妊娠期高血压疾病患者凝血指标变化的意义

目的 探讨妊娠期高血压疾病妇女血浆凝血因子的变化及临床意义。方法 检测非妊娠妇女、正常妊娠和妊娠期高血压疾病妇女的血浆血小板（PLT）、凝血酶原时间（PT）、纤维蛋白原（FIB）、部分凝血活酶时间（APTT）的含量。结果 妊娠期高血压疾病组妇女的PLT、PT、AP，IT测定值明显低于正常妊娠晚期妇女和非妊娠妇女（P〈0．05）；正常妊娠晚期妇女的PLT、PT、APTT测定值较非妊娠妇女的略低，但差异无显著性（P〉0．05）。妊娠期高血压疾病组FIB含量高于正常妊娠组和非妊娠组。差异有显著性（P〈0．05）；正常妊娠组FIB含量高于非妊娠组，差异有显著性（P〈0．05）。结论 产前动态监测凝血功能对预防和治疗妊娠期高血压疾病具有一定指导意义。     

Stepwise application of fibrosis index based on four factors,red cell distribution width–platelet ratio,and aspartate aminotransferase–platelet ratio for compensated hepatitis B fibrosis detection

Background and Aim

Fibrosis index based on four factors (FIB‐4) and aspartate aminotransferase–platelet ratio (APRI) were validated with unsatisfactory efficiency. Routine hematology index red cell distribution width–platelet ratio (RPR) had been tried in liver fibrosis detection. This study tries to evaluate the stepwise application of FIB‐4, RPR, and APRI in detecting chronic hepatitis B (CHB) fibrosis.

Methods

A total of 246 compensated CHB patients who underwent liver biopsies, transient elastography, and routine blood tests including complete blood count were included. Dual cut‐offs were determined to exclude or include cirrhosis diagnosis. Performance of stepwise combining routine biomarkers including RPR, FIB‐4, and APRI were statistically analyzed.

Results

The Metavir F0, F1, F2, F3, and F4 were identified in 2.4%, 22.0%, 32.1%, 24.0%, and 19.5% of the eligible patients, respectively. The area under receiver operating characteristics curves for detecting significant fibrosis and cirrhosis were 0.853 and 0.883 for transient elastography; 0.719 and 0.807 for FIB‐4; 0.638 and 0.791 for RPR; 0.720 and 697 for APRI; and 0.618 and 0.760 for mean platelet volume–platelet ratio, respectively. The proportion of patient determined as cirrhosis or non‐cirrhosis was 65.9% by transient elastography, 36.9% by FIB‐4, 30.5% by RPR, and 19.5% by APRI, respectively. These numbers for determining significant fibrosis were 49.6%, 24.2%, 21.5%, and 23.6% in the same order. Detected by stepwise application of FIB‐4, RPR, and APRI, 41.5% and 52.8% of patients could be determined the state of significant fibrosis and cirrhosis, respectively.

Conclusions

In source‐limited settings without transient elastography, stepwise applying FIB‐4, RPR, and APRI could free nearly half of CHB patients from liver biopsies in detecting significant fibrosis and cirrhosis.     

高血压病合并颈动脉硬化患者中医证型与血脂等相关指标的关系

目的通过回顾性研究,探讨高血压合并颈动脉硬化患者中医证型与血脂等相关指标的关系。方法收集广州3家三级中医院住院的高血压合并颈动脉硬化患者553例的临床资料,包括中医证型、颈动脉斑块、血脂、血尿酸、纤维蛋白原、超敏C反应蛋白、血液流变学等,分析中医证型与高血压合并颈动脉硬化相关指标的内在联系。结果气虚痰瘀证组血尿酸、纤维蛋白原、超敏C反应蛋白、血液流变学水平均显著高于其余各组,气虚痰浊证组总胆固醇及低密度脂蛋白胆固醇水平明显高于其余各组。结论临床可以通过中医证型判断高血压病合并颈动脉硬化患者血脂、血尿酸等相关指标的异常情况,对指导临床治疗有重要意义。     

清络通脉片治疗下肢血栓性浅静脉炎急性期临床观察

目的:观察清络通脉片治疗下肢血栓性浅静脉炎急性期的临床疗效。方法:将下肢血栓性浅静脉炎急性期患者120例随机分为2组,对照组口服脉络舒通颗粒治疗,治疗组口服清络通脉片治疗,治疗28天后观察2组患者临床疗效、相关炎症因子水平及凝血功能。结果:总有效率治疗组为93.33%,对照组为83.33%,2组比较差异有统计学意义(P0.05);2组肿瘤坏死因子α(TNF-α)、高敏C反应蛋白(CRP)、白介素6(I L-6)、纤维蛋白原(FI B)、D二聚体(DD)水平治疗后均下降(P0.05),治疗组下降程度较对照组显著(P0.05)。结论:清络通脉片治疗下肢血栓性浅静脉炎急性期的临床效果优于脉络舒通颗粒,可能与其降低TNF-α、CRP、I L-6及FI B、DD水平有关。     

参蛇偏瘫胶囊联合依达拉奉治疗急性脑梗死的临床研究

目的探讨参蛇偏瘫胶囊联合依达拉奉注射液治疗急性脑梗死的临床疗效。方法选取2017年2月—2017年11月在赤峰学院附属医院治疗的急性脑梗死患者106例,根据用药的差别分为对照组(53例)和治疗组(53例)。对照组静脉滴注依达拉奉注射液,30 mg加入100 m L生理盐水,2次/d;治疗组在对照组基础上口服参蛇偏瘫胶囊,1.6 g/次,3次/d。两组均治疗2周。观察两组患者临床疗效,同时比较治疗前后两组患者NIHSS、ADL和SF-36评分及血流流变学指标和血清学指标。结果治疗后,对照组和治疗组临床有效率分别为81.13%和96.23%,两组比较差异具有统计学意义(P0.05)。治疗后,两组NIHSS评分显著降低,ADL和SF-36评分显著升高,同组治疗前后比较差异具有统计学意义(P0.05),且治疗后治疗组NIHSS、ADL和SF-36评分明显优于对照组(P0.05)。治疗后,两组红细胞压积(HCT)、全血黏度(WBV)、纤维蛋白原(FIB)和血浆黏度(PV)均显著降低(P0.05),且治疗组上述血流流变学指标水平明显低于对照组(P0.05)。治疗后,两组血清酪蛋白磷酸肽(CPP)、血红素加氧酶1(HO1)、胱抑素C(Cys C)水平均显著下降,转化生长因子β1(TGF-β1)水平显著升高,同组治疗前后比较差异具有统计学意义(P0.05),且治疗后治疗组上述血清学指标水平明显优于对照组(P0.05)。结论参蛇偏瘫胶囊联合依达拉奉治疗急性脑梗死可有效改善机体血液流变学指标,降低机体炎症反应、促进神经功能恢复,有利于提高患者日常活动能力和改善生活质量。     

Dynamic personalized prediction of the individual liver-related risk after sustained viral response in HCV patients

Sustained viral response (SVR) significantly improves the prognosis in patients with hepatitis C virus (HCV) chronic infection but does not totally alleviate the risk of liver-related complications (LRC). We aimed to evaluate whether the dynamics of multiple measurements of simple parameters after SVR enable the development of a personalized prediction of prognosis in HCV patients. HCV mono-infected patients who experienced SVR in two prospective cohorts (ANRS CO12 CirVir cohort: derivation set; ANRS CO22 HEPATHER cohort: validation set) were included. The study outcome was LRC, a composite criterion including decompensation of cirrhosis and/or hepatocellular carcinoma. Joint latent class modelling accounting for both biomarker trajectory and event occurrence during follow-up was developed in the derivation set to compute individual dynamic predictions, with further evaluation in the validation set. In the derivation set (n = 695; 50 LRC during the median 3.8 [1.6–7.5] years follow-up), FIB4 was identified as a biomarker associated with LRC occurrence after SVR. Joint modelling used sex and the dynamics of FIB4 and diabetes status to develop a personalized prediction of LRC. In the validation set (n = 7064; 273 LRC during the median 3.6 [2.5–4.9] years follow-up), individual dynamic predictions from the model accurately stratified the risk of LRC. Time-dependent Brier Score showed good calibration that improved with the accumulation of visits, justifying our modelling approach considering both baseline and follow-up measurements. Dynamic modelling using repeated measurements of simple parameters predicts the individual residual risk of LRC and improves personalized medicine after SVR in HCV patients.     

补血益母颗粒联合麦角新碱治疗宫缩乏力性产后出血的疗效观察

目的 探讨补血益母颗粒联合麦角新碱治疗宫缩乏力性产后出血的临床疗效。方法 选取2021年3月-2023年3月海口市妇幼保健院收治的80例宫缩乏力性出血患者，随机法分为对照组（40例）和治疗组（40例）。对照组肌肉注射马来酸麦角新碱注射液，0.2 mg/次，每日次数不超过5次。在对照组的基础上，治疗组口服补血益母颗粒，12 g/次，3次/d。两组均完成5 d治疗。观察两组患者临床疗效，比较治疗前后两组患者活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、凝血酶原时间（PT）和纤维蛋白原（FIB）指标水平，产后出血量和止血时间，及子宫体积和宫底下降高度。结果 治疗后，治疗组临床有效率（97.50%）明显高于对照组（85.00%，P<0.05）。治疗后，两组患者TT、PT、APTT指标均低于治疗前，而FIB指标高于治疗前（P<0.05），且治疗组凝血功能指标明显好于对照组（P<0.05）。治疗后，治疗组患者止血时间显著短于对照组（P<0.05），治疗组30 min及2、24 h的出血量均逐渐低于对照组（P<0.05）。治疗后，两组患者子宫体积、宫底下降高度指标均低于治疗前（P<0.05），且治疗组明显低于对照组（P<0.05）。结论 补血益母颗粒联合麦角新碱治疗宫缩乏力性产后出血效果确切，可有效纠正机体凝血状态，增强子宫收缩力，并同时缩短产后出血量，且安全有效。     

Effects of TM6SF2 rs58542926 polymorphism on hepatocellular lipids and insulin resistance in early type 2 diabetes

Background and aimsIncreased hepatocellular lipid content (HCL) is linked to insulin resistance, risk of type 2 diabetes and related complications. Conversely, a single-nucleotide polymorphism (TM6SF2^EK; rs58542926) in the transmembrane 6 superfamily member 2-gene has been associated with nonalcoholic fatty liver disease (NAFLD), but lower cardiovascular risk. This case-control study tested the role of this polymorphism for tissue-specific insulin sensitivity during early course of diabetes.Methods and resultsMales with recent-onset type 2 diabetes with (TM6SF2^EK: n = 16) or without (TM6SF2^EE: n = 16) the heterozygous TM6SF2-polymorphism of similar age and body mass index, underwent Botnia-clamps with [6,6-²H₂]glucose to measure whole-body-, hepatic- and adipose tissue-insulin sensitivity. HCL was assessed with ¹H-magnetic-resonance-spectroscopy. A subset of both groups (n = 24) was re-evaluated after 5 years. Despite doubled HCL, TM6SF2^EK had similar hepatic- and adipose tissue-insulin sensitivity and 27% higher whole-body-insulin sensitivity than TM6SF2^EE. After 5 years, whole-body-insulin sensitivity, HCL were similar between groups, while adipose tissue-insulin sensitivity decreased by 87% and 55% within both groups and circulating triacylglycerol increased in TM6SF2^EE only.ConclusionsThe TM6SF2-polymorphism rs58542926 dissociates HCL from insulin resistance in recent-onset type 2 diabetes, which is attenuated by disease duration. This suggests that diabetes-related metabolic alterations dominate over effects of the TM6SF2-polymorphism during early course of diabetes and NAFLD.