B型脑钠肽、D-二聚体、超敏C反应蛋白检测在老年急性冠状动脉综合征中的应用

目的探讨老年急性冠状动脉综合征(ACS)中血浆B型脑钠肽(BNP)、D-二聚体(D-D)和超敏C反应蛋白(hs-CRP)水平的变化及其与预后的关系。方法 118例老年ACS患者按临床类型分为:急性心肌梗死(AMI)组60例,不稳定型心绞痛(UAP)组58例,同期入选体检健康者45例作为对照组。检测各组血浆BNP、D-D和hs-CRP值及超声心动图检测左心室射血分数(LVEF),比较各组三指标间的差异;AMI组患者根据Killip分级行心功能分级,同时按BNP水平分为四个等级,比较分析Killip心功能分级与BNP水平的关系;所有患者平均随访1年,观察随访期间的药物治疗和主要不良临床事件的发生率。结果 AMI组血浆3项指标明显高于UAP组(P<0.05),UAP组明显高于对照组(P<0.05);AMI组中,Killip分级Ⅱ^Ⅳ级者共35例,按BNP水平分级2Ⅳ级者共35例,按BNP水平分级2⁴级者分别为7、12、16例,BNP水平4级患者数与其他三组相比,差异明显(P<0.05);BNP水平3级与1、2级相比,差异有统计学意义(P<0.05)。BNP、D-D均升高者发生不良临床事件的次数明显高于都正常者(P<0.05);BNP、D-D中仅一项高的患者组比较略有差异,无统计学意义(P>0.05)。结论 BNP、D-D和hs-CRP的水平反映心肌缺血损伤的程度,联合分析有助于老年ACS患者的临床诊断、危险分层及预后评估。     

D-二聚体在创伤后颅内进展性出血性损伤中的变化及意义

目的探讨急性颅脑创伤后血浆D-二聚体变化及其与颅内进展性出血性损伤（PHI）的关系。方法回顾性分析108例颅脑创伤患者（PHI组48例,非PHI组60例）的临床资料,比较不同性别、年龄、受伤至首次CT检查时间、格拉斯哥昏迷评分、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、血浆D-二聚体浓度对PHI发生的影响;Logistic回归分析PHI发生的危险因素;受试者工作特征（ROC）曲线计算血浆D-二聚体浓度与PHI发生的关系。结果PHI组的D-二聚体浓度为（7．08&#177;3．87）mg／L,非PHI组为（4．34&#177;3．21）mg／L,两组间差异有统计学意义（P〈0．05）。Logistic多元回归分析显示,受伤至首次CT检查时间和D-二聚体浓度与PHI的发生有关（分别为OR=0．407,95％CI：0．132—0．825,P=0．018和OR=1．254．95％CI：0．980～1．374,P=0．021）。ROC曲线推算D-二聚体浓度的最佳临界值为4．05mg／L,此时灵敏度和特异度分别为79％和70％,大于此值PHI的发生率达74,1％。结论颅脑外伤后血浆D-二聚体的水平可作为PHI发生的一个预判指标,结合影像学检查及其他相关临床因素分析可以更好地预判和及时诊断颅脑创伤后PHI的发毕。     

2型糖尿病肾病患者血浆D-二聚体、纤维蛋白原、抗凝血酶Ⅲ检测的意义

目的：探讨2型糖尿病肾病患者血浆D-二聚体、纤维蛋白原、抗凝血酶Ⅲ的改变及其临床意义。方法：采用TOP全自动血凝分析仪,检测121例2型糖尿病患者和健康对照组36例的血浆D-二聚体、纤维蛋白原浓度和抗凝血酶Ⅲ活性。根据24h尿蛋白排泄率（UAE）将2型糖尿病患者分为无蛋白尿组（UAE〈30mg／24h）62例与微量白蛋白尿组（UAE为30～300mg／24h）59例。结果：2型糖尿病无蛋白尿组D-二聚体、纤维蛋白原含量明显高于健康对照纽（P〈0．05）,抗凝血酶Ⅲ活性两纽比较差异无统计学意义（P〉0．05）;微量白蛋白尿组D-二聚体、纤维蛋白原含量明显高于无蛋白尿组和健康对照组,抗凝血酶Ⅲ活性明显低于无蛋白尿组,差异均有统计学意义（P〈0．05）。结论：血浆D-二聚体、纤维蛋白原、抗凝血酶Ⅲ的检测对于2型糖尿病肾病的早期判断以及疾病的早期预防和病情监测有重要意义。     

D-二聚体检测在围生期心肌病中意义的探讨（附33例分析）

目的通过观察D-二聚体在正常围生期及围生期心肌病中的变化,探讨其对于判断围生期心肌病病情的意义。方法以围生期心肌病患者33例,健康围生期妇女50例、非妊娠健康女性50例为观察对象,比较3组患者D-二聚体水平有无差异。将围生期心肌病患者按D-二聚体浓度是否高于正常围生期水平分为2组,比较2组的住院时间有无差异。结果正常围生期妇女较非妊娠妇女D-二聚体升高,围生期心肌病患者总体较正常围生期妇女D-二聚体升高;D-二聚体较正常围生期升高的围生期心肌病患者住院时间明显延长。结论D-二聚体检测对判断围生期心肌病患者的病情有重要意义。     

D二聚体及FDP检测在骨折患者的应用价值

目的:探讨D二聚体(DD)及纤维蛋白(原)降解产物(FDP)定量检测在骨折病人的临床价值。方法:采用免疫比浊法对124例骨折患者术前、术后第2天及第7天进行血浆DD及FDP的定量检测,观察指标变化。结果:124例患者有15例并发深静脉栓塞(DVT),其中3例并发肺栓塞(PE),并发DVT组术前、术后血浆DD及FDP的检测结果有显著性差异(P<0.05),呈进行性增高。未并发DVT组术前、术后的检测结果无显著性差异(P>0.05)。而并发DVT组与未并发DVT组相比较,血浆DD及FDP的检测结果有显著性差异(P<0.05)。结论:血浆DD及FDP的动态监测对骨折术后并发血栓性疾病具有早期诊断价值。     

全身炎症反应综合征新生儿的凝血功能研究

目的　探讨全身炎症反应综合征 (SIRS)新生儿凝血功能的变化及其临床意义。方法　符合SIRS诊断标准的新生儿 12 6例 ,在入院后 2 4h内进行新生儿危重病例评分 ,并采血测定凝血酶原时间 (PT)、凝血酶时间 (TT)、部分活化凝血活酶时间 (APTT)、D 二聚体 (DD)含量和血小板 (PLT)计数。分别以SIRS符合项数及预后、疾病严重程度分组 ,观察其与凝血功能紊乱间的关系。结果　随着SIRS符合项数的增加 ,SIRS新生儿中危重病例所占百分比及病死率明显增高 ,PT、TT、APTT、DD也增高 ,具有明显的相关性。存活组与死亡组间PT、TT、APTT差异无显著性意义 (P >0 0 5 ) ,死亡组DD显著高于存活组 (P <0 0 1)。危重症组PT、TT、APTT、DD与非危重症组比较 ,差异均具显著性意义 (P<0 0 1)。结论　SIRS新生儿存在凝血机制的活化 ,符合SIRS诊断标准项数越多 ,病情越重 ,凝血功能紊乱越显著 ,病死率越高。     

急性白血病病人血浆TM、PC抗原和D-D测定及其临床意义

①目的　探讨急性白血病病人治疗前后血浆凝血酶调节蛋白 (TM)、蛋白C(PC)抗原、D 二聚体 (D D)含量的变化及其意义。②方法　用酶联免疫吸附测定方法对 12例健康体检者及 2 2例急性白血病病人治疗前后血浆TM、PC抗原和D D含量进行检测。③结果　急性白血病病人化疗前血浆TM、D D升高 ,PC抗原降低 ,与正常对照组比较有显著性差异 (t=3.5 0 9～ 6 .0 77,P <0 .0 1)。缓解后 ,血浆TM、PC抗原均恢复至正常水平 ,血浆D D含量比化疗前有明显降低 (t=5 .0 99,P <0 .0 1) ,但仍高于正常水平 (t=3.5 0 9,P <0 .0 1)。④结论　急性白血病病人存在不同程度的血管内皮细胞损伤及凝血和纤溶系统的激活 ,并随病情的好转而改善 ,血浆TM、PC抗原和D D含量可作为急性白血病病情进展、疗效观察及预后评估的指标之一     

The effect of different exercise intensities on the fibrinolytic system

Summary The effects of moderate 30-min cycle ergometer exercise (aerobic metabolism) followed by short-term exercise at maximal capacity (anaerobic metabolism) on fibrinolytic activity were investigated in ten female and ten male healthy, untrained subjects. The following parameters of fibrinolytic activity were measured initially (t ₀), at the end of the aerobic phase (t ₁), at the end of the anaerobic phase (t ₂) and after a 30-min recovery period (t3): tissue plasminogen activator (PA_t) activity, PA_t concentration, plasminogen activator inhibitor (PA_i) activity, and D-Dimer concentration. Moderate long-term exercise caused a slight but significant increase in PA_t concentration and PA_t activity (t ₁; P<0.01), whereas short-term exercise at maximal capacity (t ₂) produced a substantial elevation in both these parameters (P<0.01). This would suggest that PAt was not inhibited totally by PA_i which would itself seem to be consumed during exercise. In addition, a slight exercise intensity-dependent increase in D-Dimer concentration was measured — circumstancial evidence not only for elevated fibrinolytic potential, but also for an actual increase in fibrin degradation (t ₂: P<0.01). After t ₃ both PA_t activity and D-Dimer concentration were still slightly but significantly increased. The results obtained in the tests of fibrinolytic activity showed no significant difference between the men and the women. It would seem that the release of PA_t is more markedly stimulated by short-term intense physical exercise than by long-term moderate exercise and actually causes increased fibrin degradation.     

血D-二聚体检测在类风湿关节炎中的临床意义

目的 检测类风湿关节炎(RA)患者血中D-二聚体水平,探讨其在RA中的临床意义.方法 本研究纳入RA患者58例,疾病对照组患者64例(包括系统性红斑狼疮18例、血清阴性脊柱关节病15例、骨关节炎11例、其他结缔组织病20例).所有患者均排除血栓性疾病,近6个月无手术、外伤和肿瘤病史.记录患者的临床和实验室指标,采用免疫比浊法检测血中D-二聚体水平.并研究其与RA患者疾病活动度(DAS28评分)、红细胞沉降率(ESR)、C反应蛋白(CRP)、类风湿因子(RF)等指标的关系.采用Mann-Whitney U检验、t检验及Spearman相关分析.结果 ①RA患者血D-二聚体增高的比例明显高于疾病对照组(分别为82.6%和21.9%,P＜0.01).血D-二聚体水平在RA患者中明显高于对照组[分别为(1.76±1.57)和(0.32±0.25)mg/L,P＜0.01].②在RA患者中,D-二聚体增高组DAS28水平高于D-二聚体正常组(5.4±1.0和4.4:±0.8,P＜0.01).D-二聚体增高组RA患者的ESR、CRP和RF水平均高于D-二聚体水平正常组RA患者[分别为(58±29)和(28±13)mm/1 h;(39±36)和(11±9)mg/L;(409±718)和(46±40)U/ml,P均＜0.05].③相关性分析显示,D-二聚体水平与DAS28评分(r=0.406,P＜0.01)、ESR(r=0.355,P＜0.01)和RF(r=0.319,P＜0.05)具有相关性.结论 RA患者血D-二聚体水平较其他风湿病患者明显升高,且与病情活动度密切相关.提示凝血-纤溶系统激活可能在RA的病情发展和病理过程中发挥作用.

Abstract：

Objective To detect D-Dimer in the blood of rheumatoid arthritis (RA) patients and to investigate its clinical significance in RA. Methods Blood samples were obtained from 58 patients with RA,18 patients with systemic lupus erythematosus (SLE), 15 patients with ankylosing spondylitis, 11 patients with osteoarthritis, and 20 patients with other connective tissue diseases. The presence of thrombotic diseases was excluded in all patients. The presence of D-Dimer in the blood was examined by immunoturbidimetry. The following clinical and laboratory data were collected: disease activity index DAS28, rheumatoid factor (RF),erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Mann-Whitney U test, t-test ,Spearman correlation were used for statistical analysis. Results ① The prevalence of high level D-Dimer in RA patients was higher than that of the control group (82.6％ vs 21.9％, P＜0.01). The titer of D-Dimer in RA was significantly higher than that of the control group [(1.76±1.57) vs (0.32±0.25) mg/L, P＜0.01]. ②DAS28 was higher in RA patients with positive D-Dimer than those with negative D-Dimer (5.4±1.0 vs 4.4±0.8,P＜0.01). The values of ESR, CRP and RF in RA patients with positive D-Dimer were significantly higher than those in patients with negative D-Dimer (P＜0.05). ③ There was positive correlation between D-Dimer and DAS28 (r=0.406, P＜0.05), ESR (r=0.355, P＜0.01), and RF (r=0.319, P＜0.05). Conclusion The level of D-Dimer in the blood of RA patients is significantly higher than other rheumatic diseases, and is positively correlated with disease activities. The results indicated that the activation of coagulation-fibrinolytic systems may play a role in the pathogenesis of rheumatoid arthritis.     

Fundus Examination to Guide Anticoagulation Therapy in Suspected COVID-19 in a Critical Care Unit

How to cite this article: Saha R, Singh SK, Samanta S. Fundus Examination to Guide Anticoagulation Therapy in Suspected COVID-19 in a Critical Care Unit. Indian J Crit Care Med 2021;25(6):737–738.