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.     

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)     

Hypercoagulation following brain death cannot be reversed by the neutralization of systemic tissue factor

Background

Cerebral injury and brain death is associated with apparent hypercoagulation and poor organ outcome. This experimental study challenges the hypotheses that i) brain death causes hypercoagulation and microvascular thrombosis and that ii) neutralizing systemic tissue factor (TF) by in vitro addition of a TF inhibitor (recombinant active site-inhibited factor VIIa (ASIS)) can reverse the hypercoagulable profile.

Methods

Using a validated pig model of intracranial hemorrhage and brain death, 20 pigs were randomized to either control or brain death. The primary endpoints were coagulation parameters measured with whole blood thromboelastometry (ROTEM), thrombin generation and a porcine TF-sensitive plasma clotting time assay. In vitro spiking experiments with ASIS were performed in parallel with the latter two assessments. The kidneys were examined histologically for microvascular thromboses.

Results

Brain death induced hypercoagulation, as demonstrated with ROTEM, thrombin generation, and reduced TF-sensitive plasma clotting time. In vitro inhibition of TF with ASIS did not reverse the hypercoagulation. No microvascular thromboses were found in the kidneys.

Conclusion

Brain death causes hypercoagulation; however, inhibition of TF does not reverse the coagulopathy. Thus, TF release does not seem to be the primary cause of this hypercoagulation. Minor changes in the levels of protein C suggest that the protein C pathway may be linked to the observed coagulopathy.     

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.     

川芎及其中成药抗凝血作用测定方法的研究

目的以延长活化部分凝血活酶时间(APTT)为指标,建立定量测定川芎抗凝血作用的方法,评价川芎及其中成药的质量。方法川芎先后用乙醇和水定量提取,以总提取物为供试品,体外测定延长APTT值。家兔心脏取血,制备血浆,加入APTT试剂后,测定凝结时间。以APTT延长率为抗凝血活性的评价指标,用阿魏酸钠标定川芎的延长APTT活性。根据量反应平行线法(2.2)计算川芎的抗凝血活性。并测定了9份川芎药材、饮片及中成药的抗凝血活性。结果阿魏酸钠和川芎总提取物均具有显著的抗凝血活性,且可靠性检验结果成立。阿魏酸钠的给药质量浓度(1~5 mg/m L)与其APTT延长率呈良好的线性关系(r=0.995 5)。供试品重复测定抗凝血活性的RSD为9.34%(n=6),可信限率为15.98%(n=6)。不同川芎样品的抗凝血活性不同,5份川芎药材的抗凝血效价分别为5.431~7.620 U/g,川芎饮片及川芎酒炙饮片分别为5.910、3.017 U/g,通脉颗粒和血府逐瘀丸分别为14.516、29.035 U/g。结论建立的方法能准确测定川芎药材、饮片及其中成药的抗凝血活性并评价其质量。     

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。     

APTT ACTIN FSL试剂对APTT及Ⅷ因子检测的影响

目的探讨Siemens公司活化部分凝血活酶时间(APTT)ACTIN FSL试剂对APTT及Ⅷ因子检测的影响。方法选取20例标本分别使用APTT ACTIN和APTT ACTIN FSL 2种试剂检测APTT,比较阴阳性符合率。选取70例标本分别使用以上2种试剂检测Ⅷ因子,比较阴阳性符合率。选取120例体检者建立APTT及Ⅷ因子新的生物参考区间。选取20例体检者及20例确诊静脉血栓或血友病的患者验证新建参考区间的适用性。结果改用APTT ACTIN FSL试剂后重新建立APTT和Ⅷ因子的生物参考区间分别为25.2~32.6 s和60%~189%。使用新的生物参考区间,明显提高了APTT及Ⅷ因子使用2种试剂检测结果的阴阳性符合率,分别为95.0%和90.0%。分别采用体检者及患者APTT及Ⅷ因子的结果验证新参考区间均为合格。结论将Siemens公司的APTT ACTIN试剂升级为APTT ACTIN FSL试剂后,对APTT及Ⅷ因子的检测影响较大,实验室应修改或重新建立新的生物参考区间,并进行验证。