晚期非小细胞肺癌合并深静脉血栓18例临床分析

目的探讨晚期非小细胞肺癌合并深静脉血栓(deep venous thrombosis,DVT)的临床危险因素及预后,为晚期非小细胞肺癌合并DVT的预防及诊治提供临床依据。方法对吉林大学第一医院2008年7月至2010年4月收治的接受化疗的18例合并DVT的晚期非小细胞肺癌患者与同期87例不存在静脉血栓栓塞的晚期非小细胞肺癌患者的临床资料进行回顾性分析。结果单因素分析显示腺癌、存在并存疾病、D-2聚体增高、白细胞计数增高、活化部分凝血酶时间(activeated partial thromboplastin time,APTT)缩短是晚期非小细胞肺癌发生DVT的危险因素(P<0.05)。多因素logistic回归显示腺癌、存在并存疾病、D-2聚体增高、白细胞计数增高、APTT缩短是晚期非小细胞肺癌发生DVT的独立危险因素。晚期非小细胞肺癌合并DVT患者生存时间低于对照组(P<0.05)。结论腺癌、存在并存疾病、D-2聚体增高、白细胞计数增高、APTT缩短是晚期非小细胞肺癌发生DVT的独立危险因素。合并DVT提示晚期非小细胞肺癌患者预后不良。     

GLICOPROTEIN (GP) IIb/IIIa INHIBITORS FOR ACUTE STROKE TREATMENT

The benefit of antiplatelet therapy remains unclear, although it does appear that aspirin monotherapy started within 48 hours of stroke onset may result in a modest clinical improvement. Glicoprotein (GP) IIb/IIIa antagonists are currently considered the most powerful specific inhibitors of platelet activation in acute thrombosis. Glicoprotein IIb/IIIa inhibitor therapy could merit a prominent role also in the initial management of patients with acute ischemic stroke. Abciximab may be promising in this setting and should be evaluated in further clinical trials.     

脑血栓片治疗脑梗死的疗效分析

脑梗塞是常见缺血性脑血管疾病,发病率逐年增高,其致死率、致残率高的特性严重危害着患者身体健康及生活质量。近年已成为医学和社会重点关注的课题,如何进一步提高对脑梗塞的治疗效果,降低致残率,提高患者的生活质量同时做好二级预防,降低复发率,是我们目前需要解决的一个重要问题。各种围绕治疗卒中的药物有很多,具体疗效各有不同,我们对脑血栓片治疗脑梗塞的疗效进行了观察。     

有高危因素的妇科手术患者预防性血栓治疗的临床意义

量出血,无手术切口出血及出血倾向发生.单因素分析显示,高龄、开腹手术及恶件肿瘤为影响LDVT预防效果的相关因素(P<0.05).结论 妇科手术后对有高危因素的患者予预防性血栓治疗可以明显减少并延迟其术后LDVT的发生,且无明显不良反应发生;高龄、开腹手术及恶性肿瘤为影响LDVT预防效果的相关因素.     

Viral myocarditis and coagulopathy: increased tissue factor expression and plasma thrombogenicity

We investigated the effects of viral infection on Tissue Factor (TF) expression and activity in mice within the myocardium to understand increased thrombosis during myocarditis. Mice were infected with coxsackie virus B3 (CVB3) and the hearts were collected at day 4, 8 and 28 post infection (p.i.). Myocardial TF expression and cellular activity as well as plasma activity were analyzed from CVB3 infected mice by Western blot, chromogenic Factor Xa generation assay, in situ staining for active TF and immunohistochemistry. In addition to TF expression, hemodynamic parameters were measured during the time course of infection. Furthermore, we analyzed myocardial tissues from patients with suspected inflammatory cardiomyopathy. TF protein expression was maximally 5-fold elevated 8 days p.i. in mice and remained increased on day 28 p.i. (P < 0.001 vs. non-infected controls). Alterations in TF expression were associated with fibrin deposits within the myocardium. The TF pathway inhibitor protein expression in the myocardium was not altered during myocarditis. Active cellular TF co-localized with CD3 positive cells and VCAM-1 positive endothelial cells in the myocardium. The TF expression was positively correlated with the amount of infiltrating CD3 and Mac3 positive cells (Spearman-Rho ρ = 0.749 P < 0.0001 for CD3⁺ and ρ = 0.775 P < 0.0001 for Mac3⁺; N = 35). Increased myocardial TF expression was associated with a 2-fold elevated plasma activity (P < 0.05 vs. non-infected controls). In the human hearts, the TF expression correlated postively with an endothelial cell activation marker (ρ = 0.523 P < 0.0001 for CD62E; N = 54). Viral myocarditis is a hypercoagulative state which is associated with increased myocardial TF expression and activity. Upregulation of TF contributes to a systemic activation of the coagulation cascade.     

Predictors of venous obstruction following pacemaker or implantable cardioverter-defibrillator implantation: a contrast venographic study on 100 patients admitted for generator change, lead revision, or device upgrade.

AIM: Venous obstruction following transvenous device implantation rarely cause immediate clinical problems. When lead revision or device upgrade is indicated, venous obstruction become a significant challenge. The aim of this study was to determine the predictors of venous obstruction after transvenous device implantation, and to asess likely effects of antiplatelet/anticoagulant drugs in preventing venous thrombosis. METHODS AND RESULTS: Between March 2005 and July 2006, contrast venography was performed in 100 patients who were candidates for generator change, lead revision, or device upgrade. Vessel patency was graded as either completely obstructed, partially obstructed (>70%), or patent. The incidence of venous obstruction was 26%, with 9% of patients having total obstruction and 17% of patients exhibiting partial obstruction. No statistically significant differences between obstructed and non-obstructed patients were seen for age, sex, indication for device implantation, atrial fibrillation, cardiothoracic ratio, insulation material, operative technique, device type, and manufacturer (all Ps > 0.05). In a univariate analysis, multiple leads (P = 0.033), and presence of dilated cardiomyopathy (P = 0.036) were associated with higher risk of venous obstruction, whereas anticoagulant/antiplatelet therapy (P = 0.047) significantly reduced incidence of venous obstruction. Multivariate logistic regression analysis showed that only number of the leads (P = 0.039, OR: 2.22, and 95% CI: 1.03-4.76) and antiplatelet/anticoagulant therapy (P = 0.044, OR: 2.79, and 95% CI: 0.98-7.96) were predictors of venous obstruction. CONCLUSION: Total or partial obstruction of the access veins occurs relatively frequently after pacemaker or ICD implantation. Multiple pacing or ICD leads are associated with an increased risk of venous obstruction, whereas antiplatelet/anticoagulant therapy appears to have a preventive effect on development of access vein thrombosis.     

Arterial thrombotic manifestations in young women associated with the lupus anticoagulant

Summary To demonstrate the wide variety of clinical syndromes associated with the lupus anticoagulant (LAC), we report the case histories of three young females with arterial thrombosis in whom LAC was demonstrated. Two patients had a diagnosis of systemic lupus erythematosus and mixed connective tissue disease respectively; the other patient had no signs of underlying auto-immune disease. Arterial thrombotic events in young females should arouse suspicion of the presence of LAC although its pathophysiological significance is not established.     

Ventricular remodeling in Loeffler endocarditis: implications for therapeutic decision making

BACKGROUND: Little is known about the morphological and functional evolution of ventricular abnormalities in Loeffler endocarditis. METHODS AND RESULTS: We describe 5 patients, including 3 with long-term echocardiographic follow-up, in whom apical obliteration due to fibro-thrombotic thickening of the endocardium showed favorable patterns of evolution. In one patient there was almost complete resolution of the obliterative process with consequently increased effective ventricular volume. In two patients formation of a flow-passage in the fibrocalcific apical 'floor' between the main medioventricular cavity and the apical chamber, leading to a 'double-chambered' left ventricle was observed. CONCLUSIONS: Medical therapy and appropriate anticoagulation, can induce favorable long-term ventricular remodeling in Loeffler endocarditis.