血浆TF、TFPI、D-D测定在AL患者中临床价值研究

目的探讨急性白血病（AL）患者血浆组织因子（TF）及组织因子途径抑制物（TFPI）、D-二聚体（D-D）的含量变化对其病情进展、疗效观察及预后的意义。方法检测44例AL患者初诊时及化疗1个疗程后第7 d血浆TF、TFPI及D-D的水平,并检测20例正常体检者和随访期间8例复发的AL患者血浆TF、TFPI及D-D的水平。所有患者平均随访180 d,观察随访期间病情变化。结果 AL组患者血浆TF、TFPI和D-二聚体水平明显高于正常组;缓解组患者血浆TF、TFPI水平均较初诊时明显下降（P〈0.01）且与对照组差异无统计学意义（P〉0.05）,D-D水平比治疗前明显降低但仍高于正常组（P〈0.01）;D-D比初诊时明显降低但仍高于对照组（P〈0.01）。未缓解组患者治疗后与初诊时比较血浆TF、TFPI水平比较差异无统计学意义（P〉0.05）且均明显高于正常对照组（P〈0.01）;复发时血浆TF、TFPI和D-D水平均明显升高,与初诊相比差异均有统计学意义（P〈0.01）。结论动态观察白血病患者血浆TF、TFPI、D-D变化对AL患者判断病情、预测复发、指导治疗有重要意义。     

组织因子及其抑制物在妊娠期高血压疾病患者血浆中的表达及临床意义

目的探讨妊娠期高血压疾病患者血浆中组织因子(tissue factor,TF)及其抑制物——组织因子途径抑制物(tissue factor pathway inhibitor,TFPI)的表达变化。方法选取2012~2014年在石家庄市第二医院分娩的87例妊娠期高血压疾病患者,根据病情分为妊娠期高血压组45例,子痫前期组42例,同时选取48例正常孕妇为对照组。采用酶联免疫吸附试验(ELISA)检测TF、TFPI在妊娠期高血压患者、子痫前期患者及正常妊娠妇女血浆中的表达并探讨其临床意义。结果妊娠期高血压组血浆中TF、TFPI表达与正常妊娠组比较,差异无统计学意义(P0.05);子痫前期组TF表达显著升高,TFPI表达下降,与正常妊娠组和妊娠期高血压组比较,差异有统计学意义(P0.05)。妊娠期高血压组TFPI/TF比值降低,而子痫前期组TFPI/TF比值下降更为明显,两组与正常妊娠组比较,差异均有统计学意义(P0.05)。结论血浆中TF、TFPI值的变化及其比例失调可能导致了凝血功能的异常,并促使了妊娠期高血压疾病的发生、发展,有望成为预测妊娠期高血压疾病的新指标。     

冠心病患者血浆组织因子水平及影响因素分析

目的探讨血浆组织因子（tissue factor,TF）水平与冠心病的相关性。方法对237例疑诊为冠心病的患者进行冠状动脉造影,按结果分为冠心病组（n=149）和正常对照组（n=88）进行病例对照研究。所有入选对象检测血脂、血糖、血尿酸、超敏C反应蛋白、纤维蛋白原以及血浆TF的水平。采用spearman等级相关、pearson积差相关和Logistic多元回归等方法,分析血浆TF水平和冠心病的相关性,以及TF水平与冠心病其他危险因素的关系。结果冠心病组血浆TF较对照组明显升高（P〈0.01）;2组内男性和女性差异均无统计学意义（P〉0.05）;有糖尿病亚组和无糖尿病亚组的差异均有统计学意义（P〈0.05）。血浆TF水平与冠心病呈正相关（r=0.791,P〈0.001）,与糖尿病、低密度脂蛋白胆固醇（LDL-C）、脂蛋白（a）[Lp（a）]、超敏C反应蛋白（Hs-CRP）、纤维蛋白原（FIB）均呈正相关（分别r=0.172,0.180,0.147,0.380,0.175;P均〈0.05）。Logistic多元回归分析显示,排除年龄、LDL-C、糖尿病,高血压、吸烟等因素影响,血浆TF水平仍与冠心病发生存在有意义的回归关系。结论血浆TF升高可能是冠心病的重要危险因素之一,高水平的TF诱导血栓形成,促进冠心病的发生发展,也是冠心病患者预后的预测指标之一。     

冠心病活化血小板内TFPI的表达及低分子肝素对其抗凝机制的作用

目的探讨冠心病患者活化血小饭内组织因子途径抑制剂（TFPI）的表达及其与低分子肝素（LM—WH）抗凝机制的关系。方法用RT—PCR和ELASA法对急性心肌梗死（AMI）、不稳定型心绞痛（UA）、稳定型心绞痛（SA）患者及正常对照组（CG）进行血小板内TFPI水平和mRNA及三组患者应用LMWH前后血浆游离组织因子途径抑制剂（FTFPI）水平的检测。结果（1）AMI组、UA组血小板内TFPI mRNA的表达升高,与对照组比较,差异有统计学意义（P〈0．05）。（2）AMI组、UA组和SA组的FTFPI水平分别为93．39、74．91、62．98μg／L,与对照组相比,前两组水平明显升高。（3）血小板TFPImRNA的表达与AMI组、UA组、SA组血浆FTFPI水平具有良好的相关件。（4）三组患者应用LMWH后,FTFPI水平分别为141．87、116．82、107．28μG/L,与治疗前相比,差异有统计学意义（P〈0．01）。结论冠心病患者活化血小板内TFPImRNA的表达升高,并且血小板内TFPI参与LMWH的抗凝机制．     

冠状动脉介入治疗对组织因子途径抑制物的影响

目的　探讨冠状动脉介入治疗对冠心病患者冠脉循环前后组织因子途径抑制物 (TFPI)的影响。方法　用酶联免疫吸附法 (ELISA)检测 42例冠心病患者经皮冠状动脉球囊成形和 /或支架植入术前、术后冠状静脉窦 (CS)和冠状动脉窦 (CA)血浆TFPI含量 ,同时发色底物法测定其活性。结果　冠脉介入治疗术前冠状静脉窦比冠状动脉窦血浆TFPI含量明显升高 (P <0 0 5 ) ,但术后冠状静脉窦与冠状动脉窦血浆TFPI活性比较无显著性差异 (P >0 0 5 ) ;术后冠状静脉窦和冠状动脉窦血浆TFPI含量与活性均较其术前明显升高 ( P <0 0 5 )。结论　冠心病患者冠脉循环后血浆TFPI含量升高 ,冠脉介入治疗术后其含量与活性明显增加 ,TF PI发挥抗凝、抗血栓作用     

急性冠脉综合征患者组织因子、组织因子途径抑制物、肿瘤坏死因子-α的变化及其相关性

目的观察急性冠脉综合征(ACS)患者组织因子(TF)、组织因子途径抑制物(TFPI)、肿瘤坏死因子-α(TNF-α)水平与TF活性的变化,分析它们之间的相关性,探讨凝血与炎症在冠心病病程中的临床意义。方法选择ACS组患者36例,稳定性心绞痛(SAP)组患者32例,正常对照组28例,采用酶联免疫双抗体夹心法(ELISA法)测定血浆TF、TFPI水平,放射免疫分析法测定血清TNF-α水平,采用发色底物法测定TF活性。结果ACS组TF、TFPI、TNF-α水平及TF活性均显著高于SAP组与正常对照组(P<0.01),SAP组TF、TFPI水平与TF活性也显著高于正常对照组(P<0.01),但TNF-α在两组之间无显著性差异(P>0.05),ACS组患者血浆TF活性与血浆TFPI水平显著正相关(γ=0.524,P<0.01),血浆TF活性与血清TNF-α水平显著正相关(γ=0.462,P<0.01)。结论TF、TFPI、TNF-α水平及TF活性在ACS中可作为反映凝血异常和炎症状态的指标之一。     

急性白血病化疗前后血浆TF、TFPI的动态变化及其临床意义

目的比较急性白血病化疗前后血浆组织因子(TF)和组织因子途径抑制物(TFPI)的变化,探讨其在在病情进展、疗效观察及预后判断中的价值。方法选择2011年1月～2011年10月32例急性白血病患者为研究对象,分别于化疗前及缓解期采用酶联免疫吸附法(ELISA)测定两组血浆TF和TFPI含量。同时选择同期健康体检者30例为正常对照组。结果化疗前,急性白血病组患者血浆TF和TFPI分别为(77.9±12.2)ng/L、(160.3±20.2)ng/ml,明显高于正常对照组的(32.6±2.8)ng/L、(132.8±12.5)ng/ml,差异均有统计学意义(P﹤0.05)。32例患者化疗2个疗程后,24例缓解,8例未缓解。缓解组患者血浆TF及TFPI含量较化疗前明显下降,差异有统计学意义(P﹤0.05);未缓解组患者血浆TF及TFPI含量与化疗前比较,差异无统计学意义(P﹥0.05)。结论血浆TF及TFPI含量对急性白血病患者的病情进展及治疗效果具有一定的预测价值。     

丹红注射液对急性冠脉综合征患者血浆组织因子的影响

目的 探讨丹红注射液对急性冠脉综合征（ACS）患者血浆组织因子（TF）的影响。方法 选择典型急性冠脉综合征患者40例（ACS组），冠心病稳定期患者18例（对照组）。ACS2组随机分为常规治疗组（n=20）和丹红治疗组2个亚组，分别采用常规治疗及常规治疗＋丹红注射液治疗2周。抽取对照组及ACS组治疗前后血浆，采用酶联免疫吸附法（EHSA）测定血浆中TF浓度。结果 ACS组治疗前血浆TF浓度明显高于对照组（P〈0．05），经丹红注射液治疗2周后，TF浓度降低60％。与常规治疗相比差异有统计学意义（P〈0．05），丹红治疗组疗效明显高于常规治疗组（P〈0．05）。结论 丹红注射液可显著降低急性冠脉综合征患者血浆TF的表达。     

冠心病患者中脂联素在冠状动脉损害中的意义

目的探讨冠心病患者血浆脂联素水平与冠状动脉粥样硬化病变的关系。方法根据选择性冠状动脉造影结果将142例患者分为冠心病组和对照组。冠心病组根据临床诊断分为稳定型心绞痛（SAP）组和急性冠脉综合征（ACS）组；根据冠状动脉病变类型分为A型病变、B型病变和C型病变组；根据冠状动脉病变程度分为轻度病变、中度病变和重度病变组。血浆脂联素浓度通过ELISA方法测定。结果冠心病组脂联素浓度明显低于对照组（（6．09±1．85）μg／ml vs （10．25±1．51）μg/ml，P〈0．001），ACS组脂联素浓度又明显低于SAP组（5．45±1．53）μg／ml vs（7．60±1．67）μg／ml，P〈0．001）。随冠状动脉病变类型和病变程度的加重，脂联素浓度逐渐降低，各组间差异有统计学意义（P〈0．001）。结论脂联素是冠状动脉粥样硬化的负调控因子，低脂联素血症可以做为预测冠状动脉粥样硬化病变情况及斑块稳定性的一个指标。     

急性淋巴细胞白血病患儿血浆VEGF及TF的测定及其临床意义

目的检测血浆血管内皮细胞生长因子（VEGF）和组织因子（TF）在急性淋巴细胞白血病（ALL）患儿中的含量变化并探讨其临床意义。方法应用双抗体夹心酶联免疫吸附法检测33例ALL患儿血浆VEGF及TF在化疗前后含量的变化，并探讨两者之间的相关性及其临床意义。结果与对照组相比，初治组在化疗前血浆VEGF、TF含量明显增高，差异有统计学意义（P〈0.01）。未缓解组化疗前血浆VECF及TF的含量与完全缓解组化疗前和对照组相比明显升高，差异有统计学意义（P〈0.05或〈0.01），化疗后血浆VEGF和TF的含量无明显下降，与化疗前相比差异无统计学意义（P〉0.05），但明显高于完全缓解组化疗后和对照组（P〈0.05或〈0.01）。ALL初治患儿化疗前血浆VEGF与TF含量的增加呈正相关（P〈0.01）。结论VEGF及盯在ALL的发病中具有重要作用，可作为了解病情、观察疗效和判断预后的指标之一。     

Are olive oil diets antithrombotic? Diets enriched with olive, rapeseed, or sunflower oil affect postprandial factor VII differently

BACKGROUND: The incidence of ischemic heart disease (IHD) in Crete was lower than expected on the basis of blood lipid concentrations of participants in the Seven Countries Study. A favorable effect of a high intake of olive oil on thrombogenesis may have contributed to this finding. OBJECTIVE: We compared the effects of virgin olive oil with those of rapeseed and sunflower oils on blood coagulation factor VII (FVII), a key factor in thrombogenesis. DESIGN: In a randomized and strictly controlled crossover study, 18 healthy young men consumed diets enriched with 5 g/MJ (19% of total energy) olive oil, sunflower oil, or rapeseed oil for periods of 3 wk. On the final day of each period, participants consumed standardized high-fat meals (42% of energy as fat). Fasting and nonfasting blood samples were collected after each period. RESULTS: Mean (+/-SEM) nonfasting peak concentrations of activated FVII (FVIIa) were 11.3 +/- 5.1 U/L lower after olive oil than after sunflower oil, an 18% reduction (P < 0.05). Olive oil also tended to cause lower FVIIa peak concentrations than did rapeseed oil (mean difference: 8.6 U/L, a 15% reduction; P = 0.09). There were no significant differences between diets with respect to nonfasting factor VII coagulant activity (FVII:c), prothrombin fragment 1+2 (F1+2), and tissue factor pathway inhibitor (TFPI) concentrations, or with respect to fasting plasma values of FVII protein, FVII:c, FVIIa, F1+2, or TFPI. CONCLUSION: A background diet rich in olive oil may attenuate the acute procoagulant effects of fatty meals, which might contribute to the low incidence of IHD in Mediterranean areas.     

血浆中组织因子水平与妊娠高血压综合征关系的探讨

目的:观察妊娠高血压综合征(简称妊高征)患者血浆组织因子(TF)活性的变化。方法:用酶联免疫吸附法(ELISA)分别测定正常孕妇及妊高征患者血浆TF抗原水平。结果:妊高征组血浆TF活性高于正常对照组(P<0.01)。结论:妊高征患者血浆TF活性增高,可通过检测血浆TF活性作为预测妊高征预后的一种辅助手段。     

Postprandial factor VII metabolism: the effect of the R353Q and 10 bp polymorphisms

Elevated levels of coagulation factor VII activity (FVIIc) are associated with increased risk of CHD. FVIIc is strongly determined by two polymorphisms (R353Q and 0/10 base pairs (bp)) and plasma triacylglycerol (TAG) concentrations. The Q and 10 bp polymorphisms show strong linkage disequilibrium and have been associated with lower levels of fasting FVII, but there has been little investigation of the effect of these genotypes on the postprandial FVII metabolism. The present study demonstrated that fasting activated factor VII (FVIIa) and factor VII antigen (FVIIag) levels were significantly lower in the heterozygotes carrying the Q and 10 bp alleles (n 12), than in the R/0 bp homozygotes (n 12) (43.0 (SE 4.8) v. 23.9 (SE 6.5) mU/ml and 85.7 (SE 5.4) v. 71.6 (SE 7.5)% respectively). During postprandial lipaemia there was a significant increase in FVIIa in R/0 bp homozygotes but not in the heterozygotes carrying the Q and 10 bp alleles. The proportion of FVIIa (FVIIa:FVIIag) increased in the homozygotes but not in the heterozygotes (2.04 (SE 0.35) v. 1.20 (SE 0.26) respectively). Therefore possession of the relatively common Q and 10 bp alleles is not associated with postprandial activation of FVII, which may in turn have a protective effect against CHD.     

Effects of dietary fat quantity and composition on fasting and postprandial levels of coagulation factor VII and serum choline-containing phospholipids

Dietary fat influences plasma levels of coagulation factor VII (FVII) and serum phospholipids (PL). It is, however, unknown if the fat-mediated changes in FVII are linked to PL. The present study aimed to investigate the effects of dietary fat on fasting and postprandial levels of activated FVII (FVIIa), FVII coagulant activity (FVIIc), FVII protein (FVIIag) and choline-containing PL (PC). In a randomized single-blinded crossover-designed study a high-fat diet (HSAFA), a low-fat diet (LSAFA), both rich in saturated fatty acids, and a high-fat diet rich in unsaturated fatty acids (HUFA) were consumed for 3 weeks. Twenty-five healthy females, in which postprandial responses were studied in a subset of twelve, were included. The HSAFA diet resulted in higher levels of fasting FVIIa and PC compared with the LSAFA and the HUFA diets (all comparisons P< or =0.01). The fasting PC levels after the LSAFA diet were also higher than after the HUFA diet (P<0.001). Postprandial levels of FVIIa and PC were highest on the HSAFA diet and different from LSAFA and HUFA (all comparisons P< or =0.05). Postprandial FVIIa was higher on the HUFA compared with the LSAFA diet (P<0.03), whereas the HUFA diet resulted in lower postprandial levels of PC than the LSAFA diet (P<0.001). Significant correlations between fasting levels of PC and FVIIc were found on all diets, whereas FVIIag was correlated to PC on the HSAFA and HUFA diet. The present results indicate that dietary fat, both quality and quantity, influences fasting and postprandial levels of FVIIa and PC. Although significant associations between fasting FVII and PC levels were found, our results do not support the assumption that postprandial FVII activation is linked to serum PC.     

Effect of individual dietary fatty acids on postprandial activation of blood coagulation factor VII and fibrinolysis in healthy young men

BACKGROUND: Hypertriglyceridemia may represent a procoagulant state involving disturbances to the hemostatic system. Plasminogen activator inhibitor type 1 (PAI-1) is increased in the presence of hypertriglyceridemia. Free fatty acids (FFAs) in plasma may promote factor VII (FVII) activation. OBJECTIVE: We tested the hypothesis that FVII activation would be less after consumption of saturated fatty acids than after other fatty acids. DESIGN: The effects of 6 matching dietary test fats, rich in stearic (S), palmitic (P), palmitic + myristic (M), oleic (O), trans 18:1 (T), and linoleic (L) acid, respectively, on the postprandial lipid and hemostatic profile (after 2, 4, 6, and 8 h) were investigated in 16 young men. High-fat meals (1 g fat/kg body wt; 43% from the test fatty acid) were served in the morning on 6 separate days. RESULTS: All fats increased FVII activation. The S fat resulted in a lower increase in activated FVII (FVIIa) than did the T fat and in a lower FVII coagulant activity (FVII:c) than did the O fat (P < 0.02, diet x time interaction). When the data were pooled, the saturated (S, P, and M) test fats resulted in a smaller postprandial increase in FVIIa (P = 0.036, diet effect), a smaller increase in FVII:c (P < 0.001, diet x time interaction), a greater rise in tissue plasminogen activator concentrations (P = 0.028, diet effect), and a tendency to a greater postprandial decline in PAI-1 (P = 0.06, diet effect) compared with the unsaturated test fats (O, T, and L). The increase in FVIIa was not significantly associated with the level of lipemia, plasma FFAs, or plasma lipoprotein lipase activity. CONCLUSION: Our results indicate a lesser increase in FVIIa after the consumption of saturated fats, especially the S fat, than after unsaturated test fats.     

重度子痫前期患者血浆凝血、纤溶相关因子水平变化的意义

目的:探讨凝血相关因子在重度子痫前期患者外周血病理性高凝状态发病机制中的作用。方法:采用ELISA方法测定30例重度子痫前期孕妇(子痫前期组)及42例正常晚期妊娠孕妇(正常妊娠组)外周血凝血相关因子的浓度,包括TF、TFPI、t-PA、PAI-1和PAI-2,并进行对比分析。结果:两组孕妇的年龄、孕周无显著性差异;重度子痫前期组患者的D-二聚体浓度及FDP阳性率均显著高于对照组而血小板计数则显著低于对照组。子痫前期组的血浆TF浓度为(53.02±8.64)pg/ml显著高于对照组的(30.84±9.04)pg/ml,TFPI浓度为(3.04±1.08)ng/ml则显著低于对照组的(5.13±0.93)ng/ml(P<0.01);子痫前期组的t-PA浓度为(42.03±16.08)ng/ml显著低于对照组的(67.12±18.91)ng/ml(P<0.01);子痫前期组PAI-1、PAI-2的浓度分别为(81.37±14.87)ng/ml、(469.14±29.20)ng/ml均显著高于对照组的(63.15±8.88)ng/ml和(122.56±17.67)ng/ml。结论:重度子痫前期患者的病理性高凝血状态和凝血相关因子的平衡失调有关,内皮细胞的损伤或激活、胎盘表达凝血相关因子异常可能是重要原因。     

藏族先天性心脏病合并肺动脉高压影响因素分析

目的了解高原低氧对藏族先天性心脏病(CHD)并发肺动脉高压(PAH)的影响。方法选取2007年1月-2009年12月CHD住院藏族患者220例,采用超声心动图估测肺动脉压,分析CHD合并PAH发生率以及性别、居住海拔高度对病种分布的影响;采用二分类logistic回归分析不同病种形成PAH的危险因素。结果 220例CHD患者中,合并PAH为115例,占52.27%,其中房间隔缺损(ASD)合并PAH为64例,占64.65%,高于动脉导管未闭(PDA)合并PAH32例,占41.56%;χ2=9.312,P<0.005)及室间隔缺损(VSD)合并PAH(19例,占43.18%;χ2=5.763,P<0.05);VSD合并PAH患者的肺动脉收缩压(sPAP)高于PDA合并PAH患者及ASD合并PAH患者(F=15.751,P<0.05);海拔>3 000 m ASD合并PAH的发生率高于其他2种先天性心脏缺损(F=10.79,P<0.05),但sPAP低于PDA合并PAH患者(t=8.45,P<0.05)及VSD合并PAH患者(t=24.26,P<0.05);PDA和VSD患者合并PAH主要影响因素为缺损大小(OR=1.153,P<0.05),而ASD患者合并PAH的影响因素为年龄(OR=1.31,P<0.05)、缺损大小(OR=1.15,P<0.05)及海拔(OR=2.75,P<0.05)。结论高原地区CHD合并PAH的发生率远高于国内外报道;高原低氧对ASD患者合并PAH的影响较大。