妇宝胶囊止血机制的实验研究

目的:通过观察妇宝胶囊对动物出凝血时间、血液凝固系统的影响,探讨妇宝胶囊的止血机制。方法:采用毛细玻璃管法测定小鼠凝血时间(CT),用断尾法测定出血时间(BT);用ACL-200型血液凝集仪测定大鼠凝血酶原时间(PT)和部分凝血活酶时间(APTT)。结果:妇宝胶囊能明显缩短小鼠CT、BT,缩短大鼠PT和APTT。结论:妇宝胶囊的止血机制主要通过促进内源性和外源性凝血系统,抑制纤维蛋白溶解系统达到目的。     

APTT测定值和APTT测定值比率的临床应用价值探讨

目的;探讨APIT测定值(秒)和APIT测定值比率中哪一种是更稳定、更可靠的临床应用指标。方法:将同一标本采用法国STA-Compat全自动血凝仪以及两种手工法同时测定,比较同组标本不同方法的APTT测定值(秒)和APTT测定值比率。结果:手工法(一)与法国STA-Compact全自动血凝仅比较,如APTT值以秒表示,对照组、口服抗凝剂组及肝病组病人同组标本不同方法之间存在显著性差异(P<0.01,PAPTT测定值比率表示各组间并无显著性差异(P>0.10,P>0.50,P>0.05);手工法(二)与法国STA-Compact全自动血凝仪在对照组、口服抗凝剂组及白血病组的比较中,也获得类似的结果。结论:将APTT测定值(秒)转化为病人与对照APTT测定值比率报告,使不同方法结果间更具可比性。在APTT报告的标准化方面,建议将APTT和APTT测定值比率同时报告。     

Prothrombin times and activated partial thromboplastin times in toxicology: a comparison of different blood withdrawal sites for wistar rats

The prothrombin time (PT) and the activated partial thromboplastin time (APTT) for untreated male Wistar rats were determined on the Sysmex CA-5000 Instrument for blood taken from the orbital sinus, tail vein, vena cava and aorta. Boxplot and statistical analysis was performed. Only orbital sinus puncture yields unpredictable and unacceptable variation/prolongation of clotting times.     

阿藿烯对大鼠抗血栓活性作用研究

目的:研究阿藿烯对大鼠血栓形成和凝血功能的影响,评价其抗血栓活性。方法:将SD大鼠随机分为空白对照组、血塞通阳性药组(50mg/kg)、阿藿烯低剂量组(25mg/kg)、中剂量组(50mg/kg)、高剂量组(75mg/kg),各组动物连续灌胃5d,末次给药2h后建立下腔静脉结扎模型、FeCl3致动脉血栓模型、断尾流血时间测定模型测定阿藿烯对血栓形成和凝血的影响;并测定各组大鼠给药前及给药后2h血浆凝血酶原时间(PT)、活化部分凝血酶时间(APTT)。结果:阿藿烯能抑制动静脉血栓的形成,使血栓重量降低,且高剂量阿霍烯对动静脉血栓形成的抑制率均大于40%;同时有效延长大鼠断尾流血时间,并能使大鼠血浆APTT、PT明显延长(P<0.05),且都具有剂量依赖关系。结论:阿藿烯有抗血栓活性。     

唐山地区健康新生儿凝血结果正常参考范围的探讨

目的：建立唐山地区新生儿血浆凝血酶原时间（PT）,活化部分凝血活酶时间（APTT）和纤维蛋白原（FIB）的生物参考区间。方法按照美国临床和实验室标准协会（CLSI）C28-A2推荐方法,选取2010年5月-2013年5月健康新生儿1102例,按照性别不同分为男（584例）、女（518例）二组;根据不同民族分男（汉族548例,少数民族36例）、女（汉族495例,少数民族23例）二组,采用法国STAGO全自动血凝仪测定其PT ,APTT ,FIB ,对检测结果进行比较分析。结果经正态性检验,新生儿PT ,APTT ,FIB测定值均呈正态分布。经 Z检验发现不同性别新生儿 APTT 分布差异有统计学意义（tAPTT ＝6．693,P＜0．05）,不同民族新生儿PT ,APTT ,FIB分布差异无统计学意义（t男＝0．058～0．317,t女＝0．049～0．317, P＞0．05）。各项指标的参考区间（P2．5～ P97．5）如下：新生儿PT 参考范围11．1～14．9s;APTT 参考范围（男）29．9～62．6s ,（女）30．6～63．4s ;FIB的参考范围1．51～3．46 g/L。结论初步建立唐山地区新生儿PT ,APTT ,FIB的生物参考区间,提高新生儿出血性疾病、凝血功能障碍、血液病诊治的准确性。     

血液采集量对凝血功能检测影响的研究

目的：探讨采血量对于凝血功能检测中各项指标的影响情况。方法：收集2012年3月～2012年10月长沙市中医医院（市八医院）心胸外科病人标本32例、血液科病人30例及正常健康者标本30例,以血液采集量不足（1.4～1.5mL）为实验组,重抽采血量合格标本（1.8mL）为对照组,运用 sysmex CA1500全自动凝血分析仪检测各组样本凝血七项（血浆凝血酶原时间（PT）、纤维蛋白原（Fbg）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原降解产物（FDP）、D 二聚体（D-D）、抗凝血酶Ⅲ（AT-Ⅲ））。运用统计学分析血液采集量对于健康者、心胸外科病人与血液内科病人凝血功能检测的影响。结果：与对照组相比,各实验组 APTT、FDP、D-D 测定值均明显增加,AT-Ⅲ明显减小,具有统计学差异。心胸外科病人则凝血七项检测值均有统计学差异。血液科病人的 PT、Fbg、TT 则无显著性差异。正常健康组 PT 无差异。结论：血液采集量影响凝血功能的检测。特别是对心胸外科的影响较血液内科病人和正常健康人更甚。     

脂肪乳对PT、APTT和Fib凝血结果的影响与对策

目的探讨减少脂肪乳对凝血酶原(PT)、部分凝活酶时间(APTT)和纤维蛋白原(Fib)干扰的方法。方法制备正常新鲜混合血浆并检测PT、APTT、Fib;在正常新鲜混合血浆中加入不同浓度的脂肪乳并检测其PT、APTT和Fib,取均值计算干扰物影响度,同时在强生干化学分析仪VITRO FS5.1上检测血浆指数,并分析血浆指数与脂肪乳干扰之间的关系。通过CS2000i自带的稀释功能,寻找最佳的稀释倍数,减少脂肪乳对Fib的干扰。结果当添加干扰物脂肪乳4.76%体积分数时,对PT、APTT和国际标准化比值(INR)影响均7.5%,未超过1/2 CLIA’88规定的允许误差;脂肪乳添加的体积与血浆指数存在良好的线性相关:y=18.284x+4.557 9,R2=0.993 3;脂肪乳添加的体积与衍算纤维蛋白原(PT-der fibrinogen,PT-DFbg)添加前后的差值也存在良好的线性相关:y=0.146 9x-0.891 4(x≥6),R2=0.961 7;标本稀释可以很好地消除脂肪乳对Fib检测结果的干扰。结论利用血浆指数,可以减少一定浓度内脂肪乳对PT、APTT和Fib的干扰,标本稀释可以很好地消除脂肪乳对Fib检测结果的干扰。     

Utility of a weight-based heparin nomogram for patients with acute coronary syndromes

Abstract
Background:  Unfractionated heparin has been pivotal in the management of acute coronary syndromes (ACS), and continues to be used widely despite the emerging role of low molecular weight heparins (LMWH). The apparent superiority of LMWH over unfractionated heparin may, at least partially, reside in its more predictable achievement of therapeutic effect, with high rates of non-therapeutic activated partial thromboplastin time (APTT) results being observed in the intravenous heparin treatment groups.
Aim:  To evaluate the impact of introduction of a weight-based heparin nomogram developed for use in patients with ACS on frequency of 'therapeutic' APTT results.
Methods:  The effectiveness of an existing non-weight-based heparin nomogram in achieving a therapeutic APTT was compared sequentially with that of a weight-based heparin nomogram in 89 and 84 consecutive patients admitted with a diagnosis of ACS.
Results:  Patients in whom heparin dosage adjustment was weight based rapidly achieved therapeutic APTT. The median time to achieve an APTT within the target range was 8.75 h in the weight-based group versus >24 h in the non-weight-based group. Utilization of a weight-based nomogram was associated with markedly increased proportions of readings within the therapeutic APTT range at 6 h and at 24 h (51% vs . 26% and 72% vs . 36%, respectively).
Conclusions:  The current study confirms the marked superiority of the weight-based heparin regimen for treatment of patients with ACS. The nomogram dramatically facilitated the attainment of therapeutic APTT, and may represent the optimal method for titration of heparin dosage to individual heparin requirements in patients with ACS. (Intern Med J 2003; 33: 18−25)     

Enhanced thrombin generation in women with a history of oral contraception-related venous thrombosis

Introduction

In women who suffer venous thrombosis (VT) during oral contraceptive (OC) use, a transient risk factor (OC) is removed during the acute event, while most co-existing forms of thrombophilia persist and presumably continue to maintain hypercoagulability. The aim of this study was to establish if hypercoagulability persists long after OC-related VT and if it could be attributed to thrombophilia.

Materials and Methods

60 women (age 33.0 ± 8.5 years) were investigated 5 – 64 (median 33) months after OC-related VT (patients) and compared to 63 apparently healthy women (controls). All women were tested for thrombophilia, activated partial thromboplastin time (APTT), fibrinogen, D-dimer, P-selectin and C-reactive protein. Thrombin generation was measured by Technothrombin® TGA assay. Overall haemostasis potential (OHP) assay with overall coagulation potential (OCP) and overall fibrinolytic potential (OFP) as supplementary parameters were measured by repeated fibrin formation and degradation registration.

Results

In patients increased endogenous thrombin potential (4205 ± 440 nM x min vs 4015 ± 421 nM x min, p = 0.017), increased OCP (22.6 ± 4.6 Abs-sum vs 20.8 ± 4.1 Abs-sum, p = 0.025), shorter APTT (30.9 ± 3.8 s vs 33.4 ± 3.6 s, p < 0.001) and lower antithrombin activity (99, 93-105% vs 104, 100-109%, p < 0.05) were observed. Thrombophilia was observed in 22/60 (36%) patients and in 5/63 (7.9%, p < 0.001) controls. The only significant difference between thrombophilic and non-thrombophilic patients was higher soluble P-selectin in the former subgroup (22, 20-33 μg/L vs 17, 12-22 μg/L, p = 0.012).

Conclusions

In women with a history of OC-related VT persistent hypercoagulability was observed, which, however was not augmented by the presence of thrombophilia.     

血栓通注射液联合利伐沙班治疗髋关节置换术后下肢深静脉血栓的疗效观察

目的探究血栓通注射液联合利伐沙班治疗髋关节置换术后下肢深静脉血栓的临床疗效。方法选取2011年11月—2014年11月在延安大学附属医院骨科接受髋关节置换术后发生下肢深静脉血栓的患者78例,按照治疗方案不同分为对照组和治疗组,每组各39例。对照组口服利伐沙班片,1片/次,1次/d。治疗组在对照组治疗的基础上静脉滴注血栓通注射液,5 m L溶于0.9%生理盐水250 m L中,1次/d。两组均连续治疗14 d。观察两组的临床疗效,比较两组治疗前后D-二聚体、患肢膝上差、膝下差、静脉血流速度、激活部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)的变化情况。结果治疗后,对照组和治疗组的总有效率分别为84.62%、97.44%,两组比较差异有统计学意义(P0.05)。治疗后,两组D-二聚体、膝上差、膝下差、FIB均显著降低,患侧血流速度、APTT、PT、TT显著升高,同组治疗前后差异具有统计学意义(P0.05);且治疗组这些观察指标的改善程度优于对照组,两组比较差异具有统计学意义(P0.05)。结论血栓通注射液联合利伐沙班治疗髋关节置换术后下肢深静脉血栓具有较好的临床疗效,可显著改善患者的凝血状态,具有一定的临床推广应用价值。