深静脉血栓形成与凝血因子Ⅷ及蛋白C、蛋白S的相关性

目的 检测下肢深静脉血栓形成的患者血浆中凝血因子Ⅷ(FⅧ)及蛋白C、蛋白S水平的变化,探讨其与深静脉血栓形成的关系.方法 用ACL TOP型全自动血凝分析仪检测40例急件期深静脉血栓形成患者及40例健康体检者血浆中FⅧ及蛋白C、蛋白S的活性.结果 与正常对照组比较,病例组患者体内FⅧ的活性明显增高,是深静脉血栓形成的危险因素,OR值为11.0,95%可信区间为3.3～36.7,排除蛋白C、蛋白S降低的影响,则OR值为5.4,95%可信区间为1.6～18.2.两组比较,病例组中蛋白C和蛋白S的活性明显降低,差异有统计学意义(P<0.05).结论 深静脉血栓形成的患者体内FⅧ活性明显升高,而蛋白C及蛋白S的活性明显降低,凝血及抗凝系统的异常是深静脉血栓形成的高危因素之一.     

下肢慢性静脉功能不全临床分类与评估系统

下肢慢性静脉功能的评估方法在规范下肢慢性静脉功能不全患者的诊断以及疗效评估中起重要的作用.文章主要就CEAP分类系统、VSS评分系统、慢性静脉功能不全生活质量调查表及其临床应用进行阐述.     

膝下动脉闭塞的腔内治疗

Objective To evaluate the results of endovascular intervention for infrapopliteal arterial occlusion in 40 patients. Methods There were 41 affected limbs in these 40 patients receiving 44 times of endovascular intervention for infrapopliteal arterial occlusion during Nov. 2006 and Dec. 2007. The average age was 76±6. The ABI(ankle brachial index)before intervention was 0.39±0.20 in anterior tibial artery and 0.39±0.23 in posterior tibial artery. CLI (critical limb ischemia) was 80.49% (33/41). Results The after intervention ABI increased by 0.43±0.22 (P<0.01) in anterior tibial artery and 0.43±0.25(P<0.01)in posterior tibial artery. 35 patients (36 limbs) were followed-up for (6±3) months. The limbs of Fontaine Ⅰ and Fontaine Ⅱ A were 28 (77.78%), CLI decreased to 19.44% (7/36) (P<0.01). At follow-up the ABI in anterior tibial artery was 0.63±0.22 and 0.56±0.22 in posterior tibial artery. The difference were all significant when compared with that before intervention and after intervention. The perioperative amputation rate was 0. The perioperative mortality rate was 2.5%. The total mortality rate was 15%. The limb salvage rate were 100%. Conclusion The effect of endovascular intervention for infrapopliteal arterial occlusion is satisfactory.     

抗凝溶栓治疗对急性下肢深静脉血栓形成预后的影响

Objective To explore the effect of anticoagulant thrombolytic therapy on acute deep venous thrombosis (DVT) and the incidence and severity of post-thrombotic syndrome (PTS). Method A total of 111 patients (113 limbs) with central or mixed types of deep venous thrombosis admitted from March 2003 to November 2008 were analyzed. The patients were divided into 3 groups by different therapies:anticoagulant group (41 limbs) , thrombolysis group (27 limbs), and catheter-directed thrombolysis group (45 limbs). In the follow-up, patients' swelling of lower extremity and recanalization of vein were found out by physical examination and venous ultrasound Duplex through following-up. The Villalta and VCSS marking scales were used in rating the incidence and severity of PTS, discussing treatments for acute phase as well as adjuvant treatment for chronic phase and the correlation between the incidence and severity of PTS. Results The average time of follow-up were (41±19) months in anticoagulant group, (52±1) months in thrombolysis group, and (26 ±10) months in catheter-directed thrombolysis group. According to the consequences from Villalta and VCSS rating scales, the incidences of PTS in the three groups were 58. 5% (24/41), 55.6% (15/27), and 35.6% (16/45), in which 20.8% (5/24), 3/15, and 1/16 were severe. The the catheter-directed thrombolysis group had a better consequence than the other two groups in reducing incidence and severity of PTS ( P ＜ 0. 05 ). The differences of circumferences of lower extremities of all patients had obvious improvement compared to that before the treatments. For patients who were treated by catheter-directed thrombolysis, the thigh circumference difference and calf circumference difference were (0. 5 ±1. 0) cm and (0. 7±1. 0) cm, which were more obvious compared to other two groups (P ＜0. 05).Most patients had their external-iliac and common-femoral veins recanalized. Using anticoagulant Pharmaceuticals and compression stockings can lead to a reduction in the incidence of PTS. Conclusions The incidences and symptoms of PTS and swelling of limbs can be significantly moderated by catheterdirected thrombolysis based on anticoagulating in the acute phase of DVT. Consequently, it would be the most efficient way in decreasing the occurrences of PTS and moderating the severities of PTS with the aids of regular anticoagulating and compression stockings.     

缓释纳米尿激酶的制备

目的制备包载尿激酶的水溶性壳聚糖(WSC)纳米粒子,观察纳米尿激酶的活性。方法采用离子交联法制备包载尿激酶的WSC纳米粒子;检测尿激酶纳米粒子的包封率,分析WSC与三聚磷酸钠质量比、尿激酶浓度、磁力搅拌速度和时间、超声时间和功率等条件对包封率的影响,获得包封率最高的制备条件;粒径仪测量尿激酶纳米粒子粒径;超滤离心法纯化尿激酶纳米粒子,注入新西兰兔体内(纳米尿激酶组),于不同时间点取血测定尿激酶活性,以注射单纯尿激酶的动物作为对照组。结果室温下,将三聚磷酸钠溶液(0.6 g/L)滴加入包含尿激酶(1 mg/10 mL)的WSC溶液(1.0 g/L),磁力搅拌速度800 r/min,滴加完毕后继续搅拌60 min,冰浴条件下超声30 s(功率10 W),成功制备出包封率为94.8%的尿激酶纳米粒子;对照组血尿激酶活性达到峰值后随着时间的延长逐渐降低,纳米尿激酶组血尿激酶活性达到峰值后仍保持较高水平。结论成功制备了包载尿激酶的WSC纳米粒子,纳米尿激酶具有缓释功能并保持了尿激酶的活性。     

血液透析患者肿胀手综合征的诊治

目的 总结血液透析患者患肢肿胀的诊断、治疗经验.方法 回顾性分析上海交通大学医学院附属仁济医院2006年7月至2011年6月收治的51例肿胀手综合征的临床资料,总结其发病部位、治疗方法及效果.结果 男31例,女20例,平均年龄(60.18±14.38)岁.平均血管通路建立时间 (36.35±28.94)月,左上肢28例,右上肢23例,病程1天～2年.术前经静脉造影、血管超声及CTV明确诊断,50例病例为动静脉内瘘回流静脉狭窄或闭塞病变,1例为返流性病变导致静脉高压.分别采用手术重建、球囊扩张术、支架植入术、血管通路关闭术等方法,症状均缓解.结论 肿胀手综合征是由于静脉回流障碍或返流造成肢体远端静脉高压,影响血管通路的使用.血管超声和静脉造影联合应用能明确诊断病变部位及范围,最常见的病变部位多为中心静脉病变.上肢浅静脉病变,手术重建是最好的治疗方法.头静脉汇入锁骨下静脉处病变、中心静脉病变位置较深,手术重建创伤大,以腔内治疗为主,但远期通畅率低,需要加强随访监测.     

硫酸依替米星治疗75例急性细菌性感染

目的:评价硫酸依替米星注射液治疗急性细菌性感染的临床疗效与安全性。方法:以进口硫酸奈替米星注射液为对照药进行随机对照临床试验,共治疗住院患者95例,其中随机对照组42例(试验组22例、对照组20例)、开放组53例。硫酸依替米星与奈替米星均为每次 100 mg,q12h静脉滴注,疗程 7~10 d。结果:试验组、对照组和开放组的痊愈率与有效率分别为68.8%与90.91%、65.00%与90.00%和66.04%与084.91%。细菌清除率试验组为95.45%、对照组为100.00%、开放组为92.59%。不良反应发生率3组分别为 9.10%、5.0%和 7.55%。试验组和对照组以上各项指标比较差异均无显著性(P＞0.05)。结论:国产硫酸依替米星注射液治疗急性细菌性感染疗效确切、使用安全。     

高效液相梯度洗脱法测定尿中氢化可的松和可的松含量

目的测定尿中氢化可的松与可的松的比值以表达人体肾脏11β-羟化类固醇脱氢酶活性,为其研究提供一个准确、精密、重现性好的分析手段。方法HPLC-UV法,梯度洗脱,内标定量。结果尿中氢化可的松和可的松在10～100.0ng.ml     

移植静脉粥样化与管壁蛋白聚糖关系的实验研究

观察移植静脉粥样化过程 ,蛋白聚糖 (PG)变化同移植静脉粥样化关系。方法　将移植静脉蛋白聚糖对阴离子蛋白层析柱过柱 ,分为硫酸乙酰肝素蛋白聚糖 (HSPG)、硫酸软骨素蛋白聚糖(CSPG)及硫酸皮肤素蛋白聚糖 (DSPG) ,测定含量。结果　普食组术后 8周CSPG DSPG含量较正常静脉明显增加 (P <0 .0 5 ) ,术后 12～ 2 0周含量下降 ,接近正常 (P >0 .0 5 )。移植静脉术后 2 0周可见泡沫细胞形成 ;高脂组术后 8周CSPG DSPG含量较正常静脉明显增加 ,术后 12～ 2 0周持续在高水平 (P <0 .0 5 ) ,移植静脉术后 4周有泡沫细胞形成 ,术后 2 0周血管壁出现无组织结构区域。两组HSPG含量无明显区别 (P >0 .0 5 ) ,但其在总PG比例均降低。结论　CSPG DSPG对移植静脉粥样化具有促进作用 ,HSPG具有一定的保护作用。     

聚合酶链反应扩增人动脉粥样硬化抗体全套可变区基因

目的 利用二次聚合酶链反应(PCR)扩增人动脉粥样硬化抗体全套可变区基因,并将其克隆到T载体进行测序验证.方法 收集50例动脉粥样硬化患者外周动脉血标本,密度梯度离心法分离淋巴细胞,TRIzol法提取总RNA,用逆转录-PCR扩增轻链可变区基因(包括VK和Vλ)和重链可变区基因(VH),分别酶切后克隆到T载体上,随机挑取2个克隆进行测序验证.结果 总RNA的纯度和完整性都较好,经过2次PCR成功扩增出了抗体全套轻、重链可变区基因.测序结果与已有的人抗体基因的序列高度同源.结论 该方法成功扩增出了人动脉粥样硬化抗体全套可变区基因,为下一步噬菌体单链抗体库的构建和筛选奠定了基础.