary excretion of 11-dehydro-TXB2 and plasma levels of vWF were significantly increased in RTRs who received CsA compared with those who did not. After an overall follow-up of 120 months, RTRs who experienced cardiovascular events had a higher frequency of abnormal plasma levels of vWF than patients who remained event free. CONCLUSION: Renal transplantation is associated with in vivo platelet activation highly related to endothelial activation. This is particularly evident in CsA-treated patients. Administration of drugs that are able to reduce or eliminate thromboxane-dependent platelet activation in vivo may be beneficial to reduce the risk of cardiovascular events in RTRs.     

Platelet activation in patients after splenectomy with total gastrectomy for gastric cancer

OBJECTIVE: We investigated change in platelet activation using flow cytometry in patients before and after splenectomy with total gastrectomy for gastric cancer. METHODS: Six patients who underwent splenectomy for lymphadenectomy with total gastrectomy for gastric cancer were the subjects in this study. In the patients, platelet count and platelet activation were evaluated before the operation, 1 week after the operation, and 1 month after the operation. Expression of CD62P (P-selectin) was analysed as a marker of platelet activation using flow cytometry. RESULTS: Although platelet count significantly increased 1 week after the operation, the platelet count 1 month after the operation did not increase significantly. Expression of CD62P (P-selectin) significantly decreased at 1 week and 1 month after the operation, compared with the level before the operation. No postoperative complications occurred in any patient. CONCLUSION: In the present study, platelet activation did not progress after the operation. The results mean that the risk of thrombosis after splenectomy does not increase.