抗凝联合抗血小板聚集治疗预防糖尿病下肢动脉硬化闭塞症支架植入后再狭窄的疗效分析

目的:探讨抗凝联合抗血小板聚集治疗预防糖尿病下肢动脉硬化闭塞症患者支架植入后再狭窄的临床疗效。方法:将61例糖尿病下肢动脉硬化闭塞症患者分为观察组(30例)与对照组(31例),术后观察组采用华法林+西洛他唑治疗,对照组则采用拜阿司匹林+西洛他唑治疗。随访1年,比较两组的再狭窄发生率及其他相关指标。结果:两组术前资料具有可比性。随访期内,观察组术后再狭窄发生率、晚期管腔丢失以及血浆D二聚体水平均明显低于对照组(均P0.05),两组术后血小板聚集率、血糖/血脂相关指标以及出血事件的发生率差异均无统计学意义(均P0.05)。结论:抗凝联合抗血小板聚集治疗预防糖尿病下肢动脉硬化闭塞症患者支架植入后再狭窄的安全、有效,值得推荐使用。     

小剂量阿司匹林对PCOS患者冻融胚胎移植周期妊娠结局的影响

目的探讨小剂量阿司匹林对多囊卵巢综合征(PCOS)患者人工周期冻融胚胎移植(FET)妊娠结局的影响。方法收集2014年1月至2015年1月期间在我院生殖中心就诊的、行FET治疗的PCOS患者155例为研究对象。根据患者FET期间有无使用阿司匹林分为两组:阿司匹林组(n=61)与对照组(n=94)。回顾性分析两组患者的临床资料,比较两组的胚胎种植率、临床妊娠率、早期流产率、早产率、妊娠期糖尿病(GDM)发病率、妊娠期高血压疾病(HDCP)发病率及新生儿体重等。结果 (1)阿司匹林组的早期流产率(3.0%)显著低于对照组(22.9%)(P0.05),而胚胎种植率、晚期流产率及临床妊娠率与对照组比较,均无显著性差异(P0.05);(2)阿司匹林组的HDCP发生率(3.4%)、早产率(10.3%)均显著低于对照组(分别为20.6%和32.4%)(P0.05),其他晚期流产率、活产率、GDM发病率、新生儿体重等与对照组比较,均无显著性差异(P0.05)。结论小剂量阿司匹林的应用能降低行人工周期FET助孕的PCOS患者的早期流产率、早产率及HDCP发病率。     

三七皂甙抗血小板聚集作用的临床观察

目的 比较三七皂甙与阿司匹林对血小板聚集率的影响,分析二者抵抗概率,探讨二者抗血小板聚集实验室指标差异.方法 三七皂甙组与阿司匹林组各60名脑梗塞患者,分别用二磷酸腺苷(ADP),花生四烯酸(从)诱导做血小板聚集试验,检测最大血小板聚集率(MAR).各组患者均于入院当天,治疗第14天检测血小板聚集率.结果 三七皂甙组与阿司匹林组血小板聚集功能在同一诱导剂作用下,未表现出统计学差异.都存在抵抗、半抵抗现象.结论 三七皂甙对血小板聚集率的影响与阿司匹林相比无统计学意义,临床有可能作为抗血小板聚集药物应用,但也存在抵抗现象.三七皂甙抗血小板聚集的长期临床效果,与其他抗血小板聚集药物联合应用能否解决抵抗问题,还需进一步,大规模临床实验研究.     

不同剂量丙种球蛋白联合地塞米松治疗小儿特发性血小板减少性紫癜的临床疗效分析

目的：探讨不同剂量丙种球蛋白联合地塞米松治疗小儿重症特发性血小板减少性紫癜的疗效观察。方法将120例小儿特发性血小板减少性紫癜患儿随机分为对照组,小剂量组和大剂量组,每组各40例,所有患者均接受采用地塞米松注射液治疗,大剂量组患儿给予丙种球蛋白400mg/（kg·d）,1次/d,连用5d;小剂量组患儿给予丙种球蛋白200mg/（kg·d）,1次/d,连用5d,观察比较三组临床疗效,血小板上升时间,血小板恢复正常时间,出血停止时间。结果小剂量组与大剂量组临床疗效,血小板上升时间,血小板恢复正常时间,出血停止时间比较,差异无统计学意义（P ＞0.05）,但与对照组比较,差异均有统计学意义（P ＜0.05）。结论丙种球蛋白联合地塞米松能够显著改善小儿特发性血小板减少性紫癜临床症状,迅速提高血小板数,同时小剂量丙种球蛋白与大剂量治疗效果相当,治疗费用更低,值得临床推广使用。     

血液透析对尿毒症患者血小板功能及膜糖蛋白的影响

观察血液透析对尿毒症患者血小板功能、血小板膜糖蛋白（ＧＰ）的影响并探讨其作用机理。方法应用血小板聚集仪和流式细胞仪观察尿毒症患者血液透析前后，血小板聚集功能和血小板膜糖蛋白的变化。结果血液透析前，尿毒症组的血小板聚集率明显低于正常对照组；其血小板膜糖蛋白Ⅰｂ、Ⅱｂ／Ⅲａ量与对照组相比无明显差异。血液透析后，患者血小板聚集率无明显增加，但其血小板膜ＧＰⅠｂ、ＧＰⅡｂ／Ⅲａ量明显增高。血液透析前后，以ＡＤＰ活化血小板，患者血小板表达的ＧＰⅡｂ／Ⅲａ量与对照组相比无显著性差异。结论血液透析不能改善尿毒症患者血小板功能。血液透析可使血小板活化，导致其膜糖蛋白升高。     

地屈孕酮应用于同种免疫型复发性流产的临床观察

目的观察地屈孕酮应用于同种免疫型复发性流产的临床效果,为同种免疫型复发性流产寻求可预防的方案。方法 86例同种免疫型复发性流产随机分为两组,观察组43例应用地屈孕酮保胎治疗,对照组43例应用黄体酮保胎治疗,观察两组妊娠结局。结果观察组妊娠成功率86.05%(37/43),显著高于对照组的76.74%(33/43)(P0.05)。结论地屈孕酮应用于同种免疫型复发性流产患者,妊娠成功率较高,值得临床推广。     

地屈孕酮联合小剂量肠溶阿司匹林在治疗复发性流产中的作用

目的探讨地屈孕酮联合小剂量肠溶阿司匹林在治疗复发性流产中的作用。方法将90例有复发性流产史的妇女随机分为三组,每组30例。第1组月经周期第3~25天每天口服肠溶阿司匹林25mg bid,排卵后给予口服地屈孕酮片10mg bid至孕12周;第2组月经周期第3~25天每天口服肠溶阿司匹林25mg bid,排卵后给予安慰剂至孕12周;第3组在相同时间给予安慰剂。统计分析三组的血浆血栓素A2和前列环素I2比值(TXA2/PGI2)、子宫动脉阻力指数(resistance index,RI)和流产率。结果地屈孕酮+肠溶阿司匹林组较安慰剂组,TXA2/PGI2显著降低(0.62±0.27vs.1.13±0.21)、子宫动脉搏动指数显著增高(1.20±0.13vs.1.01±0.04)、足月分娩率显著增高(96.70%vs.83.33%)(P均0.05),而单纯阿司匹林组与安慰剂组比较,各观察指标均无显著差异(P0.05)。结论地屈孕酮联合小剂量肠溶阿司匹林能有效减少复发性流产的发生。     

淋巴细胞免疫疗法治疗复发性流产的疗效分析

目的：探讨不明原因复发性流产临床治疗中淋巴细胞主动免疫治疗的临床价值。方法选取2010～2012年我院诊治的复发性流产患者50例,随机分为两组,分别行无特殊处理和淋巴细胞主动免疫治疗,同时对主动免疫治疗患者封闭抗体阴性与阳性的妊娠结局进行统计。结果观察组患者流产率显著低于对照组（P＜0.05）。主动免疫治疗后封闭抗体阳性患者妊娠成功率为88.5%,阴性患者妊娠成功率为57.1%,阳性组显著高于阴性组（P＜0.05）。结论淋巴细胞主动免疫治疗能过有效治疗复发性流产,具有良好的临床效果,而封闭抗体检测能够对妊娠结局有积极的预测作用。     

380例淋巴细胞主动免疫疗法治疗不明原因的复发性流产疗效观察

目的探讨淋巴细胞主动免疫治疗不明原因的复发性流产临床疗效。方法选取2009年10月至2013年6月我院诊治的复发性流产患者749例,分为淋巴细胞主动免疫治疗组(380例)和黄体酮常规保胎对照组(369例)。根据淋巴细胞注射时机和淋巴细胞来源不同,淋巴细胞免疫治疗组又分为3组。A方案:常规方案;B方案:应急方案;C方案:备选方案。对各组的妊娠结局、再发流产率与妊娠成功率进行比较分析。结果治疗组患者流产率(10.3%)显著低于对照组(67.8%)(P0.05)。主动免疫治疗组患者妊娠成功率为89.7%,对照组治疗成功率为32.2%,差异有统计意义(P0.01)。治疗A、B、C三方案的再发流产率与妊娠成功率进行比较,差异均无统计学意义(P0.05)。结论淋巴细胞主动免疫治疗能有效治疗复发性流产,具有良好的临床效果。封闭抗体检测能够对妊娠结局有积极的预测作用。     

小剂量抑肽酶在体外循环中对血小板功能的保护作用

本文取３０例患者，随机分为两组（每组１５例），对照组预充液中加入等量的生理盐水；实验组预充液中一次性加入１５～２０×１０６ＫＩＵ抑肽酶。观察两组转机前后血小板计数和平均体积及血小板粘附、聚集功能。结果为转机后血小板数量变化不大，对照组的血小板功能较实验组明显下降。实验组的出血量及输血量较对照组低，表明小剂量抑肽酶能够保护转机期间血小板功能，减少术后出血。     

新生化颗粒联合米索前列醇治疗药物流产后阴道流血的疗效观察

目的观察新生化颗粒联合米索前列醇治疗药物流产后阴道流血的临床疗效。方法选取我院2012年4月-2013年10月期间收治的药物流产患者68例,按照随机分配的原则,分为观察组和对照组各34例。观察组在常规治疗的基础上给予米索前列醇联合新生化颗粒口服,对照组在常规治疗的基础上给予益母草浸膏口服。对两组的临床疗效进行比较。结果治疗组阴道流血量明显少于对照组,出血持续时间≤1周也明显短于对照组（P〈0.05）。对药物流产后阴道流血的总有效率,治疗组明显高于对照组（P〈0.05）。结论新生化颗粒联合米索前列醇治疗药物流产后阴道流血疗效确切,可以明显缩短药物流产后阴道流血时间和减少流血量,值得临床推广使用。     

The effect of low-dose aspirin and platelet aggregation in familial hypercholesterolaemia

Since the platelets of patients with familial hypercholesterolaemia (FH) are hyperaggregable, the inhibitory effect of low-dose aspirin on platelet aggregation in response to adenosine diphosphate, collagen, adrenaline and arachidonic acid was tested in 9 young adult patients with FH and compared with that in 9 normal subjects. After a single oral dose (150 mg) of aspirin the degree of inhibition of platelet aggregation was the same in the two groups, as was the recovery time (in days) for full restoration of platelet aggregation . In a second experiment in which 162 mg aspirin was administered daily for 28 days, inhibition of platelet aggregation was sustainable in both the patient and the control groups. These results suggest that despite the recognized hyperaggregability of platelets from patients with FH, daily low-dose aspirin ingestion effectively inhibits their in vitro aggregation and may therefore prove beneficial as supplemental therapy to reduce the rate of myocardial infarction in this high-risk group.     

小剂量阿斯匹林在显微血管外科应用中的研究

目的 研究小剂量阿斯匹林对小动物吻合口血小板沉积及对凝血系统功能的影响，为临床用药提供实验依据。方法 ＳＤ大鼠２８只，实验组（２１只）阿斯匹林４ｍｇ／ｋｇ，经股静脉插管注射，对照组（７只）用等体积生理盐水，实验组动物按给药后存活２４、４８和７２小时再分组，每组７只。给药后，在上述时间间隔，经心脏穿刺采血，测血小板最大聚集率（ＭＡＲ）、凝血酶原时间（ＰＴ）和白陶土部分凝血活酶时间（ＫＰＴＴ）。新西半     

Platelet function profiles in patients with type 2 diabetes and coronary artery disease on combined aspirin and clopidogrel treatment

To assess platelet function profiles in diabetic and nondiabetic patients on aspirin and clopidogrel therapy, two patient populations were included to investigate the 1) acute effects of a 300-mg clopidogrel loading dose (group 1, n = 52) and 2) long-term effects of clopidogrel (group 2, n = 120) on platelet function in diabetic compared with nondiabetic patients already on aspirin treatment. Patients were stratified according to the presence of type 2 diabetes. Platelet aggregation was assessed using light transmittance aggregometry (groups 1 and 2). Platelet activation (P-selectin expression and PAC-1 binding) was determined using whole-blood flow cytometry (group 2). Clopidogrel response was also assessed. In group 1, platelet aggregation was significantly increased in diabetic (n = 16) compared with nondiabetic (n = 36) patients at baseline and up to 24 h following a 300-mg loading dose (P = 0.005). In group 2, platelet aggregation and activation were increased in diabetic (n = 60) compared with nondiabetic (n = 60) subjects (P < 0.05 for all platelet function assays). Diabetic subjects had a higher number of clopidogrel nonresponders (P = 0.04). Diabetic patients have increased platelet reactivity compared with nondiabetic subjects on combined aspirin and clopidogrel treatment. Reduced sensitivity to antiplatelet drugs may contribute to the increased atherothombotic risk in diabetic patients.     

重症感染患者早期应用小剂量肝素治疗的临床研究

目的观察早期小剂量肝素治疗重症感染患者的疗效。方法重症感染成年患者22例,随机分为两组：实验组和对照组。对照组行常规ICU治疗,实验组除常规治疗外,早期应用小剂量肝素。在入ICU后每日检测记录患者凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、血小板计数、APACHEⅡ评分、入ICU的时间、住院时间、治愈率、28d生存率。结果治疗后实验组胛、APTT改善,对照组PT,APTT无明显变化,两组间血小板变化无差异;实验组入ICU的时间明显少于对照组（P〈0．01）;实验组治愈率（81．8％）明显高于对照组（54．5％）;实验组住院时间和28d生存率与对照组之间无显著差异（P〉0．05）。结论早期小剂量肝素治疗可改善重症感染患者的凝血指标,减少患者在ICU的住院时间,提高其治愈率,但未能改善生存率。     

Low-dose aspirin protects against lipid accumulation in primate vein bypass grafts

Platelet inhibition with high-dose aspirin combined with dipyridamole reduces lipid accumulation and improves early patency of coronary artery bypass grafts. However, recent evidence suggests that platelet inhibition can be achieved with substantially lower aspirin doses than have been conventionally prescribed. To evaluate whether low-dose aspirin protects against lipid accumulation in bypass grafts, we studied 15 stump-tailed macaque monkeys in which autologous cephalic veins were grafted into the femoral arteries. A control group received no treatment, a second group was treated with a low, single daily dose of aspirin (12 mg), and a third group was given a higher dosage of aspirin (80 mg/day) combined with dipyridamole (50 mg/day) divided into two daily doses. A special diet was fed that resulted in plasma cholesterol levels (224 +/- 50 mg/dl, mean +/- standard deviation) and plasma lipoprotein distributions that mimic the profile in humans. Cholesterol concentration in grafts removed 3 months after insertion was 0.47 +/- 0.12 mg/100 mg tissue in the control group; it was reduced to 0.23 +/- 0.04 mg/100 mg (p less than 0.001) by low-dose aspirin and to 0.17 +/- 0.05 mg/100 mg (p less than 0.001) by combined aspirin and dipyridamole therapy. Graft apolipoprotein B concentration was 66 +/- 19 micrograms/100 mg in control group; it was reduced to 40 +/- 8 micrograms/100 mg (p less than 0.05) by low-dose aspirin and to 23 +/- 7 micrograms/100 mg (p less than 0.001) with the combination treatment. There were no differences between groups in either cholesterol concentration (0.09 +/- 0.02 mg/100 mg) or apolipoprotein B concentration (10 +/- 3 micrograms/100 mg) in normal ungrafted vein. Platelet function tests demonstrated platelet aggregation in all control monkeys, in none of the combined therapy group, and in two of five monkeys receiving low-dose aspirin. This study indicates that low-dose aspirin is protective against graft lipid accumulation in monkeys. The mechanism of this antilipid effect and its relation to any antithrombotic effect remain to be elucidated.     

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)     

Inhibition of platelet aggregation by combined therapy with aspirin and cilostazol after off-pump coronary artery bypass surgery

BACKGROUND: Although off-pump coronary artery bypass (OPCAB) has become an increasingly common surgical procedure, recent concerns have been raised regarding the existence of a hypercoagulable or prothrombotic state associated with OPCAB. To determine the optimal antiplatelet regimen after OPCAB, we investigated the effects of aspirin alone and of combined therapy with aspirin + cilostazol on platelet aggregation in patients after OPCAB. Material and Methods: Twenty patients scheduled to undergo OPCAB were randomized to one of two antiplatelet regimens: aspirin alone (n=10) and aspirin + cilostazol (n=10). Anti-platelet agents had not been received for at least 1 week before surgery and were initiated on the afternoon of postoperative day 1. Platelet aggregability and hemostatic parameters were evaluated at four time points: before and 3, 7, and 14 days after OPCAB. We measured agonist-and shear stress-induced platelet aggregation (SIPA) using a modified cone-plate viscometer. RESULTS: No complications resulting from postoperative antiplatelet therapy-related bleeding were seen in either group. Collagen-and arachidonate-induced platelet aggregation and SIPA were significantly inhibited in the aspirin + cilostazol group compared with the aspirin-alone group (collagen-and arachidonate-induced aggregation, p<0.0001; SIPA, p=0.0367). Adding cilostazol to aspirin augmented the inhibitory effects on platelet aggregation induced by collagen and arachidonate. adenosine diphosphate (ADP)-induced platelet aggregation tended to be inhibited in the aspirin + cilostazol group compared with the aspirin-alone group (p=0.0534). CONCLUSION: The results of this study suggest that combined therapy with aspirin + cilostazol is more effective than aspirin monotherapy in reducing platelet aggregation in patients after OPCAB. This combination therapy may represent a new therapeutic option for an anti-thrombotic regimen in patients after OPCAB.