Therapeutic Use of FGA1 Infusions in Severe Pre-Eclampsia-A Major Clinical Potential

Pilot studies showed that, i.v. infusions of the renal prostaglandin A₁ (PGA₁) induced a triad of beneficial clinical responses in severe pre-eclampsia : the blood pressure became normotensive, renal function was markedly improved and labour was successfully induced. The present study was an attempt to develop a therapeutic schedule of PGA₁ administration in severe toxemia. Twenty one cases of severe pre-eclampsia (in 3 equal groups) received i.v. infusions of PGA₁ in a dose range of 0.1–0.5 μg/kgm/min for 12–24 hours and the B.P., uterine activity and FHR were contiuously monitored during and for 12 hours following the infusion period. The 0.1 μg/Kgm/min dose for 12 hours was inadequate while 0.5 μg/Kgm/min for 12 hours induced a good hypotensive response and the cases delivered within 48 hours but a post-infusion rebound in hypertension was observed. The dose of 0.5 μg/Kgm/min for 24 hours appeared to be optimal in clinical terms since a satisfactory effect on B.P. was recorded and all the subjects delivered normal babies during the infusion period with minimal or no post-infusion rebound rise in B.P. This approach holds a major potential in the treatment of severe pre-eclampsia.     

探讨血VEGF、PAPP-A、D-D和尿NAG/Cr对妊娠高血压综合征的临床意义

目的探讨妊娠高血压综合征(PIH)患者血管内皮生长因子(VEGF)、血清妊娠相关血浆蛋白-A(PAPP-A)、D-二聚体(D-D)和N-乙酰-β-D-氨基葡萄糖甙酶/肌酐(NAG/Cr)比值的变化及意义。方法通过检测92例PIH患者和35例健康妊娠孕妇PAPP-A、VEGF、D-D和NAG/Cr的水平,分析其与PIH的关系。结果妊娠高血压综合征患者VEGF水平显著低于健康对照组,差异有统计学意义(P0.01),且随着病情的加重而显著降低,而PAPP-A、D-D、NAG/Cr水平显著高于健康对照组,差异有统计学意义(P0.01);且随着病情加重PAPP-A、D-D、NAG/Cr水平显著增高。结论 VEGF、PAPP-A、D-D、NAG/Cr与PIH的发生、发展密切相关,动态监测其水平变化对于PIH患者的病情判断、临床治疗均有重要意义。     

逐瘀通脉胶囊对糖尿病早期肾病患者胱抑素C和D二聚体的影响

目的观察逐瘀通脉胶囊佐治糖尿病早期肾病的疗效,以及对胱抑素C和D二聚体的影响,并探讨其机制。方法选择78例糖尿病早期肾病患者为研究对象,均予以糖尿病饮食、运动疗法、胰岛素或(和)口服降糖药物、抗栓、调脂、ACEI或ARB制剂等常规治疗。入选后随机分为观察组和对照组,每组39例。观察组予以逐瘀通脉胶囊0.4g,3次/日,口服;对照组加服复方丹参片,3片,3次/日。疗程为12周。分别检测两组患者治疗前、后尿微量白蛋白排泄率(UAER),血清胱抑素C(CysC)和血浆D二聚体水平,并予以比较。结果①两组患者治疗后UAER、CysC、D二聚体均较前降低,差异经检验,具有统计学意义(P<0.01,P<0.05)。②观察组上述指标较之对照组降幅更甚,差异经检验,亦具有统计学意义(P<0.05)。结论逐瘀通脉胶囊对糖尿病早期肾病有一定的治疗效果,可能是通过提高肾小球滤过率,抗凝血等机制来实现的。     

Diagnostic value of D-dimer in patients with suspected pulmonary embolism: results from a multicentre outcome study

BACKGROUND: D-dimer tests are used in various diagnostic strategies to exclude pulmonary embolism (PE). However, their role as an exclusionary first-line test is still uncertain, mainly because accuracy of the test varies according to the assay and the studied population. METHODS: The aim of this multicentre study was to evaluate the accuracy of D-dimer testing in patients with suspected PE. Diagnosis of PE was based on pre-test clinical probability (PCP) evaluation and both single-detector spiral CT (CT) and lower limbs compression ultrasonography (CUS). Lung scanning and/or pulmonary angiography was mandatory when CT or CUS was inconclusive and when both CT and CUS were normal in a patient with a high PCP. All patients were followed-up for 3 months, looking for VTE recurrence. D-dimers were collected within 24 h of inclusion and stored in each local hematology unit, to be analyzed at the end of all inclusions; physicians in charge of the patient were blinded to D-dimer results. RESULTS: Three hundred and fifty two patients were included in 4 centres. Prevalence of PE was 38.6%. PCP was low in 82 (23.3%), intermediate in 176 (50%) and high in 94 (26.7%) patients. Sensitivity of D-dimer was 96.3% (95% CI: 93-99) and negative predictive value reached 94.4% (95% CI: 90-99). Five patients with a confirmed PE had a D-dimer level below 500 ng/ml (two patients with a high PCP). Among 258 patients with low or intermediate PCP, 80 (31%) had a negative D-dimer test result; three of them had a false negative result and the number needed to test was 3.3. Among 94 patients with a high PCP, 9 had a negative D-dimer test result; two of them had a false negative result and the number needed to test was 13.5. CONCLUSION: These results confirm that rapid assays used in this study can safely exclude PE in first-line testing only in non-high CP patients.     

髓过氧物酶在冠状动脉粥样硬化性心脏病诊断和预后中的意义

目的评估血清髓过氧化物酶(myeloperoxidase,MPO)浓度在冠状动脉粥样硬化性心脏病(冠心病)进展过程中作为诊断和预后标志物的可行性。方法采用酶联免疫分析法测定血清MPO、心肌肌钙蛋白,肌酸激酶(CK-MB),C反应蛋白,纤维蛋白原和D二聚体浓度,并对它们的诊断敏感性进行比较。结果血清MPO浓度随着冠心病进展而增加,作为的诊断和预后标志物,其敏感性要高于心肌肌钙蛋白I,肌酸激酶,C反应蛋白,纤维蛋白原和D二聚体。结论MPO在冠心病进展过程中对不稳定动脉粥样硬化的风险评估时,可以充当诊断和预后的标志物。     

Proteolytic activity during storage of platelets in plasma

Proteolytic activity was studied in platelet concentrates (PC) stored in plasma at 22 degrees C. In experiment 1, two PC with a higher (A) and a lower (B) white cell concentration were prepared from each of nine donors by centrifugation. Aliquots of the cell-free plasma, PPP, were stored as a control. Samples for the assay of fibrinopeptide A (FPA), elastase, spontaneous proteolytic activity (SPA), kallikrein-inhibiting activity, thrombin-antithrombin complexes (TAT) and D-dimers were collected initially and on days 1, 3, 5 and 7 of storage. Consumption of glucose, pH and concentrations of lactate dehydrogenase (LDH) and ATP were determined to investigate the metabolic status of the PC. The decrease in pH correlated to the leucocyte count, r = -0.74, P < 0.001 and to the increase in LDH, r = -0.74, P < 0.01. The levels of elastase and the SPA were consistently low in the PPP bags. In the PC elastase had increased by day 5 and the SPA by day 3; the levels in PC A were significantly higher than in PC B, P < 0.01. The leucocyte count correlated with the elastase activity, r = 0.71, P < 0.01, and with the SPA, r = 0.65, P < 0.01. A minor increase in FPA was demonstrated while no TAT and D-dimers could be detected. The cause of the formation of FPA was studied in experiment 2; three bags of PC and four of PPP were prepared from each of 16 donors. To the PC and three of the PPP bags either hirudin, aprotinin or no enzyme inhibitor (control) was added.(ABSTRACT TRUNCATED AT 250 WORDS)     

血VEGF、D-D和尿NAG/Cr与妊娠高血压综合征的关系

目的探讨妊娠高血压综合征(PIH)患者血管内皮生长因子(VEGF)、D-二聚体(D-D)和N-乙酰-β-D-氨基葡萄糖苷酶/肌酐(NAG/Cr)比值的变化及意义。方法通过测定92例PIH患者和35例健康妊娠孕妇VEGF、D-D和尿NAG/Cr的水平,分析其与PIH的关系。结果 PIH患者VEGF水平显著低于健康妊娠组差异有统计学意义(P0.01),且随着病情的加重而显著降低,D-D、NAG/Cr水平显著高,与健康妊娠组比较差异有统计学意义(P0.01)。结论 VEGF、D-D、NAG/Cr与PIH的发生、发展密切相关,动态监测其水平变化对于PIH患者的病情判断、临床治疗均有重要意义。     

New guidelines for the diagnosis and management of pulmonary embolism:Key changes

Pulmonary embolism (PE) is an important public health problem. In August2019, the European Society of Cardiology in collaboration with the European Respiratory Society released new guidelines for the diagnosis and management of PE. We discuss the basic changes between these recent guidelines and the previous guidelines that were published in 2014. Regarding diagnosis, the new guidelines propose the use of an age-adjusted cut-off level of D-dimers instead of a fixed cut-off value. A D-dimer test adapted to clinical possibility should also be considered instead of fixed cut-off level of D-dimer. Detailed recommendations for the diagnosis of PE during pregnancy are also provided. Regarding risk stratification, assessment of PE-related early mortality risk is recommended.Moreover, the importance of right ventricular dysfunction is emphasized in lowrisk patients. For further risk stratification of the severity of PE in patients without hemodynamic instability, use of validated scores that combine clinical,imaging and laboratory PE-related prognostic factors might also be considered.Regarding treatment, the possibility of early discharge is mentioned in patients without severe comorbidities, who are not of high risk for sudden death and in whom proper medical management at home and proper medical follow up can be ensured. The new guidelines also suggest that pro-brain natriuretic peptide levels, right ventricular function and the presence of thrombus in the right heart could be useful for guiding the decision of early discharge. Overall, these new guidelines introduce several key changes and knowledge and adherence to them will improve the outcome of patients with PE.     

Predictors of blood loss after coronary artery bypass grafting

To assess the predictive value of variables possibly associated with blood loss after coronary artery bypass grafting (CABG). A prospective study. A university hospital. Eighty-nine patients scheduled for elective CABG. Blood samples were drawn before and after surgery. Chest tube drainage was measured hourly until removal of drains. Activation of coagulation and fibrinolysis, routine clotting tests, and expression of platelet surface antigens were analyzed using flow cytometry. A significant correlation was found among blood loss and activated partial thromboplastin time, fibrinogen, prothrombin fragment 1 + 2, D-dimers, platelet count, GPlb and P-selectin expression on platelets, use of internal thoracic artery, cross-clamp time, and thrombin-antithrombin III complex. In a multiple regression model, glycoprotein (GP) Ib expression on platelets, platelet count, use of internal thoracic artery, and D-dimers were significantly associated with blood loss. Logistic regression analysis showed that GPIb and D-dimers predicted an increased blood loss with a positive predictive value of 73% and a negative predictive value of 91%. Postoperative D-dimers and GPIb expression may be useful to exclude nonsurgical causes in bleeding patients after CABG.     

正常妊娠和妊娠期高血压妇女凝血指标变化

目的：观察比较正常妊娠和妊娠期高血压妇女血浆凝血因子的变化及临床意义。方法：检测正常妊娠和妊娠期高血压孕妇各30例及非妊娠妇女20例的血浆凝血酶原时间（PT）、部分凝血活酶时间（APTT）、纤维蛋白原（Fg）及D-二聚体（D-D）的含量．并进行比较分析。结果：正常妊娠和妊娠期高血压两组血浆Fg、D—D含量均高于非孕妇女（P均〈0．01），妊娠期高血压组的高于正常妊娠组（P〈0．01）。妊娠期高血压组轻、中、重度患者血浆Fg、D-D含量随病情加重逐渐升高，并有非常显著差异（P〈0．01）。重度妊娠高血压组与正常妊娠及轻、中度妊娠高血压组比较，PT、APTT均缩短（P〈0．01）。结论：动态检测孕妇血浆中凝血指标对于妊娠期高血压的早期诊断与防治有重要意义。