急性心肌梗死血小板及纤溶活性的改变

目的：了解急性心肌梗死（AMI）患血小板活化及纤溶状态，探讨其在发病机制中的作用及应采取的对策。方法：测定27例AMI患及正常对照组的血浆GMP－140、t-PA、PAI、DD含量。结果：AMI患血浆GMP－140、PAI的含量明显高于正常对照组（P＜0．01）。而t-PA含量则明显低于正常对照组（P＜0．01）。AMI恢复期血浆GMP－140水平低于急性期的（P＜0．05）。DD在急性期内（≤2天）无显增高。恢复期高于急性期及正常对照组（P＜0．01）。结论：急性心肌梗死患血小板活性增高而纤溶活性降低；要施行积极的抗血小板治疗和早期溶栓治疗，要重视动脉粥样硬化防治以防止血管内皮细胞损害，预防心肌梗死的发生。     

Inflammation, Coagulation, and the Pathway to Frailty

There are inevitable physiologic changes associated with advancing age, yet for some people these changes are exaggerated, and as a result a phenotype emerges recognized as “frailty.” Why some people become frail and others do not remains incompletely understood. Although chronic illnesses are common among frail elderly persons, some will develop all of the phenotypic features without a diagnosed underlying disease. It has been recognized that certain proinflammatory cytokines and coagulation factors are elevated to a greater extent in those who are frail than in age-matched nonfrail individuals. In this review, we provide an overview of current research in the biology of frailty with particular emphasis on the role of inflammatory pathways and disordered coagulation in its pathogenesis.     

Common genetic variants associated with plasma fibrin D-dimer concentration in older European- and African-American adults

Summary.  Background and Objectives:  D-dimer is a hemostasis marker that reflects ongoing fibrin formation and degradation. There is significant inter-individual and inter-population variability in D-dimer concentration, but whether genetic factors underlie these differences is largely unknown. We hypothesized that common coagulation gene variants contribute to differences in circulating D-dimer concentration. Methods:  The setting was European-American (EA; n  =   1858) and African-American (AA; n  =   327) unrelated older adults from the Cardiovascular Health Study (CHS), in which we genotyped SNPs in 42 genes related to blood coagulation and fibrinolysis. Results:  Several fibrinogen gene polymorphisms, including the Thr312Ala Aα chain variant and the FGG-10034 C/T variant, were associated with ∼20% higher plasma D-dimer levels in EA (false discovery rate < 5% for covariate-adjusted model). There was also some evidence that a Pro41Leu variant of the PLAU gene encoding urinary plasminogen activator and non-coding polymorphism of the plasminogen activator inhibitor type 1 gene (SERPINE1) were associated with higher plasma D-dimer in EA. There were no significant associations between the studied coagulation or fibrinolysis gene SNPs and plasma D-dimer levels in the smaller AA sample. However, each standard deviation increase in European ancestry assessed by ancestry-informative gene markers was associated with ∼10% lower mean D-dimer levels in AA. Conclusions:  Together, common coagulation/fibrinolysis gene SNPs explained only ∼2% of the variance in plasma D-dimer levels in EA. These findings suggest that the association of D-dimer with risk of vascular outcomes may be mediated largely by environmental factors, other genes, and/or genetic interactions.     

中国检测D-二聚体诊断试验的文献质量评价

目的评价国内关于D-二聚体的检测文献方法学质量。方法电子检索中国学术期刊网(1994～2006)和中国生物医学数据库(1978～2006),收集免疫比浊法、乳胶凝集法、胶体金免疫渗透法、酶联免疫吸附法检测D-二聚体的方法学研究文献。结果共检索到相关文献63篇,最终纳入7篇文献,其中仅有一篇文献可提取四格表数据进行临床诊断准确性评价。结论目前国内检测D-二聚体的诊断试验文献不多,质量较低。今后关于检测D-二聚体的研究应注重临床诊断敏感度和特异度的研究,以给读者提供更多有价值的信息。     

缺血性脑血管病患者血D-二聚体和脂蛋白(a)含量的变化及其临床意义

目的探讨缺血性脑血管病 (ICVD)患者血脂蛋白 (a) [LP(a) ]和D 二聚体水平的变化及其临床意义。方法测定86例ICVD患者血LP(a)和D 二聚体水平 ,并与 2 1例健康对照组比较。结果脑血栓形成 (CI)急性期和短暂性脑缺血发作 (TIA)患者D 二聚体、LP(a)的含量均明显高于健康对照组 (P <0 .0 5或P <0 .0 1)。TIA伴有梗死灶者血D 二聚体、LP(a)的含量均高于无梗死灶者 (P <0 .0 5 )。结论ICVD患者血D 二聚体、LP(a)水平升高 ,这与体内血液凝固性增强和高发血栓形成有关。测定血D 二聚体和LP(a)水平对ICVD病情预测和辅助诊断具有重要意义。     

D－二聚体胶乳试验在血栓性疾病早期诊断中的应用

采用Ｄ－二聚体（Ｄ－Ｄ）胶乳试验，检测５２例正常人，３０例心血管疾病、２８例肺心病、２５例脑梗塞、２０例ＤＩＣ、４１例脑外科手术和２０例其它疾病的患者。结果表明Ｄ－Ｄ水平除肺心病缓解期和脑外科手术前与正常对照比较Ｐ＞０．０５外，其余均有显著性差异（Ｐ＜０．００５，Ｐ＜０．０５）。Ｄ－Ｄ胶乳法与传统的止凝血检验相比较，对血栓性疾病的早期诊断有较高的特异性（６０．３％）和敏感性（９０．６％），能提示继发性纤溶亢进，具有一定的临床意义和实用价值。     

降纤剂治疗脑梗死D二聚体变化及临床疗效的观察

目的：探讨降纤药物治疗脑梗死血浆D－二聚体的变化及疗效。方法：将62例急性脑梗死患随机分成两组，分别使用降纤酶和精纯抗栓酶治疗，进行治疗前后神经功能缺损评分，并观察治疗前及治疗后1、3、7、14d的血浆D－二聚体。结果：两组间比较D－二聚体的变化无显性差异，但两组治疗后1、3d较治疗前D－二聚体明显升高，而治疗后14d回到原来水平。降纤酶和精纯抗栓酶的显效率均＞50％，两以神经功能缺损改善无显性差异。结论：两种降纤剂均可短期内使D－二聚体升高产生抗栓作用，治疗脑梗死均有效。     

血浆D-二聚体联合床旁超声对下肢深静脉血栓的诊断价值

目的:探讨血浆D-二聚体水平联合床旁超声对下肢深静脉血栓的诊断价值。方法:回顾性分析2018年4月至2019年3月复旦大学附属中山医院厦门医院69例重症监护室行床旁下肢静脉彩超检查患者的病例资料,记录血浆D-二聚体水平以及彩超检查结果,计算彩超发现下肢深静脉血栓的血浆D-二聚体水平截断值,分析血浆D-二聚体水平对床旁彩超发现下肢深静脉血栓的诊断效能。结果:床旁彩超诊断无血栓组39例,血栓组30例,男女比例分别为26∶13和15∶15,平均年龄分别为(63.7±13.8)岁和(65.9±12.6)岁,血浆D-二聚体水平分别为3.26(0.91,6.22)mg/L和6.72(3.33,13.24) mg/L(P0.05)。血浆D-二聚体截断值为4.54 mg/L,其对应的灵敏度为66.7%,特异度为69.2%,阳性预测值为60.6%,阴性预测值为72.2%,诊断准确率为68.1%。结论:血浆D-二聚体水平大于4.54 mg/L可作为临床医师申请床旁下肢静脉彩超检查的参考依据,从而减少医疗资源的浪费。     

肛周脓肿患者病情严重程度与纤维蛋白原、D-二聚体水平相关性分析

目的：分析肛周脓肿患者的严重程度与纤维蛋白原、D-二聚体间的相关性。方法：选择150例肛周脓肿患者，检测其纤维蛋白原（FIB）、D-二聚体检测水平，并分析肛周脓肿严重程度与FIB、D-二聚体的关系。结果：FIB与病情严重程度负相关（r=-0.147，P=0.046），而D-二聚体与病情严重程度正相关（r=0.810，P=0.007）。结论：肛周脓肿患者的FIB、D-2聚体水平与其病情严重程度相关，均可作为判断患者病情严重程度和预后指标之一。     

血清同型半胱氨酸、C反应蛋白和D-二聚体联合检测对急性脑梗死患者的临床意义

目的探讨血清同型半胱氨酸(Hcy)、C反应蛋白(CRP)、D-二聚体(D-D)联合检测对急性脑梗死(ACI)患者的临床价值。方法选取2012年1月至2014年10月该院收治的82例ACI患者作为观察对象,根据梗死体积分为3组:大梗死组(L组)13例,中梗死组(M组)47例,小梗死组(S组)22例;选取同一时期的100例健康者作为健康对照组,比较各组Hcy、CRP、D-D水平和Hcy、CRP、D-D三者联合检测对ACI的诊断价值。结果各组研究对象Hcy、CRP、D-D水平比较,差异有统计学意义(P0.05)。Hcy灵敏度为84.14%,特异度96.00%,正确诊断指数0.801 4,阴性预测值88.07%;CRP灵敏度90.24%,特异度91.00%,正确诊断指数0.812 4,阴性预测值91.92%;D-D灵敏度75.61%,特异度98.00%,正确诊断指数0.736 1,阴性预测值83.05%;Hcy+CRP+D-D灵敏度98.78%,特异度89.00%,正确诊断指数0.877 8,阴性预测值98.89%,差异有统计学意义(P0.05)。Hcy、CRP、D-D三者联合的阳性预测值差异无统计学意义(P0.05)。结论 Hcy、CRP、D-D联合检测可用于ACI预测,具有一定的临床诊断价值。