丙泊酚麻醉应用于食管癌内镜黏膜下剥离术中的有效性及对患者纤维蛋白原和D-二聚体的影响

目的观察丙泊酚麻醉应用于食管癌内镜黏膜下剥离术中的有效性以及对患者血清纤维蛋白原和D-二聚体水平的影响。方法选取食管癌患者89例,根据患者麻醉方法不同分为对照组44例和观察组45例。对照组患者应用维库溴铵和芬太尼进行麻醉;观察组在对照组基础上给予持续静脉泵入丙泊酚;2组患者均采取内镜黏膜下剥离术(ESD)。比较2组手术时间、术中出血量及住院时间;记录2组患者1个月随访期间并发症发生情况。比较2组术后Ransay和视觉模拟疼痛评分(VAS)。检测2组血清中纤维蛋白原和D-二聚体水平。结果观察组患者的手术时间、术中出血量及住院时间均显著少于对照组(P<0.01)。对照组患者并发症发生率为11.36%,观察组患者并发症发生率为4.44%,差异无统计学意义(P>0.05)。术后6 h,观察组患者的Ransay评分显著高于对照组,VAS评分显著低于对照组(P<0.01)。术后6 h,观察组患者血清中纤维蛋白原和D-二聚体水平显著低于对照组,差异有统计学意义(P<0.01)。结论在食管癌内镜黏膜下剥离术中加用丙泊酚麻醉效果确切,安全性好,且可降低患者血清纤维蛋白原和D-二聚体水平。     

晚期非小细胞肺癌患者化疗过程中体内血浆D-二聚体及纤维蛋白原水平临床分析

目的检测晚期非小细胞肺癌(NSCLC)患者化疗前和化疗过程中体内血浆D-二聚体及纤维蛋白原(fibrinogen,FIB)水平,研究二者浓度变化与化疗效果和无进展生存期(progression-free survival,PFS)的关系。方法选取晚期非小细胞肺癌患者120例,收集并记录患者第1、2、3次化疗前血浆D-二聚体及纤维蛋白原水平、肿瘤病理类型、分期及无进展期。同时收集60例健康人员的血浆D-二聚体及纤维蛋白原水平作对照。结果血浆D-二聚体及纤维蛋白原水平的异常升高与晚期非小细胞肺癌患者的年龄、性别、肿瘤分期及病理类型均无相关性。对照组D-二聚体和FIB水平分别为0.47 mg/L和3.76 g/L,明显低于化疗前晚期NSCLC患者的(0.96 mg/L和4.32 g/L),差异具有统计学意义(P<0.05)。化疗两个周期后,有效(PR+SD)的晚期NSCLC患者D-二聚体和FIB水平分别为0.65 mg/L和2.74 g/L,无效患者分别为1.72 mg/L和4.65 g/L,对比差异具有统计学意义(P<0.05)。晚期NSCLC患者的PFS中位数为5.4个月,化疗前D-二聚体和FIB阴性的患者PFS明显长于阳性患者,差异具有统计学意义(P<0.05)。将3次化疗前患者的D-二聚体和FIB水平进行对比,虽在不断降低,但差异无统计学意义(P均>0.05)。结论晚期非小细胞肺癌患者化疗前D-二聚体和FIB水平异常升高,能够提示肺癌的诊断。治疗过程中要监测肿瘤进展情况,及时调整治疗方案,延长患者PFS。     

急性白血病血浆内皮素水平及其对纤溶系统的影响

为研究急性白血病患者血浆内皮素水平及其对纤溶系统的影响。方法测定了５３例急性白血病性白血病患者ＥＴ及纤溶指标ＰＡ、ｔＰＡ：Ａ、ＰＡＩ：Ａ、Ｄ－Ｄ。结果急性白血病患者ＥＴ水平明显高于正常,以初治及未缓解组ＥＴ升高显示,完全缓解组较初治及未缓解组明显降低。     

直肠癌患者血浆D-二聚体和纤维蛋白水平的检测及临床价值

目的探讨直肠癌患者血浆D-二聚体(D-dimer)和纤维蛋白原(Fib)水平变化与直肠癌疗效、预后的关系。方法取250例直肠癌患者和40例对照组(健康体检者)的静脉血,应用全自动血凝仪测定,血浆D-二聚体含量采用乳胶凝集半定量法测定,血浆纤维蛋白原含量采用Clauss法测定。结果250例直肠癌患者中,直肠癌初治组、难治转移组、治疗缓解组的血浆D-二聚体和纤维蛋白原水平明显升高,与对照组比较差别有显著性;治疗缓解组的血浆D-二聚体、纤维蛋白原水平较初治组及难治转移组有明显下降。结论血浆D-二聚体和纤维蛋白原水平变化与直肠癌的病情严重程度及预后有明显相关性,可作为直肠癌的辅助诊断及预后判断的一项早期实验室参考指标。     

结肠癌术前血浆纤维蛋白原水平与临床病理特征的关系

目的 探讨结肠癌术前血浆纤维蛋白原与临床病理特征的关系。方法 收集新疆医科大学附属肿瘤医院2005年6月至2008年6月收治的接受根治术治疗的255例结肠癌患者临床病理资料,对其术前纤维蛋白原水平与临床病理特征间的关系进行单因素分析,Logistic回归进行多因素分析。结果 255例结肠癌患者的术前纤维蛋白原为（3.17±0.88）g/L,单因素分析显示年龄、吸烟、肿瘤大小、肿瘤位置、TNM分期、mGPS（modify glasgow prognostic）评分、白细胞计数、NLR（neutrophil/lymphocyte ratio）、PLR（platelet/lymphocyte ratio）及CEA均与纤维蛋白原有相关性,差异具有统计学意义（P<0.05）;而民族、BMI、分级、大体类型、神经/淋巴管浸润、AFP均与纤维蛋白原无相关性（P>0.05）。多因素分析显示白细胞计数（RR=4.08, 95.0%CI:2.07~8.04, P=0.00）和PLR（RR=1.79,95.0%CI:1.02~3.14, P=0.04）与纤维蛋白原具有相关性,差异具有统计学意义（P<0.05）。结论 年龄、吸烟、肿瘤大小、肿瘤位置、TNM分期、mGPS评分、白细胞计数、NLR、PLR及CEA与纤维蛋白原均具有相关性,白细胞计数与PLR可能成为影响纤维蛋白原的独立危险因素;这一发现为降低血清纤维蛋白原以纠正高凝状态、降低炎性微环境提供理论基础。     

Characterization of the Fibrinogen Binding Factor from Candida albicans and Candida tropicalis in Quantitative Immunoelectrophoresis

Summary:  The fibrinogen binding factor (FBF) was characterized in Candida albicans and Candida tropicalis reference systems by crossed immunoaffinoelectrophoresis (CIAE) with free fibrinogen in the first dimension gel. The FBF of Candida albicans and Candida tropicalis showed the same mobility and reactivity and corresponded to a cross reactive glycoproteic antigen. Thus CIAE provides a useful tool for the identification of biologically active antigens.
Zusammenfassung:  Der Fibrinogen-bindende Faktor (FBF) wurde in Candida albicans- und Candida tropicalis -Referenz-systemen mittels gekreuzter Immunoaffinoelektrophorese (CIAE) mit freien Fibrinogen in der ersten Dimension charakterisiert. Die FBF von Candida albicans und Candida tropicalis zeigten die gleiche Motilität und Reaktivität und entsprachen einem kreuzreagierenden Glykoprotein. Die CIAE erweist sich somit als geeignetes Instrument für die Identifizierung biologisch aktiver Antigene.     

恶性肿瘤患者凝血指标的临床分析

目的观察恶性肿瘤患者凝血指标的变化并探讨其临床意义。方法选取50例恶性肿瘤患者作为试验组,以同期50例健康体检者作为正常对照组。检测患者及正常体检者的血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原定量(FIB)及凝血酶时间(TT),并对比分析。结果试验组患者的PT和TT与健康体检者相比,差异无统计学意义(P>0.05);而APTT和FIB与正常对照组相比,差异有统计学意义(P<0.05)。不同类型恶性肿瘤患者的PT、TT、APTT、FIB比较,差异无统计学意义(P>0.05)。结论 APTT和FIB的测定在监测恶性肿瘤患者凝血功能上有一定的意义,其应用价值可作进一步研究。     

血浆纤维蛋白原水平与肺癌临床病理特征及预后的相关性分析

目的 探讨血浆纤维蛋白原水平与肺癌临床病理特征及预后的相关性.方法 回顾性分析120例初治肺癌患者的临床病理资料,设为观察组,另选取100例同期健康体检人群为对照组.比较两组血浆纤维蛋白原(FIB)及D-二聚体(DD)水平,同时分析观察组患者FIB及DD水平与其病理特征的关系,并统计观察组患者生存期与FIB及DD水平的相关性.结果 经研究发现,观察组患者FIB及DD水平明显较对照组高,P＜0.05;观察组患者FIB及DD水平与肿瘤大小、病理类型及临床分期等无明显关联,P ＞0.05.观察组患者生存期与FIB及DD表达水平呈负相关性,P＜0.05.结论 密切关注肺癌患者FIB及DD水平,并加强抗凝治疗,从而对改善其预后具有重要价值.     

Effects of Chemoendocrine Therapy on the Coagulation-Fibrinolytic Systems in Patients with Advanced Breast Cancer

In order to predict a hypercoagulable state in patients with advanced breast cancer receiving medical treatment, the effects of Chemoendocrine therapy on the coagulation-flbrinolytic systems were investigated prospectively. The patients were randomly divided into two groups. The ACT group had 38 patients, who received 20 mg/m² adriamycin (ADM) i.v. on days 1 and 8, 100 mg cyclophosphamide (CPA) p.o. on days 1–14, and 20 mg tamoxifen (TAM) p.o. daily. The ACM group had 44 patients, who received 20 mg/m² ADM i.v. on days 1 and 8, 100 mg CPA p.o. on days 1–14 and 1200 mg medroxyprogesterone acetate (MPA) p.o. daily. The treatment was repeated every 28 days until there was evidence of progressive disease or until the full ADM dose (550 mg/m²) had been given. The following 9 hematologic parameters were measured every 4 weeks: alpha 2-plasmin inhibitor plasmin complex (PIC), anti-thrombin-III (AT-III), D-dimer (Dd), fibrinogen (Fg), plasminogen (Pg), protein C (PC), thrombin-antithrombin-III complex (TAT-III), tissue plasminogen activator (t-PA), and factor × (FX). Compared to the ACT group, patients in the ACM group showed significantly higher values of AT-III and PC, which exceeded the normal ranges. The levels of Pg, t-PA and FX were significantly higher in the ACM group than in the ACT group, but were still within the normal ranges. The levels of TAT-III, Dd and PIC decreased in the ACT group and were unchanged in the ACM group after the start of treatment. Fg remained unchanged in both groups after the start of treatment. One patient in the ACM group had thrombophlebitis of the lower extremities with high levels of TAT-III, Dd and PIC and a decrease of Fg, but her condition returned to normal after reduction of the MPA dose. Although these data are not directly indicative of a hypercoagulable state in patients receiving Chemoendocrine therapy, changes in AT-III, TAT-III, Dd and PIC should be monitored carefully when this type of treatment is given.     

晚期恶性肿瘤患者凝血、抗凝、纤溶状况的初步调查

目的调查晚期恶性肿瘤患者凝血、抗凝及纤溶系统分子标志物的改变情况,初步探讨恶性肿瘤的发生发展与凝血状况间的关系。方法采用酶联免疫吸附双抗体夹心法检测68例晚期恶性肿瘤患者和70名正常人与凝血、抗凝、纤溶系统和内源性抗凝防御活性相关的实验室指标,包括血浆纤维蛋白原(Fbg),血管性血友病因子抗原(vWF∶Ag),凝血酶—抗凝血酶复合物(TAT),组织型纤溶酶原活化剂活性(t-PA∶A),尿激酶型纤溶酶原活化剂活性(u-PA∶A),纤溶酶原活化抑制物-1活性(PAI-1∶A),D-二聚体(D-dimer)。结果晚期恶性肿瘤患者的血浆D-二聚体、纤维蛋白原、组织型纤溶酶原活化剂活性、纤溶酶原活化抑制物-1活性、血管性血友病因子抗原的水平较正常人显著升高(P<0.05)。结论晚期恶性肿瘤患者体内存在凝血、抗凝、纤溶系统的激活及内源性抗凝防御活性的降低,机体呈现高凝状态。     

Significance of fibrinogen, D-dimer, and LDH levels in predicting the risk of bleeding in patients with acute promyelocytic leukemia

This study was performed to determine whether any clinical parameters measured at diagnosis or during treatment are associated with bleeding in patients with acute promyelocytic leukemia (APL). Ninety patients with APL who were treated with all-transretinoic acid (ATRA) and anthracycline-based chemotherapy were analyzed. There were 24 significant bleeding events, classified by onset as ‘hyperacute’ (n = 5), ‘acute’ (n = 11) and ‘late’ (n = 8). Fifteen patients (17%) died because of bleeding. A poor fibrinogen (FBG) response during ATRA and chemotherapy was associated with an increased risk of bleeding (p = 0.003). Increased LDH and decreased FBG levels were associated with an increased incidence of bleeding, and low PLT count was correlated with death from bleeding. Our findings suggest that LDH/FBG levels and FBG response may be associated with morbidity and mortality from bleeding in patients with APL.     

Thoracic tumor effects on plasmatic coagulation: Role of hemeoxygenase-1

Objectives

Lung cancer is an important health threat worldwide, and is associated with a 3.8–13.9% incidence of thrombophilia. Of interest, patients with lung tumors have been noted to have an increase in endogenous carbon monoxide production via upregulation of hemeoxygenase-1 activity. Given that it has been demonstrated that carbon monoxide enhances plasmatic coagulation in vitro and in vivo via formation of carboxyhemefibrinogen, we sought to determine if patients with thoracic tumors undergoing lung resection/pneumonectomy had an increase in endogenous carbon monoxide and concurrent plasmatic hypercoagulability.

Materials and methods

Nonsmoking patients with thoracic tumors (n = 19) had preoperative carboxyhemoglobin (a measure of carbon monoxide production) determined, and a thromboelastometric method to assess citrated plasma coagulation kinetics and the formation of carboxyhemefibrinogen was utilized. Thoracic tumor patient coagulation kinetics was compared with normal subject (n = 30) plasma samples.

Results and conclusion

Patients with thoracic tumors were determined to have an abnormally increased carboxyhemoglobin concentration of 2.1 ± 0.6%, indicative of hemeoxygenase-1 upregulation. It was found that 84% of thoracic tumor patients had plasma clot strength that exceeded the 95% confidence interval value observed in normal subjects, and 44% of this hypercoagulable subgroup had carboxyhemefibrinogen formation. Future investigation of the role played by plasmatic hypercoagulability and hemeoxygenase-1 derived carboxyhemefibrinogen in the pathogenesis of thoracic tumor related thrombophilia is warranted.     

术前纤维蛋白原联合血小板与淋巴细胞比值对膀胱癌根治术后患者的预后预测价值

目的探讨术前纤维蛋白原(FIB)联合血小板与淋巴细胞比值(PLR)对膀胱癌根治术(RC)后患者预后的预测价值。方法纳入141例行根治性切除术后的尿路上皮膀胱癌患者。ROC曲线确定FIB和PLR的cut-off值。将FIB、PLR分成高水平组和低水平组,二者均为低水平定义为组合评分0(S0),余均定义为组合评分1(S1)。单因素方差和非参数检验分析患者临床特征,Kaplan-Meier法行单因素生存分析,Log rank法进行检验,Cox比例风险模型进行多因素回归分析。结果 FIB和PLR最佳截断值分别为3.43和110.54。FIB水平与T分期、病理分级及肿瘤大小密切相关(均P<0.05),PLR水平与病理分级及肿瘤大小密切相关(P<0.05)。术前组合评分与T分期、N分期、病理分级及肿瘤大小密切相关(均P<0.05)。组合评分、T分期、肿瘤大小、FIB及PLR是影响预后的重要因素。组合评分(P=0.019)、T分期(P=0.021)及FIB(P=0.010)是影响膀胱癌患者预后的独立危险因素。结论组合评分是影响膀胱癌根治术后患者总生存期的独立危险因素,可作为预测膀胱...     

凝血功能与肺癌分期及病理分型的关系

目的 研究肺癌患者的凝血功能与肿瘤病理类型及分期的关系,并探讨其临床意义。方法 收集南京医科大学第一附属医院胸心外科2012年1月至2012年6月连续76例行手术治疗的肺癌患者,检测患者血浆组织因子（TF）、D-二聚体、血浆纤维蛋白原（FIB）、纤维蛋白原降解产物（FDP）水平及血小板（PLT）计数,按不同病理类型及术后分期对以上指标进行比较。结果 Ⅲ期、Ⅳ期患者的血浆D-二聚体、TF水平明显高于Ⅱ期患者,差异有统计学意义（P＜0.05） 。肺腺癌患者TF、D-二聚体水平明显高于肺鳞癌患者,差异有统计学意义（P＜0.05）。结论 肺癌患者凝血功能与病理类型、肿瘤分期有关,早期发现并改善高凝状态,可能对肺癌预后有意义。     

凝血和纤维蛋白溶解系统与实体瘤静脉血栓形成及转移的相关研究

 【摘要】　目的　探讨凝血和纤维蛋白溶解系统在实体瘤中的变化，对实体瘤易于并发血栓形成的机制以及实体瘤转移机制进行探讨。方法　ELISA 法检测实体瘤患者血浆组织因子（TF）和组织因子途径抑制物（TFPI）、组织型纤溶酶原活化剂（t-PA）、尿激酶型纤溶酶原活化剂（u-PA）及其抑制物PAI-1的浓度。同时发色底物法检测血浆蛋白C活性（PC：A）。结果　血浆TF、TFPI、u-PA、PAI-1 浓度实体瘤均高于正常对照；发生转移组高于无转移者。死亡组 u-PA、PAI-1高于存活组而TFPI降低。并发静脉血栓组t-PA明显增高而PC：A低于对照组。结论　实体瘤患者容易形成静脉血栓与其存在的凝血系统和纤维蛋白溶解系统紊乱有关；凝血和纤维蛋白溶解相关因子参与了肿瘤的转移和向周围组织的浸润；u-PA、PAI-1及TFPI与肿瘤预后有关。     

急性白血病TF、TFPI、t-PA以及PAI-1的变化及其意义

 目的　观察凝血和纤维蛋白溶解系统在急性白血病（AL）的变化,为AL凝血功能紊乱提供依据。方法　采用ELISA 法检测71例AL患者血浆组织因子（TF）和TF途径抑制物（TFPI）、组织型纤维蛋白酶原活化剂（t-PA）及其抑制物PAI-1浓度,同时用发色底物法检测血浆蛋白C活性（PC∶A）。30 名门诊体检正常人作为对照组 。结果　AL初治组和未缓解组,TF、t-PA和PAI-1均增高,差异有统计学意义（TF,F =1238.5,Ｐ＜0.001;t-PA,F = 61.2,P＜0.001;PAI-1,F = 91.7,P＜0.001）。TFPI 在各组之间差异无统计学意义。蛋白C活性在AL并发DIC组低于非DIC组,差异有统计学意义（F = 78.1,P＜0.001）。DIC组TF、t-PA 及PAI-1则较非DIC组明显增高,差异有统计学意义（TF,F = 479.0,P＜0.001;t-PA,F = 139.6,P＜0.001;PAI,F = 260.2,P＜0.001）。结论　AL患者凝血功能紊乱与凝血系统和纤维蛋白溶解系统失平衡有关,TF、t-PA和PAI-1与病情变化有关,可以作为AL的预后指标。蛋白C活性降低及TF,t-PA、PAI-1增高在AL并发DIC过程中有重要意义。