慢性肾功能衰竭血浆P物质,心钠素与肾功能的关系

目的了解慢性肾功能衰竭（ＣＲＦ）患者血浆Ｐ物质（ＳＰ）、心钠素（ＡＮＰ）含量变化与肾功能的关系。方法采用放射免疫分析法检测正常对照组及ＣＲＦ组血液透析前后ＳＰ、ＡＮＰ，同时测定血清肌酐（Ｓｃｒ）。结果（１）透析前ＳＰ显著高于正常对照组（Ｐ＜００１），透析后ＳＰ高于透析前（Ｐ＜００５）；ＳＰ透析前与Ｓｃｒ呈正相关（ｒ＝０６６，Ｐ＜００５），ＳＰ透析后与Ｓｃｒ呈负相关（ｒ＝－０４６，Ｐ＜００５）；（２）透析前ＡＮＰ显著高于对照组（Ｐ＜００１），透析后ＡＮＰ显著低于透析前（Ｐ＜００５），ＡＮＰ透析前后与Ｓｃｒ呈正相关（ｒ＝０８２，Ｐ＜００５）；（３）透析前后ＳＰ变化值与ＡＮＰ变化值呈负相关（ｒ＝－０４８，Ｐ＜００５）。结论ＣＲＦ患者血浆ＳＰ、ＡＮＰ含量的变化与肾功能的改变有较明显的相关性。     

辽宁绝经妇女骨密度与绝经年限、体重关系研究

目的　研究绝经年限、体重对辽宁地区绝经后女性不同部位骨密度的影响。方法　测定共９６ 例绝经后妇女腰椎（Ｌ２～４）、股骨颈（Ｎｅｃｋ）、大转子（Ｔｒｏｃｈ）、Ｗａｒｄ＇ｓ 区的ＢＭＤ,同时测定了血ＡＬＰ、血尿钙、肌肝（Ｃｒ）等指标,分析其相互关系。结果　１． 绝经后妇女各部位的ＢＭＤ 不同。２．Ｌ２～４的ＢＭＤ与体重（Ｗ ）、血小板、尿Ｃａ／Ｃｒ呈正相关（Ｐ＜ ０．０１、Ｐ＜ ０．０５、Ｐ＜ ０．０１）。与绝经年限的自然对数（ＰＦＮＬ）、ＡＬＰ呈负相关（Ｐ＜ ０．０１、Ｐ＜ ０．０１）。３．Ｎｅｃｋ 区ＢＭＤ 与体重、血小板呈正相关（Ｐ＜ ０．０１、Ｐ＜ ０．０５）,与ＰＦＮＬ呈负相关（Ｐ＜ ０．０５）。４．Ｗａｒｄ＇ｓ 区ＢＭＤ 与体重、血小板、尿Ｃａ／Ｃｒ 呈正相关（Ｐ＜ ０．０１、Ｐ＜ ０．０５、Ｐ＜ ０．０５）,与ＰＦＮＬ及ＡＬＰ呈负相关（Ｐ＜ ０．０１、Ｐ＜ ０．０５）。５． 大转子区骨密度与体重、血小板、转氨酶呈正相关（Ｐ＜ ０．０１、Ｐ＜ ０．０１、Ｐ＜ ０．０５）,与ＡＬＰ呈负相关（Ｐ＜ ０．０１）。结论　体重、绝经年限、尿Ｃａ／Ｃｒ、血小板及血ＡＬＰ能影响骨密度。     

心率变异性分析尿毒症自主神经病变

为评价尿毒症患者的自主神经活动，使用心率变异性（ＨＲＶ）分析法对４４病例进行研究，同时和传统的方法进行比较。结果发现，安静时患者心率总变异性（ＴＶ），低频成分（ＬＦ），高频成分（ＨＦ）均比对照组低（Ｐ＜０．００１）。心算后上述三项指标的变化值也低于对照组（Ｐ＜０．０１或０．００１）。传统方法评分和ＴＶ（ｒ＝－０．７３８３，Ｐ＜０．００１），ＬＦ（ｒ＝－０．４１３９，Ｐ＜０．０１），ＨＦ（ｒ＝－０．５９１７，Ｐ＜０．００１）有明显相关。提示尿毒症患者自主神经受损或（和）抑制。同时说明ＨＲＶ分析是一项可以定量的，无创伤性的评价自主神经的方法。     

通里攻下法治疗肠源性内毒素血症的临床观察——附34例？…

我们选择临床中急性弥漫性腹膜炎患者，给予通里攻下法配合常规治疗，进行临床观察。结果表明：腹膜炎病人血中内毒素含量增高（Ｐ〈０．０１），并引起ＴＮＦ、ＰＧＦ１α和ＴＸＢ２的增高（Ｐ〈０．０１）。术后用通里攻下法的代表方剂大承气汤、承气合剂治疗，能使血中ＬＰＳ、ＴＮＦ、ＴＸＢ２含量下降（Ｐ〈０．０１ Ｐ〈０．０１ Ｐ〈０．０５），机体恢复加快，抗生素的使用减少（Ｐ〈０．０５）。通里攻下法是一种治疗肠源     

输精管吻合术后睾丸cAMP含量与精子密度的关系

日本大耳白雄兔３２只，随机分为输精管结扎组（ＶＧ）、输精管结扎－吻合组（ＶＡＧ）和假手术组（ＳＯＧ）。结果显示：ＶＡＧ的精子密度明显低于ＳＯＧ（Ｐ＜０．０１），并且与睾丸组织ｃＡＭＰ含量呈明显正相关（ｒ＝０．８４１，Ｐ＜０．０１）。血清睾酮水平３组无显著差异。ＶＧ，ＶＡＧ的睾丸重量均低于ＳＯＧ（Ｐ＜０．０１，Ｐ＜０．０５），但ＶＡＧ与ＶＧ比较有显著差异（Ｐ＜０．０５），且ＶＡＧ和ＳＯＧ的睾丸重量与精子密度也呈明显正相关（ｒ＝０．６９９，Ｐ＜０．０１）．说明输精管结扎及吻合后一段时间内睾丸生精功能处于相对抑制状态，且与对垂体促性腺激素反应性下降有关。     

糖尿病纤维连接蛋白血小板聚集功能改变临床分析

为探讨ＮＩＤＤＭ患者Ｆｎ、ＰＡＧ改变与缺血性心脑血管病的关系，分析５３例ＮＩＤＤＭ患者Ｆｕ、ＰＡＧ测定结果，并与５３名健康人比较。患者组Ｆｎ明显高于（Ｐ〈０．０１），前者ＰＡＧ（１）、ＭＡＲ、Ｉ与后者有显著统计学差异（Ｐ〈０．０１）。患者组中并发症组与无并发症组Ｆｎ、Ｉ较对照组有明显统计学差异（Ｐ〈０．０１），并发症组ＰＡＧ（１）、ＭＡＲ明显高于对照组（Ｐ〈０．０５）。ＮＩＤＤＭ患者Ｆｎ降低、ＰＡ     

慢性肾功能衰竭患者血清及尿白细胞介素—8的检测及意义

目的 了解慢性肾功能衰竭（ＣＲＦ）患者血清及尿ＩＬ－８水平的变化及意义。方法 双抗体夹心ＥＬＩＳＡ法。结果 ＣＲＦ患者血清及尿中ＩＬ－８的含量均显著高于正常对照组（Ｐ〈０．００１），但与Ｓｃｒ无明显相关性（ｒ＝－０．２７，Ｐ〉０．０５和ｒ＝－０．０５，Ｐ〉０．０５）。结论 ＣＲＦ仍存在比较严重的免疫炎症反应，此可能为肾小球功能受损的重要原因之一。     

一氧化氮在原发性骨质疏松症中的作用探讨

目的　探讨一氧化氮在原发性骨质疏松症中的作用。方法　酶法测定 １６ 例老年骨质疏松症患者及２１ 例青壮年创伤患者血清内一氧化氮（ＮＯ）水平,并检测血清内骨钙素（ＢＧＰ）及白细胞介素－６（ＩＬ－６）水平的变化。结果　老年骨质疏松症组ＮＯ、ＩＬ－６ 水平明显高于青壮年组（Ｐ＜ ０．０５）,ＢＧＰ显著高于青壮年组（Ｐ＜ ０．０１）。青壮年组ＮＯ 与ＩＬ－６、ＢＧＰ呈正相关,但无显著性意义（ｒ＝０．０４３,ｒ＝ ０．０２８,Ｐ＞ ０．０５）;而老年骨质疏松症患者体内ＮＯ 与ＩＬ－６ 的变化呈负相关（ｒ＝ － ０．５７９,Ｐ＜ ０．０５）,与ＢＧＰ正相关（ｒ＝ ０．５４９,Ｐ＜ ０．０５）,血清内ＩＬ－６ 的水平与骨质疏松的程度密切相关。结论　老年骨质疏松症患者由于体内ＮＯ的内源性合成相对减少,对促进破骨细胞活性的细胞因子抑制作用减弱,使骨吸收加速,从而导致骨质疏松的发生,因而促进内源性ＮＯ 的合成有助于骨质疏松症的防治。     

充血性脾大伴脾功能亢进患者不同脾切除术前后血小板相关抗体的变化

目的 了解充血性脾肿大伴脾功能亢进（脾亢）患者血小板相关抗体（ＰＡ－ＩｇＧ）水平及不同脾切除术后的改变,探索脾肿大、血小板、ＰＡ－ＩｇＧ之间的关系。方法 采用竞争性酶联免疫吸附试验（ＥＬＩＳＡ）检测了２４例脾肿大伴脾亢患者血清ＰＡ－ＩｇＧ水平。结果 脾肿大伴脾亢患者的ＰＡ－ＩｇＧ水平明显高于正常者（Ｐ〈０．０１）,而血小板值低,ＰＡ－ＩｇＧ与血小板之间存在显著负相关（ｒ＝－０．４７４７,Ｐ〈０．０     

尿毒症患者红细胞变形能力与膜磷脂和收缩蛋白变化的关系

探讨尿毒症患者红细胞变形能力（ＥＤ）与红细胞膜磷脂成分和收缩蛋白的关系。方法检测了４８例尿毒症患者和４０例健康人红细胞滤过指数（ＩＦ）、红细胞膜磷脂成分和收缩蛋白二聚体（ＳＰ－Ｄ）和四聚体（ＳＰ－Ｔ）相对含量的变化。结果尿毒症患者红细胞ＩＦ明显高于对照组（Ｐ＜０．００１），膜磷脂成分中神经磷脂（ＳＭ）、磷脂酰胆碱（ＰＣ）、磷脂酰丝氨酸（ＰＳ）和磷脂酰乙醇胺（ＰＥ）明显低于对照组（Ｐ＜０．０１），而ＳＭ／ＰＣ高于对照组（Ｐ＜０．０５）；尿毒症患者红细胞ＳＰ－Ｄ和ＳＰ－Ｄ／ＳＰ－Ｔ明显增高，而ＳＰ－Ｔ明显减低，与对照组比较有显著性差异（Ｐ＜０．０１）。尿毒症患者红细胞ＩＦ与ＳＭ、ＰＣ、ＰＳ、ＰＥ和ＳＰ－Ｔ呈负相关（Ｐ＜０．０５，０．０１），与ＳＭ／ＰＣ、ＳＰ－Ｄ和ＳＰ－Ｄ／ＳＰ－Ｔ呈正相关（Ｐ＜０．０１）。结论尿毒症患者ＥＤ降低与红细胞膜磷脂和收缩蛋白异常有关     

乌司他丁联合CRRT对重症急性胰腺炎患者血管内皮功能和血小板活化因子的影响

目的 探讨乌司他丁联合连续肾脏替代治疗（CRRT）对重症急性胰腺炎（SAP）患者血管内皮功能和血小板活化因子的影响。方法 选择西安交通大学第二附属医院2016年1月至2019年12月收治的60例SAP患者,采用随机数字表法随机分为对照组和干预组,每组30例。对照组行常规治疗,干预组在此基础上给予乌司他丁联合CRRT治疗。比较两组患者治疗前及干预7 d后血管内皮功能指标[内皮素-1（ET-1）、一氧化氮（NO）、血管性假血友病因子相关抗原（vWF:Ag）、血管内皮生长因子（VEGF）]和血小板活化因子[血小板α颗粒膜蛋白（GMP-140）、血栓烷B₂（TXB₂）],并比较两组治疗前后APACHE II、Balthazar CT评分情况。结果 两组患者治疗前血清ET-1、NO、vWF:Ag、VEGF等血管内皮功能指标无统计学差异（P＞0.05）;治疗后,两组患者血清ET-1、vWF:Ag水平均较治疗前明显降低（P＜0.05）,NO、VEGF水平均较治疗前明显升高（P＜0.05）,且干预组患者ET-1、NO、vWF:Ag的改变程度均大于对照组,差异均有统计学意义（P＜0.05）,但干预组患者VEGF的改变程度小于对照组,差异有统计学意义（P＜0.05）。两组患者治疗前血清GMP-140、TXB₂等血小板活化因子水平无统计学差异（P＞0.05）;治疗后,两组患者上述指标水平均较治疗前明显降低（P＜0.05）,且干预组患者上述指标下降程度均大于对照组,差异均有统计学意义（P＜0.05）。两组患者治疗前APACHE II、Balthazar CT评分比较无统计学差异（P＞0.05）;治疗后,两组患者上述评分均较治疗前明显降低（P＜0.05）,且干预组患者上述评分的降低程度均大于对照组,差异均有统计学意义（P＜0.05）。Spearman分析发现,Balthazar CT评分与ET-1、vWF:Ag、GMP-140、TXB₂呈正相关,与NO呈负相关。结论 血管内皮功能及血小板活化情况改善可能是乌司他丁联合CRRT治疗SAP有效的作用机制之一。     

Effect of recombinant human erythropoietin (rHuEpo) on the hemostatic system in chronic hemodialysis patients.

Hemostatic measurements were undertaken in eight chronic hemodialysis uremic patients on recombinant human erythropoietin (rHuEpo). Same measurements were repeated in another seven patients in whom anemia was corrected by the transfusion of red blood cells. The correction of the anemia by rHuEpo therapy was accompanied by 1. correction of the prolonged Simplate Bleeding Time (BT) to normal less than 10.0, minutes after 16 weeks of rHuEpo treatment; 2. significant increases in the levels of fibrinogen, clotting FVIII:C, vWF:antigen, vWF:ristocetin cofactor and platelet count; 3. enhanced aggregation responses to ADP, adrenaline, arachidonic acid, collagen and ristocetin. There was no significant fluctuation in other coagulation parameters PT, APTT, TT, reptilase time and antithrombin III and plasma fibrinogen. In patients who were treated with RBC transfusion and despite the correction of the anemia, the bleeding time shortened significantly but not corrected, mean BT before and after RBC transfusion was 17.1 +/- 1.4 and 11.6 +/- 1.9 minutes respectively. Besides there was significant elevation of vWF:Ricofactor levels but not FVIII:C, vWF:Ag or platelet count. Platelet aggregation responses to ADP remained unchanged. It is concluded that significant elevations of FVIII:related activities, plasma fibrinogen, improved platelet aggregability and correction of the BT are salient hemostatic changes that follow rHuEpo therapy in uremic patients.     

Paradoxical Effect of Nonphysiological Shear Stress on Platelets and von Willebrand Factor

Blood can become hypercoagulable by shear‐induced platelet activation and generation of microparticles. It has been reported that nonphysiological shear stress (NPSS) could induce shedding of platelet receptor glycoprotein (GP) Ibα, which may result in an opposite effect to hemostasis. The aim of this study was to investigate the influence of the NPSS on platelets and von Willebrand factor (vWF). Human blood was exposed to two levels of NPSS (25 Pa, 125 Pa) with an exposure time of 0.5 s, generated by using a novel blood‐shearing device. Platelet activation (P‐selectin expression, GPIIb/IIIa activation and generation of microparticles) and shedding of three platelet receptors (GPIbα, GPVI, GPIIb/IIIa) in sheared blood were quantified using flow cytometry. Aggregation capacity of sheared blood induced by ristocetin and collagen was evaluated using an aggregometer. Shear‐induced vWF damage was characterized with Western blotting. Consistent with the published data, the NPSS caused significantly more platelets to become activated with increasing NPSS level. Meanwhile, the NPSS induced the shedding of platelet receptors. The loss of the platelet receptors increased with increasing NPSS level. The aggregation capacity of sheared blood induced by ristocetin and collagen decreased. There was a loss of high molecular weight multimers (HMWMs) of vWF in sheared blood. These results suggest that the NPSS induced a paradoxical effect. More activated platelets increase the risk of thrombosis, while the reduction in platelet receptors and the loss of HMWM‐vWF increased the propensity of bleeding. The finding might provide a new perspective to understand thrombosis and acquired bleeding disorder in patients supported with blood contacting medical devices.     

O-linked glycosylation and functional incompatibility of porcine von Willebrand factor for human platelet GPIb receptors

BACKGROUND: Xenograft rejection is associated with vascular inflammation, thrombocytopenia and the accelerated consumption of coagulation factors. Primary biological incompatibilities of the xenograft in the regulation of clotting appear to amplify pathological processes associated with rejection. The functional incompatibility of porcine von Willebrand factor (vWF) expressed within the xenograft vasculature may heighten interactions with the primate platelet receptor GPIb, hence augmenting formation of platelet microthrombi and vascular injury. Here, we address the functional impact of O-linked glycosylation of the vWF A1 domain on primate platelet activation. METHODS: Recombinant human or porcine vWF A1-domains were transiently over-expressed in COS-7 cells as FLAG-tagged fusion protein, linked to plasma membranes via GPI anchors. O-linked glycosylation was blocked by the addition of phenyl-alpha-GalNAc2 to cultures. Expressed vWF-A1 domains were characterized utilizing cytofluometric- and Western blot analyses. RESULTS: Cytofluometric analysis confirmed equivalent levels of human and porcine vWF A1-domain expression irrespective of the levels of O-linked glycosylation. Differential glycosylation patterns of vWF-A1 under these conditions were confirmed by Western blot analyses. Native porcine vWF A1-domains had enhanced human platelet activation potential when compared with human recombinant vWF A1. However, the loss of O-linked glycosylation abolished differences in aggregatory responses between human and porcine vWF A1 domains. CONCLUSIONS: Various degrees of O-linked glycosylation of vWF-A1-domains modulate levels of functional interaction with platelet receptor GPIb and consequent platelet aggregation responses in vitro. These data may have implications for outcomes of xenotransplantation. We speculate that alterations in glycosylation of vWF and other adhesion proteins associated with the targeting of the alpha1,3-Gal-epitope in mutant swine may have salutatory effects on the primate platelet activation observed in these xenografts.     

von Willebrand factor and platelet count in ruptured abdominal aortic aneurysm repair.

OBJECTIVE: von Willebrand factor (vWF) is essential for the formation of platelet aggregates at sites of vascular endothelial cell (EC) injury. Peri-operative thrombocytopenia is associated with poor outcome in ruptured abdominal aortic aneurysm (AAA) repair. This prospective study examines the relationship between vWF and platelet count (PC) in ruptured AAA repair. METHODS: plasma vWF antigen, PC and C-reactive protein (CRP) were measured pre-operatively, and immediately before and 5 min after aortic clamp release, and on post-operative days 1 and 2 in 20 patients (18 men and 2 women of median age 74, range 63-86, years) with ruptured AAA. RESULTS: elevated vWF was present in 13 (65%) patients pre-operatively, and 14 of 16 (88%) survivors at 24 h post-operatively. All patients demonstrated an intra-operative fall in vWF. There was no significant difference in vWF levels between survivors and non-survivors. PC was below the normal range in 8 (40%) patients pre-operatively and all patients at 24 h. Eighteen (90%) patients demonstrated an intro-operative fall in PC. PC was significantly lower in non-survivors pre-operatively (p=0.007), immediately before (p=0.009) and 5 min (p=0.009) and 24 h (p=0.02) after clamp release. There was a significant positive correlation between vWF and PC pre-operatively (r= +0.48, p=0.033), and immediately before (r= +0.47, p=0.044) and 5 min after clamp release (r= +0.5, p=0.043). There was a significant positive correlation between peak vWF level and the greatest fall in PC (r= +0.65, p=0.006). There was a significant negative correlation between vWF and CRP and operative blood loss; and between PC and CRP, operative blood loss and aortic clamp time. CONCLUSIONS: these data demonstrate that EC activation, the acute phase protein response, operative blood loss and aortic clamp time all contribute to the peri-operative fall in PC in patients with ruptured AAA. The peri-operative fall in circulating levels of vWF and PC may represent consumption secondary to macro- and microvascular thrombus formation. The resultant procoagulant state may partly explain the association between low PC and poor outcome in ruptured AAA.     

Recipient levels and function of von Willebrand factor prior to liver transplantation and its consumption in the course of grafting correlate with hepatocellular damage and outcome.

Von Willebrand factor (vWF) is a major platelet adhesion molecule at sites of vascular injury, such as observed in ischemia/reperfusion injury following orthotopic liver transplantation (OLT). Thirty-three OLT patients were divided into groups with elevated or low markers of hepatocellular damage (high and low-HD). Whole-blood aggregometry was performed to evaluate platelet function. Multimeric analysis was utilized to evaluate functional vWF levels in the course of OLT. Donor and recipient demographics were comparable among groups. Low-HD patients demonstrated better preserved coagulation parameters on POD 1-6 if contrasted to high-HD patients. One year graft survival for the high-HD group was lower than low-HD patients (P = 0.037). Preoperative vWF-dependent platelet aggregation and functional vWF plasma levels correlated directly with alanine transaminase levels early after OLT as did the decrease of functional vWF to reperfusion. In summary, these data suggest that vWF may serve as a significant mediator of platelet recruitment and hepatocellular injury in the graft following reperfusion.     

Elevated plasma glycocalicin levels and decreased ristocetin-induced platelet agglutination in hemodialysis patients

A bleeding diathesis caused by platelet dysfunction is a major cause of morbidity and mortality in patients with uremia. Platelet adhesion to vascular subendothelium is defective in uremia and depends on the interactions of the platelet glycoprotein (GP) Ib/IX complex with the vascular wall. We measured levels of platelet surface GPIb, platelet surface GPIX, plasma glycocalicin (a product of enzymatic cleavage of GPIb), and ristocetin-induced platelet agglutination (RIPA) in patients undergoing chronic hemodialysis compared with patients undergoing peritoneal dialysis and healthy controls. Patients undergoing chronic maintenance hemodialysis have higher levels of platelet surface expression of GPIb (187+/-10 fluorescent units; P < 0.001) than either healthy controls (120+/-4 fluorescent units; P < 0.001) or patients undergoing peritoneal dialysis (127+/-5 fluorescent units; P < 0.001). Similar changes were observed in platelet surface GPIX. Plasma glycocalicin levels were elevated in chronic hemodialysis patients (71+/-5 nmol/L) compared with healthy controls (36+/-3 nmol/L; P < 0.001). Plasma glycocalicin levels also increased progressively throughout the hemodialysis procedure. The slope of RIPA was significantly lower in chronic hemodialysis patients (46+/-3) than in either healthy controls (67+/-4; P < 0.05) or peritoneal dialysis patients (62+/-2; P < 0.05). In conclusion, patients undergoing chronic maintenance hemodialysis have increased plasma glycocalicin levels and decreased RIPA, which may contribute to diminished platelet adhesion to vascular subendothelium and increased bleeding associated with uremia.     

丙泊酚对心肺转流病人血浆血栓调节蛋白和血管性假血友病因子水平的影响

目的 探讨丙泊酚用于心肺转流(CPB)对全身性血管内皮细胞(VEC)急性损伤的保护作用.方法 30例心脏瓣膜置换术病人随机均分为观察组和对照组,CPB过程中分别持续输注丙泊酚、硝酸甘油维持病人血流动力学的稳定.分别于术前、CPB前、CPB 30 min、停CPB、手术结束、术后1、3 d采血动态监测两组病人血浆可溶性血栓调节蛋白(sTM)和血管性假血友病因子(vWF)的变化.结果 两组病人血浆sTM和vWF在CPB期间和术后1 d均显著增高(P＜0.05或P＜0.01).观察组病人CPB期间至术后3d的所有指标均低于对照组(P＜0.05或P(0.01).观察组的指标术后3 d恢复到术前水平.对照组未能恢复.结论 CPB可导致全身性VEC的急性损伤,丙泊酚可以减轻CPB导致的VEC损伤.     

A preliminary study on the effects of exercising to maximum walking distance on platelet and endothelial function in patients with intermittent claudication.

BACKGROUND: Platelet and endothelial activation has been shown to be increased in patients with intermittent claudication (IC). Recent studies have suggested that exercise may induce further platelet activation. The aims of this study were to investigate the effect of exercising to maximum walking distance on platelet and endothelial function in patients with intermittent claudication who were receiving statin and aspirin therapy compared with age matched healthy controls. METHODS: Platelet aggregation through COX-mediated and thrombin receptor activator peptide (TRAP)-stimulated GPIIb/IIIa pathways was measured by the Ultegra point of care system in 20 patients with IC on aspirin and 20 healthy volunteers before, immediately and 1h after exercising to treadmill maximal walking distance (MWD). Soluble P-selectin, vWF and sICAM were measured using an enzyme linked immuno-sorbent assay technique. RESULTS: Baseline platelet aggregation was significantly reduced in patients with IC compared to volunteers (p<0.05). In patients, exercising to MWD significantly reduced platelet aggregation (COX, median -5% [range -24 to 13%]; p = 0.02; GPIIIa/IIb, median -13% [range -72 to 33%]; p = 0.02) immediately post-exercise which returned to baseline values at 1 h. There was no change in the healthy volunteers following the same median duration of exercise. Baseline sP-selectin levels were higher in the patients with IC compared to the healthy volunteers [Median values (interquartile range), 42.72 (33.28-54.24) versus 29.16 (24.40-34.10), p = 0.0003] but there were no differences in vWF levels. Both sP-selectin and vWF levels increased significantly in the control and patient group following exercise (p<0.005). sICAM were higher at baseline in the patients with IC but were unchanged following exercise [Median values (interquartile range),560.9 (405.5-739.4) versus 467.0 (325.7-643.4), p<0.05]. CONCLUSION: This study is the first to show that platelet aggregation is reduced immediately following treadmill exercise to maximum walking distance in patients with IC despite a rise in sP-selectin and vWF, suggesting endothelial activation. The inhibition of platelet aggregation after exercise in subjects on antiplatelet and statin therapy suggests that exercise is unlikely to exacerbate platelet thrombus formation in patients with IC.     

戊乙奎醚对心肺转流中患者血浆sTM和vWF水平的影响

目的研究戊乙奎醚(长托宁)对心肺转流(CPB)全身性血管内皮细胞(VEC)急性损伤的保护作用。方法30例择期瓣膜置换手术患者随机分为两组,每组15例。观察组术前肌注戊乙奎醚0.02mg/kg和吗啡0.01mg/kg;东莨菪碱组术前肌注东莨菪碱0.3mg和吗啡0.01mg/kg。分别于术前、CPB前、CPB后30min、停CPB、手术结束、术后1d和3d采血测血浆可溶性血栓调节蛋白(sTM)和血管性假血友病因子(vWF)的变化。结果两组血浆sTM和vWF在CPB后30min至术后1d均显著增高(P<0.01),术后3d恢复到术前水平。观察组患者CPB期间至术后3d的所有指标均低于对照组。结论CPB可导致全身性VEC急性损伤,戊乙奎醚可以显著减轻CPB导致的VEC损伤。