血浆纤维蛋白原和载脂蛋白AⅠ水平与急性冠脉综合征患者PCI术后近期预后的关系研究

[目的]通过观察行PCI术的急性冠脉综合征(ACS)患者血浆纤维蛋白原(FIB)及载脂蛋白AⅠ(ApoAⅠ)水平与患者PCI术后30 d内不良心血管事件(MACE)发生率的关系,探讨用FIB及ApoAⅠ水平对ACS患者PCI术后近期预后进行预测的可能性。[方法]测定121例入院后行PCI术的ACS患者,包括不稳定心绞痛(UA)组(n=53),急性心肌梗死(AMI)组(n=68),和64例除外器质性心脏病确诊为心血管神经症者(对照组)的血浆FIB、ApoAⅠ和ApoB水平。根据FIB水平将所有ACS患者分为:Ⅰ组(n=83):FIB<4 g/L,Ⅱ组(n=38):FIB≥4 g/L;按ApoAⅠ水平将所有ACS患者分为:Ⅲ组(n=78):ApoAⅠ≥1.0 g/L;Ⅳ组(n=43):ApoAⅠ<1.0 g/L。分别比较Ⅰ组和Ⅱ组,Ⅲ组和Ⅳ组患者PCI术后30 d的主要MACE的发生情况,分析影响ACS患者PCI术后近期预后的危险因素。[结果](1)AMI组FIB水平显著高于UA组和对照组(P<0.01)。AMI组与UA组同对照组比较ApoAⅠ明显降低(P<0.01),AMI组ApoAⅠ水平低于UA组(P<0.05)。(2)AMI组与UA组分别同对照组比较,ApoAⅠ/ApoB的比值差异有非常显著性意义(P<0.01)。(3)在MACE中,Ⅱ组与Ⅰ组比较,严重心律失常、充血性心力衰竭、心室壁瘤、心源性休克的发生率明显增加(P<0.05)。Ⅳ组与Ⅲ组比较,充血性心力衰竭发生率上有明显差异(P<0.05);Ⅱ组与Ⅰ组比较,Ⅳ组与Ⅲ组比较总事件率差异有非常显著性意义(P<0.01)。[结论]不同FIB和ApoAⅠ水平是影响ACS患者PCI术后近期预后的主要危险因素。     

老年溃疡性结肠炎患者D-二聚体、部分凝血活酶时间及纤维蛋白原的变化与意义

目的探讨老年溃疡性结肠炎(UC)患者D-二聚体(D-D)、部分凝血活酶时间(APTT)及纤维蛋白原(FIB)的变化及意义。方法将56例老年溃疡性结肠炎活动期患者随机分为抗凝治疗组和非抗凝治疗组各28例,非抗凝治疗组采用常规治疗方法,惠迪(美莎拉嗪)每日2.0g口服,惠迪2.0g+生理盐水50ml每日1次睡前保留灌肠,四联活菌片500mg 3次/d,口服;抗凝治疗组在常规治疗同时采用低分子肝素5000U每日1次皮下注射进行抗凝治疗;两组治疗总疗程均为6周,选择同期健康体检者30例作为对照组,治疗前后检测各组患者血浆中的D-D、APTT及FIB水平,同时采用临床活动度评分计算临床活动性指数。结果治疗前,D-D、APTT及FIB水平UC组分别为(360.6±105.7)μg/L、(25.4±6.4)s、(4.1±1.1)g/L,对照组分别为(150.8±66.6)μg/L、(29.8±5.6)s、(2.3±0.5)g/L,各指标差异均有统计学意义(P<0.05);治疗后,抗凝治疗组D-D、APTT及FIB水平组分别为(212.6±62.0)μg/L、(27.2±3.4)s、(2.2±1.0)g/L,非抗凝治疗组分别为(288.5±102.6)μg/L、(26.2±4.0)s、(3.2±1.4)g/L,D-D及FIB治疗前后及组间比较差异均有统计学意义(均P<0.05),而APTT则差异无统计学意义,抗凝治疗组临床活动性指数,治疗后与治疗前比较明显下降,与非抗凝治疗组治疗后比较差异均有统计学意义(均P<0.05)。结论 UC患者血液存在高凝状态和继发纤溶,D-D、FIB可作为判定UC活动性的指标,给予适当的抗凝治疗后可明显改善血中D-D及FIB水平。     

血浆D-二聚体浓度与川崎病并发症的关系探讨

目的探讨川崎病(KD)血管损伤机制。方法应用酶联免疫吸附实验(ELISA)和双抗体夹心法检测66例KD患儿[KD组,其中冠状动脉病变(CAL)组18例,非冠状动脉病变(NCAL)组48例]、30例健康儿童(健康对照组)、35例肺炎、扁桃腺炎、肠炎等其他疾病患儿(其他疾病对照组)D-二聚体和纤维蛋白原含量,并同时检测C-反应蛋白(CRP)和血小板计数(plt)。分别于急性期(发病10d内)和恢复期(病程5～7周)进行二维彩色超声心动图检查,选择大动脉短轴切面探测左、右冠状动脉及左冠状动脉前降支内径,剑下四腔心探测左冠状动脉回旋支及右冠状动脉末端内径。冠状动脉损害诊断标准为小于3岁者大于2.5mm,4～9岁者大于3mm,10～14岁者大于3.5mm。结果KD组D-二聚体和纤维蛋白原含量高于健康对照组,差异有统计学意义(P<0.01);合并冠状动脉病变(CAL)组D-二聚体和纤维蛋白原含量高于无冠状动脉病变(NCAL)组,差异有统计学意义(P<0.01);KD组CRP、plt含量高于健康对照组,差异有统计学意义(P<0.05),与其他疾病对照组无明显差异;KD组D-二聚体和纤维蛋白原含量明显高于其他疾病对照组,差异...     

200例脑卒中患者高同型半胱氨酸血症发生率及多危险因素分析

分析脑卒中患者高同型半胱氨酸(Hcy)血症的发生率及其意义.选择脑卒中患者200例,分为脑梗死组120例,脑出血组80例,健康人100名(对照组),测定其Hcy、FIB、CRP、CHOL、TG、LDL-C、HDL-C的水平.脑梗死组和脑出血组的Hcy含量分别为20.56±9.73μmol/L、19.67±9.05μmol/L,与对照组(12.41±4.87μmol/L)相比显著升高,具有统计学意义(P＜0.01).脑梗死组和脑出血组的血浆FIB含量分别为4.17±0.71g/L、4.11±0.67g/L,与对照组(2.58±0.57g/L)相比显著升高, 具有统计学意义(P＜0.01).但脑卒中组CRP、CHOL、TG、LDL-C、HDL-C水平与对照组比较,差异无统计学意义(P＞0.05).脑梗死组和脑出血组高同型半胱氨酸血症发生率均高于对照组,具有统计学意义(P＜0.01).高同型半胱氨酸血症是脑卒中的独立危险因素, 高同型半胱氨酸致血浆纤维蛋白原升高,是造成脑梗死患者血液粘度升高的主要原因.     

Internal Crack Initiation and Growth Starting from Artificially Generated Defects in Additively Manufactured Ti6Al4V Specimen in the VHCF Regime

The aim of the present work was to investigate the ‘fine granular area’ (FGA) formation based on artificially generated internal defects in additively manufactured Ti6Al4V specimens in the early stage of fatigue crack growth in the ‘very high cycle fatigue’ (VHCF) regime. Fatigue tests were performed with constant amplitude at pure tension-compression loading (R = −1) using an ultrasonic fatigue testing setup. Failed specimens were investigated using optical microscopy, high-resolution ‘scanning electron microscopy’ (SEM), and ‘focused ion beam’ (FIB) techniques. Further, the paper introduces alternative proposals to identify the FGA layer beneath the fracture surfaces in terms of the ‘cross section polishing’ (CSP) technique and metallic grindings with special attention paid to the crack origin, the surrounding microstructure, and the expansion of the nanograin layer beneath the fracture surface. Different existing fracture mechanical approaches were applied to evaluate if an FGA formation is possible. Moreover, the results were discussed in comparison to the experimental findings.     

全自动和半自动血凝分析仪测定结果的比较

目的比较SysmexCA-1500全自动和SysmexCA-50半自动血凝仪对4组不同凝血状态的标本测定结果的差异,以评价仪器及配套试剂的优劣。方法通过对30例健康体检人员、30例孕晚期的待产妇、21例肾功能衰竭行血液透析治疗的患者、15例肝炎后肝硬化患者,通过抽取静脉血分离血浆同时采用SysmexCA-50半自动和SysmexCA-1500全自动血凝仪分别测定凝血酶原时间、活化部分凝血酶原时间、纤维蛋白原。对比观察每一组利用上述两种不同仪器测定结果之间的差异。结果对正常标本,2台仪器测定结果基本相符,但对异常标本,二者的测定结果差异有统计学意义,结果不具可比性。结论 SysmexCA-1500全自动血凝仪测定结果优于Sysmex-CA-50半自动血凝仪。     

脉络舒通丸联合贝前列素钠治疗血栓闭塞性脉管炎的临床研究

目的 探讨脉络舒通丸联合贝前列素钠片治疗血栓闭塞性脉管炎的临床疗效。方法 选取2021年10月—2022年10月廊坊市人民医院收治的164例血栓闭塞性脉管炎患者,按照随机数字表法将所有患者分为对照组和治疗组,每组各82例。对照组患者口服贝前列素钠片,2片/次,3次/d。治疗组在对照组基础上饭后口服脉络舒通丸,12 g/次,3次/d。两组患者连续治疗3个月。观察两组的临床疗效,比较两组的踝肱指数（ABI）、最大步行距离、血液流变学指标和血清炎性因子水平。结果 治疗后,治疗组总有效率为90.24%,明显高于对照组总有效率78.05%(P<0.05)。治疗后,两组的ABI、最大步行距离明显高于治疗前（P<0.05）;治疗后,治疗组的ABI、最大步行距离明显高于对照组（P<0.05）。治疗后,两组的纤维蛋白原（FIB）、血浆黏度（PV）低于治疗前,红细胞变形指数（DI）高于治疗前（P<0.05）;治疗后,治疗组的FIB、PV低于对照组,DI高于对照组（P<0.05）。治疗后,两组的血栓素B2(TXB2)、C反应蛋白（CRP）、内皮素1(ET-1)水平低于治疗前（P...     

Three‐dimensional ultrastructural analysis of development at the supraspinatus insertion by using focused ion beam/scanning electron microscope tomography in rats

To obtain a successful outcome after rotator cuff repair, the repaired tendon must be biologically anchored to the bone. However, the histological structure at the repaired tendon‐bone interface differs from that of the site of normal tendon insertion. Therefore, analyzing postnatal development in detail will contribute to understanding the repaired tendon‐bone interface after rotator cuff repair. In this study, we analyzed postnatal development at the tendon‐bone insertion in terms of temporal changes in SOX9/SCX expression and three‐dimensional (3D) ultrastructure with FIB/SEM tomography, a new scanning electron microscopic method. Sixteen postnatal Sprague–Dawley rats were used for the study. One‐, two‐, three‐, and four‐week‐old rats were sacrificed and both right and left shoulders were removed; eight normal supraspinatus tendon insertions were isolated for each time point. At each time point, four specimens were evaluated with fluorescent immunostaining for SOX9/SCX expression, and the remaining four specimens were evaluated with FIB/SEM tomography. Even in postnatal development, SOX9⁺/SCX⁺ expression was observed at the tendon insertion; expression gradually decreased with postnatal development at the normal tendon insertion. In 3D ultrastructure, the morphology of the cells and the number/orientation of the cell processes drastically changed by postnatal week 4. The pattern of SOX9/SCX expression and 3D ultrastructural changes obtained in this study contribute to an understanding of the complicated development of normal tendon‐bone insertion. Therefore, this study helps elucidate the pathophysiology of tendon‐bone insertion, especially in cases of rotator cuff tear and repair. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:969–976, 2016.