API0134对血小板α颗粒膜蛋白和血小板聚集的影响

２０例急性心肌梗死患者在溶栓后随机分为穿心莲有效成分（ＡＰＩ０１３４,ＡＰＩ）组与对照组,治疗１５ｄ,均同时给予阿司匹林等药物。检测溶栓前后血浆α颗粒膜蛋白（ＧＭＰ－１４０）浓度和ＡＤＰ诱导的血小板聚集反应。结果表明,ＡＰＩ组溶栓后７２ｈ血浆ＧＭＰ－１４０浓度轻度增加,对照组显著性增加（Ｐ＜０．０１）。ＡＰＩ组ＧＭＰ－１４０在溶栓后７２ｈ和１５ｄ均低于对照组,差异有显著意义（均为Ｐ＜０．０５）。ＡＰＩ组１ｍｉｎ和５ｍｉｎ血小板聚集率均低于对照组,差异均有显著意义（７２ｈ,Ｐ＜０．０５;１５ｄ,Ｐ＜０．０１）。研究表明,ＡＰＩ与阿司匹林联合应用可抑制溶栓后血小板的活化,优于阿司匹林单独应用,因此ＡＰＩ有可能用于临床预防溶栓后的再闭塞。     

Renal vein thrombosis and selective arterial or venous thrombolytic therapy

Summary Background: Renal vein thrombosis (RVT) complicating the nephrotic syndrome is associated with a poor prognosis. Methods/Results: RVT was diagnosed in 12 of 60 patients with a diagnosis of nephrotic syndrome suggested by computed tomography (CT) and subsequently confirmed by selective renal angiography. Fifty patients carried a diagnosis of primary glomerulonephritis with various pathological findings, and 10 patients had lupus nephritis. Renal vein and peripheral vein blood samples were collected in the 12 patients with RVT and were assayed for fibrin(ogen) degradation products (FDP), antithrombin III (AT III), VIIIR:AG, and fibrinogen. The results suggested a state of hypercoagulation. Of these 12 patients, 7 were given 200,000 units of urokinase (UK) over 60 minutes in divided doses selectively via the renal vein. Five patients were given 200,000 units UK selectively into the renal artery. All patients also received 2.5 mg/day warfarin and 75 mg/day persantine. Except for three patients with focal glomerulosclerosis, all patients received 40 mg/day prednisone. After 1 month, the CT scan and blood samples for FDP, AT III, VIIIR:AG, and fibrinogen were repeated. Patients receiving intra-arterial UK had complete resolution of their thrombi. Complete resolution was also suggested in 2 of the 7 patients receiving UK by renal vein, and there was partial resolution in the other five. The hypercoagulation state decreased in all patients. Conclusions: We conclude that RVT is not an uncommon event in patients with nephrotic syndrome. The diagnosis can be supported reliably using abdominal CT scanning. Although a small number of patients were included in this nonrandomized study, it appeared that intra-arterial thrombolytic therapy yielded better results. The patients with minimal change disease have a good prognosis.     

Ventricular fibrillation following administration of thrombolytic treatment: The EMIP experience

Reperfusion-induced ventricular fibrillation has been dem onstratedin animal models of myocardial ischaemia, but no evidence existsfor this in humans. The European Myocar dial Infarction Projectcompared the efficacy and safety of pre-hospital thrombolytictherapy with that of hospital therapy. The objective of thisstudy was to investigate the occurrence of reperfusion-inducedventricular fibrilla tion in acute myocardial infarction patientsfollowing thrombolytic therapy. In a double-blind multicentre trial, eligible patients wererandomized to receive anistreplase at home followed by placeboin the hospital (A/P group), or placebo followed by anistreplase(P/A group). The occurrence of ventricular fibrillation, andother adverse events were recorded on specific study forms andcould be attributed to defined time intervals. The incidence of ventricular fibrillation in the A/P group wassignificantly higher following the pre-hospital injection thanin the P/A group (2.5% vs 1.6%; P=0.021); the situation wasreversed following the hospital injection (3.6% vs 5.3%; P=0.002).No relationship was found be tween this excess of ventricularfibrillation and the patients condition, with the exceptionof the site of the infarct. These results suggest the existence of reperfusion-induced ventricularfibrillation in patients developing myocardial infarction whoreceive thrombolytic treatment.     

Lipid peroxidation and antioxidant status following thrombolytic therapy for acute myocardial infarction

We have investigated the timescale of increased lipid peroxidationfollowing successful early thrombolytic therapy for acute myocardialinfarction and report for the first time reciprocal changesin plasma chain-breaking antioxidants. Sixty-seven patientswere recruited following a first acute myocardial infarctionwithin 6 h of the onset of symptoms and received 70 or 100 mgof recombinant tissue plasminogen activator (Actilyse) as twointravenous bolus injections 30 min apart. Serial blood sampleswere taken before administration of thrombolytic therapy andafter 30 min, 60 min, 90 min, 6 h and 24 h. Coronary arterypatency was assessed at 90 min by coronary angiography. Malondialdehyde(MDA), a marker of lipid peroxidation, and the chain-breakingantioxidants alpha-tocopherol, retinol and ascorbate were measuredby high performance liquid chromatography. When the coronaryartery was patent there was an early rise in plasma MDA (time0.091 ± 0.05 µmol.l^–1) with levels peakingat 90 min (1.02 ± 0.06, P<0.05) and returning to baselineby 6 h (0.85 ± 0.06), accompanied by reciprocal decreasesin alpha-tocopherol (time 0 7.13 ± 0.34 µmol.mmol^–1cholesterol, 90 min 6.64±0.33, P<0.05) and retinol(time 0 1.99±0.10 µmol.l^–1, 90 min 1.81 ±0.08, P<0.05). Ascorbate levels did not change significantlyuntil 24 h (time 0 29.5 ± 4.9 µmol.l^–1, 24h 22.6 ± 4.4, P<0.05). Where the coronary artery wasoccluded no changes in these parameters were found except fora late (24 h) fall in ascorbate (time 0 18.5 ± 2.0 mol.l^–1,24 h 12.2 ± 2.2, P<0.05). The timescale of changesin MDA and antioxidants supports a role for increased free radicalproduction following successful early thrombolytic therapy foracute myocardial infarction.     

Acute myocardial infarction with normal coronary arteries. In vivo demonstration of coronary thrombosis during the acute episode

Two cases with acute myocardial infarction are presented. Both had thrombotic occlusion of the infarct-related artery. Following successful thrombolysis with streptokinase, coronary angiography was normal. These cases prove that "myocardial infarction with normal coronaries" can be associated with coronary thrombosis in the acute stage.     

静脉溶栓治疗高龄急性心肌梗死患者的临床探讨

目的　探讨静脉溶栓疗法对高龄急性心肌梗死患者的疗效及安全性。 方法　将 82例高龄急性心肌梗死患者随机分为溶栓组和常规治疗组。溶栓组 40例 ,采用尿激酶静脉溶栓加皮下注射低分子肝素钙。常规治疗组 42例 ,除不用尿激酶及低分子肝素钙外 ,其余治疗均与溶栓组相同。 结果　 血管再通率溶栓组为6 5 %(2 6 / 40 ) ,常规治疗组为 14.3%(6 / 42 ) ,两组血管再通率比较差异具有显著性 (P <0 .0 5 )。溶栓组未见严重出血等并发症。住院 4周内病死率为 5 %。而常规治疗组病死率为 2 3.8%(10 / 42 ) ,两组比较具有显著差异性(P <0 .0 5 )。 结论　 尿激酶静脉溶栓治疗高龄急性心肌梗死可以提高冠脉再通率 ,降低死亡率和改善预后 ,是可行性治疗措施。     

肝细胞癌化疗栓塞后经皮瘤内注射无水乙醇的疗效

目的比较肝动脉化疗栓塞术(THAE)后经皮瘤内注射无水乙醇(PEI)与单纯THAE治疗单个肝细胞癌的疗效。方法53例肝细胞癌随机分成A(26例)、B(27例)两组。A组单纯THAE治疗;B组THAE治疗后,在CT引导下行PEI治疗。结果THAE组肿瘤治疗的部分缓解率为26.7%,1、2、3年生存率分别为56.0%、30.0%、0.0%。THAE+PEI组肿瘤治疗的部分缓解率为55.5%(P<0.05),1、2、3年生存率分别为91.0%、57.0%、22.0%(P<0.05)。结论THAE+PEI较单纯THAE对单个肝细胞癌的治疗更安全有效。     

小儿先天性左向右分流型心脏病的介入治疗

目的　评价应用Amplatzer封堵器进行介入治疗小儿先天性心脏病的效果、安全性。方法　超声心动图确诊的动脉导管未闭 (PDA)、房间隔缺损 (ASD)及膜部室间隔缺损 (膜部VSD)患者 4 9例 ,在透视或 /和经胸超声心动图 (TTE)指引下置入Amplatzer封堵器 ,术后 2 4小时 ,1、3、6、12个月及以后每年分别TTE、ECG和X线胸片检查评价治疗效果。结果　 16例ASD球囊测量缺损伸展径为 13～ 2 8(平均 19 3± 4 9)mm ,选择封堵器直径 13～ 30 (平均 2 0 6± 5 1)mm ;2 5例PDA造影测量PDA最窄处直径为 2～ 7 7(平均 3 9± 1 5 )mm ,选择封堵器直径 4～ 12 (平均 6 6± 1 9)mm ;8例膜部VSD造影测量VSD直径 3 4～ 8(平均 4 7± 2 3)mm ,选择封堵器直径 6～ 10 (平均 7 8±1 7)mm。技术成功率为 10 0 % ,术中未发生任何并发症 ,无急诊手术病例。术后即刻造影或TTE显示 10例存在残余分流 ,3个月TTE示所有病例无残余分流和再通 ,心室内径均有不同程度的缩小 ,肺动脉压下降。结论　应用Amplatzer封堵器介入治疗小儿先天性心脏病 ,具有操作简单、安全、损伤小、成功率高等优点 ,适合于儿童继发孔型ASD、各种类型的PDA及膜部VSD的介入治疗     

尿激酶、复方丹参及维脑路通联合治疗超早期急性脑梗塞的临床观察

目的 :观察尿激酶、复方丹参及维脑路通联合治疗超早期急性脑梗塞的临床疗效和安全性。方法 :将 48例急性脑梗塞患者分为 2组。 2 6例用尿激酶、复方丹参及维脑路通联合治疗为治疗组 ,其余 2 2例单纯用尿激酶治疗为对照组。治疗后分别在1d、3d、7d、14d、2 1d进行疗效评定。结果 :治疗前两组患者神经功能缺损评分无显著性差异 ,治疗后 3d开始出现差异 (P <0 .0 1)。结论 :(1)联合用药既能溶栓又能保护脑细胞 ,故能够改善缺血后的神经功能并安全有效。 (2 )超早期溶栓联合用药优于单纯用尿激酶     

Aortic Stenosis and Patent Ductus Arteriosus: Pressure Gradients Pre- and Posttranscatheter Ductal Occlusion

Three patients with patent ductus arteriosus and moderate aortic stenosis had a marked reduction in aortic valve gradient following transcatheter ductal occlusion. The hemodynamic effects of an aortopulmonary shunt on the severity of left ventricular outflow obstruction and the implications on intervention are discussed.