硝苯地平联合依诺肝素钠对重度子痫前期术后患者妊娠期高血压的影响

目的探讨联合应用硝苯地平与依诺肝素钠治疗对重度子痫前期术后患者血压、凝血功能及对血清D-二聚体的影响。方法选取2015年6月-2017年10月期间行宫剖产术进行分娩的203例重度子痫前期孕妇,依据随机对照表分为对照组(101例)和观察组(102例)。对照组采用硝苯地平治疗,观察组采用硝苯地平联合依诺肝素钠治疗,比较2组患者采用不同方式治疗后血压、凝血功能的变化情况,以及对血清D-二聚体的影响,并统计不良妊娠结局。结果观察组总体有效率为95.10%,显著高于对照组(87.13%),具有统计学差异(P<0.05)。观察组治疗后FIB、D-二聚体、PAI-1、HB、PLT显著降低,而PT、APTT、t-PA均显著增加,各指标水平显著优于对照组(P<0.05)。治疗后2组患者的收缩压、舒张压均显著降低,且治疗后观察组各血压水平显著低于对照组(P<0.05)。治疗后2组患者的血清vWF、PAPP-A水平均显著降低,其中观察组各水平显著低于对照组(P<0.05)。观察组平均妊娠时间、胎儿体质量均显著优于对照组,24 h蛋白尿水平显著低于对照组,主要不良妊娠结局为胎儿窘迫、早产、产后出血、新生儿窒息,其中观察组不良妊娠发生率(9.80%)显著低于对照组(18.81%),具有统计学差异(P<0.05)。结论硝苯地平联合依诺肝素钠对重度子痫前期治疗效果显著,可有效降低患者术后血压,改善凝血功能,调节血清D-二聚体水平,从而降低不良妊娠结局发生率。     

NSE、hs－CRP和D－二聚体联合检测诊断急性脑梗死的价值

目的：探讨血清神经元特异性烯醇化酶（ NSE）、超敏C反应蛋白（ hs－CRP）和D－二聚体（ D－D）联合检测对急性脑梗死的临床诊断价值。方法选择2014年2月～2014年10月收治的急性脑梗死患者120例,另外选择同期健康体检者120例作为对照组,对各组别血清NSE、hs－CRP和D－D水平进行测定,并对测定结果进行统计学分析。结果急性脑梗死组患者血清中NSE、hs－CRP 和D－D水平均显著高于对照组,组间比较具有显著性差异（ P＜0．05）;轻度组、中度组、重度组患者NSE、hs－CRP和D－D水平亦逐渐升高,组间比较差异均有统计学意义（ P均＜0．05）。结论血清NSE、hs－CRP和D－二聚体水平升高与脑梗死的发生有密切关系,是脑梗死的危险因素,联合检测有助于了解脑梗死的发生和病情变化,对脑梗死的预防、治疗和早期诊断有着积极的临床意义。     

高龄髋部骨折患者围术期D-二聚体的测定及临床意义

目的探讨围术期高龄髋部骨折患者血液中D-二聚体(D-D)水平的变化及其临床意义。方法对60例80岁以上髋部骨折患者手术前、手术后血液中D-D水平进行检测。手术前包括入院时(T1)、即将手术时(T2),T后包括手术后即刻(T3)和手术后第1天(T4)。结果 T1、T2、T3、T4D-D阳性率分别为6.67%、16.67%、41.67%、80.00%,T3、T4与T1、T2相比,T3与T4相比,差异均有统计学意义(P0.05);T1与T2相比,差异无统计学意义(P0.05)。结论高龄髋部骨折患者手术前后D-D水平变化显著,D-D水平的变化是反映下肢深静脉血栓的有效指标,对于高龄髋部骨折患者围术期进行D-D水平动态监测有着极其重要的临床意义。     

CT联合D-D检查在胰腺炎预后评估中的应用价值

目的探讨CT联合D-二聚体(D-D)在急性胰腺炎(acute pancreatitis,AP)诊断及预后评估中的应用价值。方法选取2016年10月~2018年12月我院收治的重症AP患者84例,所有患者入院后均完善腹部CT检查及血清D-D检测。根据Balthazar CT分级以C级为分界,将患者分为低级组(≤C级)与高级组(> C级);并以D-D=2.00μg/mL为分界,将患者分为低水平组(≤2.00μg/mL)和高水平组(>2.00μg/mL);对上述不同组间患者预后参数进行对比分析。结果 CT分级高级组住院时间明显长于低级组(P<0.05),死亡率明显高于低级组(P<0.05),两组ICU入住率、中转手术率对比无统计学差异(P>0.05)。D-D高水平组死亡率明显高于低水平组(P<0.05)。Pearson相关分析显示,D-D水平与Balthazar CT分级呈正相关(r=0.368,P<0.05)。ROC曲线分析显示,Balthazar CT分级、D-D及二者联合预测重症AP患者死亡的曲线下面积分别为0.660 (95%CI:0.507~0.813)、0.669 (95%CI:0.558~0.780)、0.757 (95%CI:0.614~0.900)。结论 Balthazar CT分级、D-D均可对重症AP患者预后进行判断,二者联合可提高预估价值。     

缺血性脑卒中患者血清中Hcy、D-二聚体、血脂水平变化及临床意义

目的对于临床中收治的缺血性脑卒中患者,探究其血脂、Hcy与D-二聚体水平改变情况及其存在的价值作用。方法本次研究随机挑选2019年1月～2020年1月到院治疗的275例缺血性脑卒中患者与同期275例健康者进行研究,其中275例健康者作为对照组,275例缺血性脑卒中患者作为观察组,其中包括120例无斑块亚组与155例斑块亚组。分别对对照组和观察组患者的血脂水平、Hcy水平及D-二聚体水平进行检测并加以比对,同时比较无斑块亚组和斑块亚组Hcy和D-二聚体水平变化情况。结果与对照组相比较,观察组患者血脂中HDL-C水平显著偏低,而TC、TG、LDL-C、LPa、ApoA1和ApoB水平显著偏高,Hcy和D-二聚体水平显著偏高(P0.05);与斑块亚组相比较,无斑块亚组患者Hcy和D-二聚体水平显著偏低(P0.05)。结论临床中患有缺血性脑卒中疾病患者,其Hcy水平、D-二聚体水平及血脂水平均处于增长状态,针对以上三项指标进行检测可为后期的治疗以及诊断提供可靠的参考依据。     

Erythrocytic phosphatidylserine exposure and hemostatic alterations in β-thalassemia intermediate patients

Introduction

Hypercoagulable state is one of the common findings in beta-thalassemia intermedia (β-TI), particularly in splenectomized patients, with infrequent blood transfusion. Abnormality of the red blood cells (RBC) membrane due to oxidative damage is suggestive of possible etiologies. Membrane lipid peroxidation increases the exposure of phosphatidylserine (PS) that plays a role in the activation of coagulation factors V and X, subsequently initiating thrombosis. Our aim of this study was to find the probable correlation of the alteration of the PS on the RBC outer membrane with the hypercoagulable state in the β-TI patients.

Materials and methods

Our cross-sectional study was conducted on 39 splenectomized β-TI patients and 38 age-matched healthy controls. The mean age was 37 years. Analysis of the PS exposure on the RBCs was performed by fluorescein isothiocyanate (FITC) conjugated AV protein .Measurement of the coagulation factors X, V and antithrombin III (AT-III) was performed. We also checked the D-dimer levels .Analysis was performed by SPSS16.

Results

Fluorescence of FITC-Annexin V labeling on patients RBCs were higher than healthy controls; (2.8 ± 2.2%) of the patients versus (0.4 ± 0.18%) in the control group and was statistically significant (P < 0.05). Mean levels of factor X and AT-III of the patients as compared with the control group decreased and showed significant difference (P < 0.05).

Conclusions

Circulation of thalassemic RBCs, which abnormally possess PS on RBC membrane outer surface, suggests the possibility of the gradual consumption of the coagulation factors in the presence of a chronic coagulability state.     

D-dimer level predicts in-hospital mortality in patients with infective endocarditis: A prospective single-centre study

Background

Increased circulating D-dimer levels have been correlated with adverse outcomes in various clinical conditions. To our knowledge, the association of on-admission D-dimer and in-hospital mortality in infective endocarditis (IE) has not been investigated. We hypothesized that increased on-admission D-dimer levels would correlate with adverse outcomes when prospectively studied in patients with IE.

Methods

In this prospective study, a total of 157 consecutive patients with the definite IE diagnosis met the inclusion criteria and underwent testing for on-admission D-dimer and CRP assays. The outcome measure was in-hospital death from any cause.

Results

In-hospital mortality occurred in 40 (26%) patients. Increased levels of plasma D-dimer (5.1 ± 1.7 vs 1.9 ± 0.8, p < 0.001), CRP [45(13-98) vs 12(5–28), p < 0.001] were found in dead patients compared with those survived. In addition to S. aureus infection, increased leukocyte count, end-stage renal disease, LVEF < 50%, vegetation size of > 10 mm, perivalvular abscess, on-admission D-dimer (HR: 1.32; 95% CI: 1.24-1.40; p < 0.001) and CRP (HR: 1.18; 95% CI: 1.09-1.36; p = 0.001) levels were significantly associated with in-hospital mortality. Furthermore, the sensitivity and specificity of D-dimer ≥ 4.2 mg/L in predicting in-hospital death in IE were 86% and 85%, respectively. Moreover, the sensitivity and specificity of CRP levels ≥ 13.6 mg/L were 72% and 69%, respectively.

Conclusion

Our findings suggest that on-admission D-dimer level may be a simple, available and valuable biomarker that allows us to identify high-risk IE patients for in-hospital mortality. D-dimer ≥ 4.2 mg/L, CRP ≥ 13.6 mg/L were independently associated with IE related in-hospital death.     

D-二聚体在主动脉夹层中的临床意义

主动脉夹层是心血管系统的急危重症,病死率极高。早期检测、识别并预防主动脉夹层进展,对于降低其病死率具有极其重要的意义。但是,主动脉夹层的确诊需要特殊的影像检查,临床上仍缺少简便有效的实验室指标。目前,关于D-二聚体作为识别主动脉夹层的血清学标记物并提供预后信息的研究证据不断增多,有助于我们进一步了解主动脉夹层的演进过程,评估不同患者的预后情况,现对此做一综述。     

BISAP联合凝血指标对急性胰腺炎严重程度评估的意义

目的:研究BISAP(bedside index for severity in AP)评分联合凝血指标对急性胰腺炎(acute pancreatitis,AP)严重程度评估的意义.方法:回顾2008-2012年中国医科大学附属盛京医院收治的166例AP患者的临床资料.对所有患者进行入院24h的BISAP、APACHE-Ⅱ评分,48h的Ranson’s及发病72h内CTSI评分,入院24h内抽取静脉血测定部分凝血活酶活化时间、凝血酶原时间、D-二聚体(D-dimer)、纤维蛋白原及血小板水平.分析凝血指标及BISAP评分对AP严重程度判断的意义,并通过ROC曲线分析二者联合对AP严重程度评估的意义.结果:多因素Logistic回归分析发现,D-dimer对AP严重程度评估具有独立预测意义;随着BISAP评分增加,SAP的比率增加;BISAP评分系统评估AP严重程度以2为临界点时Youden指数最大(0.541),ROC曲线下面积为0.836(0.776-0.896),并不逊于传统评分系统;BISAP评分系统联合D-dimer能更好地评估AP患者的严重程度.结论:BISAP是临床判断AP轻重程度的简单有效的指标,将BISAP与D-dimer联合应用使得对AP严重程度的评估更为准确.     

In the Experimental Model of Acute Mesenteric Ischemia,The Correlation of Blood Diagnostic Parameters with the Duration of Ischemia and their Effects on Choice of Treatment

ABSTRACT

Purpose/Aim: Acute mesenteric ischemia is a syndrome characterized by sudden onset abdominal pain followed by intestinal necrosis. Morbidity and mortality increase with delayed diagnosis. Even with the latest radiological diagnostic methods, early diagnosis and initiation of treatment can be delayed. Using an experimental model, here we aim to determine the relationship between the laboratory parameters used to detect acute mesenteric ischemia and the duration of irreversible ischemia. Materials and Methods: A total of 30 male Wistar albino rats were divided into five groups, all of which underwent general anesthesia: (i) Superior mesenteric artery (SMA) dissection with laparotomy was performed, and blood samples and intestinal segment samples were taken after 2 hr (Sham group); (ii) volvulus of one-third of the small intestines was performed manually by laparotomy, and blood samples and intestinal segment samples were taken after 2 hr (Volvulus group); (iii) SMA was ligated with laparotomy, and blood samples and intestinal segment samples were taken after 2 hr (SMA+ligated 2-hr group); (iv) SMA was ligated with laparotomy, and blood samples and intestinal segment samples were taken after 4 hr (SMA+ligated 4-hr group); and (v) SMA was ligated with laparotomy, and blood samples and intestinal segment samples were taken after 6 hr (SMA+ligated 6-hr group). Results: The mean lactate dehydrogenase (LDH) activities of the SMA+ligated 2-hr and SMA+ligated 6-hr groups were statistically higher than the control group (p = .004). Compared to the Sham and Volvulus groups, the mean lactate level of the SMA+ligated 6-hr group was significantly higher (p = .004). Compared to the Sham and Volvulus groups, the mean D-dimer levels of the SMA+ligated 4-hr and SMA+ligated 6-hr groups were significantly higher (p = .004 and .003, respectively). By histopathological evaluation, we found that pathological damage increased as the ischemia lengthened. Conclusions: Mesenteric ischemia leads to an irreversible loss of intestinal perfusion and an increase in parameters of ischemia. Irreversible tissue damage occurs after 4 hr of ischemia and peaks after 6 hr, whereas parameters of ischemia (D-dimer, LDH, and L-Lactate levels) are highest at 2 hr after the onset of ischemia.