凝血因子V、凝血酶原活动度及前白蛋白与慢性重型肝炎预后关系

本研究对我科近期收治的16例慢性乙型重型肝炎患者的凝血酶原活动度（PTA）、国际标准化比值（INR）、胆红素（TBil）、凝血因子V（FV：c）、凝血因子Ⅶ（FⅦ：C）、前白蛋白（PRE—A）等生化指标的变化与预后的关系进行多因素统计学分析，以期更有效地指导临床重型肝炎的救治。     

影响重型病毒性肝炎患者预后的因素

目的:探讨影响重型肝炎患者预后的危险因素,为早期诊断提供依据。方法:将本院452例重型肝炎患者的年龄、性别、临床分型、分期、肝炎病原学、血清总胆红素(TBil)、血清白蛋白(Alb)、总胆固醇(TC)、凝血酶原活动度(PTA)及并发症情况等指标进行回顾性分析。结果:重型病毒性肝炎顸后与年龄、性别无关、而临床分型、分期、肝炎病毒混合感染、血清Alb、TBil、PTA及低钠血症、肝性脑病、肝肾综合征、上消化道出血等11个指标与重型肝炎预后有关。结论:上述11个指标是判断重型肝炎患者预后的独立危险因素。对于早期诊断,评估预后,具有重要意义。     

抗结核病史对乙型重型肝炎临床特点及预后影响

目的 探讨抗结核治疗病史对乙型重型肝炎临床特点及预后的影响.方法 通过对比有抗结核治疗病史的乙型重型肝炎85例患者与无抗结核病史的乙型重型肝炎123例患者,了解抗结核治疗病史对乙型重型肝炎的影响.结果 与无抗结核病史的乙型重型肝炎比较,有抗结核治疗病史的乙型重型肝炎死亡率高(P=0.0062),住院天数延长(P=0.04),并发症(脾大、腹水、肝硬化、自发性腹膜炎)发生频率较高(P＜0.05);凝血酶原时间、凝血酶原活动度、白蛋白、总胆红素、肌酐与无抗结核治疗病史的乙型重型肝炎比较差异有统计学意义(P＜0.05).结论 抗结核治疗病史可以显著影响乙型重型肝炎的临床表现及预后.     

中西医结合治疗早中期慢性乙型重型肝炎154例临床分析

目的:通过对154例早中期慢性乙型重型肝炎中西医结合治疗的临床分析,探讨有关治疗方案及选择使用不同的核苷类抗病毒药物对预后的影响。方法:所有病例均采用常规中西医结合保肝、退黄、抗病毒、支持、对症等治疗,部分病例应用人工肝治疗。结果:154例慢性乙型重型肝炎患者总有效率64.3%,在院病死率1.3%,无效率34.4%;治疗前后自身对比,血清总胆红素(TBil)、直接胆红素(DBil)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、胆碱酯酶(Che)、凝血酶原活动度(PTA)、总胆固醇(TC)、甘油三酯(TG)等指标均有明显改善(P0.05)。抗病毒药物当中恩替卡韦及拉米夫定组有效率较高。结论:慢性乙型重型肝炎早期、中期患者,中西医结合治疗可以取得良好的治疗效果,选择单一快速起效的恩替卡韦或拉米夫定可能会提高有效率。     

重型肝炎患者肌酐尿素氮胆固醇水平及与预后的关系

重型肝炎患者病情发展迅猛,预后差,为达到多方面、多指标及时了解病情,判断预后,我们就1996年以年我科收治的43例重型肝炎患者的肌酐(Cr)尿素氮(BUN)总胆固醇(TCh)、血清总胆红素(TBil)水平及与预后关系进行分析探讨,现报告如下:1 材料与方法1.1 研究对象 重型肝炎组(简称重肝组)43例,系重型肝炎进展期患者。其中急性重型肝炎6例,亚急性重型肝炎25例,慢性重型肝炎12例。年龄34.5±13.2岁;慢性乙型肝炎组     

影响慢性重型肝炎预后的因素分析

目的 探讨影响慢性重型肝炎预后的有关因素。方法 分析78例慢性重型肝炎的预后与年龄、血清总胆红素、凝血酶原时间、凝血酶原活动度、总胆固醇、并发症、病毒重叠感染、有无肝硬化的关系。结果 慢性重型肝炎的预后与血清总胆红素、凝血酶原时间、凝血酶原活动度、总胆固醇及并发症有关（P〈0．01或P〈0．05），而与年龄、病毒重叠感染、有无肝硬化无明显关系（P〉0．05）。结论 慢性重型肝炎患者血清总胆红素、凝血酶原时间、凝血酶原活动度、总胆固醇及并发症是判断预后的重要依据。     

影响重型肝炎患者预后的危险因素研究

目的 研究影响重型肝炎患者预后的危险因素。方法收集75例重型肝炎患者（存活组39例，死亡组36例）28项临床指标，采用Cox比例风险模型研究影响重型肝炎患者生存的危险因素与生存状态及生存时间的综合性量化关系。结果白细胞、血小板、总胆红素、碱性磷酸酶、胆固醇、凝血酶原活动度、透明质酸、肝性脑病、肝肾综合征、电解质紊乱、腹水、感染在存活组和死亡组之间差异有统计学意义（P〈0．05）。Cox模型分析显示，凝血酶原活动度、肝性脑病、感染是影响重型肝炎患者预后的主要危险因素（相对危险度分别为0．963、4．107、0．258，P〈0．05）。结论重型肝炎预后影响因素众多，凝血酶原活动度、肝性脑病和感染为主要危险因素，可望用于重型肝炎的预后判断。     

重型肝炎126例预后影响因素分析

目的对影响重型肝炎患者预后的因素进行分析和评估,对重型肝炎患者预后进行科学的预测。方法将2001-10~2004-06中国医科大学第二临床学院感染科收治的重型肝炎住院患者126例,分为死亡组(82例)与生存组(44例),比较两组在年龄、性别、亚型、生化指标、合并症上的差异。结果两组重型肝炎患者在性别、亚型方面比较差异无显著性(均为P>0.05)。≤40岁与>40岁患者的病死率比较差异有非常显著性(P<0.01);在生化指标上两组丙氨酸氨基转移酶与天门冬氨酸氨基转移酶的比值(ALT/AST)、总胆红素、直接胆红素与总胆红素比值、白蛋白、凝血酶原活动度、总胆固醇、胆碱脂酶、甲胎蛋白、钠离子比较差异具有显著性;死亡组合并症的发生率明显高于生存组(P<0.01)。结论年龄、ALT/AST、总胆红素、白蛋白、凝血酶原活动度、总胆固醇、胆碱脂酶、甲胎蛋白、钠离子及合并症是影响重型肝炎预后的重要因素。     

影响重型病毒性肝炎预后的危险因素分析

目的:探讨影响重型病毒性肝炎预后危险因素,为临床治疗提供决策参考。方法:研究了150例重型病毒性肝炎患者(存活组57例,死亡组93例)的10个指标,并进行统计学处理。结果:发现血清总胆红素、总胆固醇、胆碱脂酶、凝血酶原活动度及并发症多少对重型病毒性肝炎的预后有直接影响。结论:上述指标,对于早期判断、评估重型肝炎患者的预后有着重要意义。     

HBV相关肝病总胆汁酸测定及其临床意义

目的探讨HBV感染患者血清总胆汁酸(TBA)水平的变化。方法常规检测血清总胆汁酸水平。结果慢性乙型重型肝炎、急性乙型肝炎患者血清TBA水平显著升高,差异非常显著(P0.01);在慢性乙型重型肝炎患者,存活组TBA水平明显低于死亡组,差异非常显著(P0.01);慢性乙型重型肝炎患者TBA水平与ALT、ALB、CHE呈明显的相关性(P均0.01)。结论血清TBA水平是反映肝损伤的程度,对乙型重型肝炎患者的病情及预后判断有重要意义。     

Coagulation factors II, V, VII, and X, prothrombin gene 20210G-->A transition, and factor V Leiden in coronary artery disease: high factor V clotting activity is an independent risk factor for myocardial infarction

Increased levels of hemostatic factors and genetic mutations of proteins involved in coagulation may play a role in the pathogenesis of coronary artery disease. We investigated clotting activity of factors II (FII:C), V (FV:C), VII (FVII:C), and X (FX:C), the prothrombin gene 20210G-->A transition, and the factor V Leiden mutation in 200 survivors of myocardial infarction and in 100 healthy controls. FV:C (P<0.0001) and FVII:C (P<0.0001) were found to be independent risk factors for myocardial infarction. High FV:C or high FVII:C combined with smoking or arterial hypertension increased the relative risk for myocardial infarction up to 50-fold. One of 177 patients (0.6%) and 4 of 89 controls (4.5%) had the prothrombin 20210 AG genotype. Eleven of 177 patients (6.2%) and 6 of 89 controls (6.7%) were heterozygous for the factor V Leiden mutation. No homozygous carrier for these mutations was found. Neither the prothrombin gene 20210G-->A transition (odds ratio [OR], 0.1; 95% confidence interval [CI], 0.01 to 1.1) nor the factor V Leiden mutation (OR, 1.0; 95% CI, 0.4 to 2.8) were associated with an increased relative risk for myocardial infarction. In conclusion, our data indicate that neither the prothrombin gene 20210G-->A transition nor the factor V Leiden mutation are risk factors for myocardial infarction. High FVII:C was confirmed to be an independent risk factor for myocardial infarction. Moreover, we describe for the first time that high FV:C is an independent risk factor for myocardial infarction.     

暴发性肝功能衰竭患者的临床特征及其预后的影响因素

目的 分析各种原因所致肝功能衰竭患者的临床特征及其预后的影响因素,为选择临床治疗方案及判断预后提供依据. 方法 统计分析死亡和生存的肝功能衰竭患者的肝功能、肾功能、凝血酶原时间,血氨、血糖、血清淀粉酶和脂肪酶、血清皮质醇、血清肿瘤坏死因子(TNF)α水平,终末期肝病(MELD)评分及性别、年龄、有无并发症等因素的差异.根据不同资料分别采用均数比较、x2检验、Biraviate相关性检验和Logistic多元回归分析进行统计学分析. 结果 所观察的85例患者病死率为65%(55/85),以重叠感染者病死率最高(HBV和HEV重叠感染者为8/10,HCV和HEV重叠感染者为6/8),年龄和性别对病死率无明显影响(P值分别为0.423和0.728);病因分析中,以HBV感染者最多(52%,44/85),其次为HEV感染(39%,33/85);血清生化指标中,总胆红素定量、凝血酶原时间、胆固醇、尿素氮、肌酐和空腹血糖水平与预后相关(P值分别为0.005、0.001、0.001、0.005、0.010和0.049).并发症中,死亡组肝性脑病、肝肾综合征和肾上腺功能不全发生率明显高于生存组(P值分别为0.005、0.012和0.025).但应用Logistic多元回归分析结果 显示,只有凝血酶原时间与预后相关(P=0.035); MELD评分在死亡组明显高于生存组(t=18.236,P<0.01),且在并发肝性脑病和肝肾综合征患者中明显升高,并与血清TNFα水平呈正相关(r=0.585,P<0.01).结论 HBV感染是暴发性肝功衰竭的主要病因;病毒重叠感染者病死率最高;血清总胆红素定量、凝血酶原时间、胆固醇和空腹血糖含量以及肝性脑病、肝肾综合征和肾上腺功能不全的发生可能与预后相关;MELD评分是可以预测患者预后的指标.     

AMA阳性的原发性胆汁性肝硬化患者的临床特征

目的探讨原发性胆汁性肝硬化(primary biliary cirrhosis,PBC)的临床特征。方法回顾36例AMA阳性的PBC患者临床资料,同期住院的36例慢性乙型肝炎肝硬化(chronic hepatitis B virus-related cirrhosis,HBV-C)患者为对照组,分析两组患者的临床特点和生物化学指标。结果 PBC组以女性(83.3%)多见,平均年龄(53.5±11.5)岁,HBV-C组主要是男性(77.8%),平均年龄(56.4±12.8)岁。黄疸(66.7%)和乏力(63.9%)是PBC组的主要表现,HBV-C组以腹水(50.0%)和上消化道出血(38.9%)常见。HBV-C组的PLT和WBC水平较PBC组显著下降(P<0.01)。两组患者均有Hb和RBC水平明显降低,PBC组更明显,但两组间差异无统计学意义。ALT、AST、GGT、ALP、TBIL和DBIL水平在PBC组中均明显升高(P<0.05),而PT在HBV-C组显著延长(P=0.000)。血脂各项指标在Child-Pugh A级中,PBC组均高于HBV-C组,但差异无统计学意义;Child-Pugh B级中,TG、TC及LDL-C水平PBC组显著高于HBV-C组(P<0.05),而HDL-C水平在PBC组显著降低(P=0.006)。结论 PBC患者具有许多独特的临床特征,包括:①常合并其他自身免疫性疾病;②更容易发生黄疸和贫血;③反映胆管功能和胆汁代谢指标明显异常;④HDL-C的下降可能是反映PBC病情进展的良好指标。     

Familial thrombophilia and the occurrence of fetal growth restriction

BACKGROUND AND OBJECTIVES: To evaluate the association between unexplained or gestational-hypertension-associated fetal growth restriction (FGR) and factor V Leiden, prothrombin A20210 mutations, and methylenetetrahydrofolate reductase (MTHFR) TT 677 genotype. DESIGN AND METHODS: Sixty-one women with a previous history of FGR and 93 parous women with uneventful pregnancies from the same ethnic background were investigated for the presence of factor V (FV) Leiden, prothrombin A20210 mutations, and MTHFR TT 677 genotype. Moreover, antiphospholipid antibodies, antithrombin, protein C, and total and free protein S antigen were determined in all patients. RESULTS: Among the controls, 2 (2.2%) carried the FV Leiden mutation, 19 (20.4%) were TT MTHFR homozygotes and 1 (1.6%) carried the prothrombin A20210 allele. The FV Leiden mutation was present in 8 women with FGR (13.1%, OR: 6.9, 95%CI 1.4-33.5), the TT MTHFR homozygosity in 17 (27.8%, OR: 1.5, 95%CI 0.7-3.2) and the A20210 prothrombin allele in 7 (11.5%, OR: 5.9, 95%CI 1.2-29.4). In six cases (9.8%) there was coexistence of more than one mutation (2 had the FV Leiden and the TT MTHFR genotype and 4 carried the A20210 prothrombin allele and TT MTHFR genotype). A logistic regression analysis showed that FV Leiden and A20210 prothrombin mutations were independently associated with the occurrence of FGR. INTERPRETATION AND CONCLUSIONS: Present data indicate an association between prothrombotic genetic factors and FGR.     

Significance of serum human hepatocyte growth factor levels in patients with hepatic failure.

Serum human hepatocyte growth factor levels were measured using a newly developed enzyme-linked immunosorbent assay kit in patients with liver diseases. Serum human hepatocyte growth factor levels were increased in correlation with derangements of prothrombin time, total bilirubin and other parameters reflecting hepatocellular dysfunction in 112 patients with chronic liver disease. The levels were positively correlated with serum AST and ALT levels in 59 of these patients whose prothrombin times were within the normal range. Abnormally increased serum human hepatocyte growth factor levels were found in 100% of the determinations in 16 patients with fulminant hepatic failure and in 80% of the determinations in 16 patients with chronic hepatic failure. The levels greater than 1 ng/ml, however, were found in 94% of determinations in the former group, but only in 16% of the determinations in the latter group. This difference was seen irrespective of prothrombin time or hepatic coma grades. In patients with fulminant hepatic failure serum human hepatocyte growth factor levels were increased immediately after plasma exchange using heparin as the anticoagulant in 71% of the determinations. This increase disappeared 12 hr after discontinuation of plasma exchange. In 17 of 39 patients with chronic renal failure who had no liver disease, serum human hepatocyte growth factor levels were abnormally increased before hemodialysis using heparin, and the levels were elevated immediately after hemodialysis in all the patients. The increase of serum human hepatocyte growth factor levels in hepatic failure may be the result of hepatocellular dysfunction and necrosis.(ABSTRACT TRUNCATED AT 250 WORDS)     

老年急性脑梗塞患者血脂及血液流变学变化分析

目的研究老年急性脑梗塞患者血脂及血液流变学变化特点，并分析二者的相关性。方法７６例老年急性脑梗塞患者，测定全血粘度（ＢＶ）、血浆粘度（ＰＶ）、血小板聚集率（ＰＡｇｔ）、凝血酶时间（ＴＴ）、凝血酶原时间（ＰＴ）、白陶土部分凝血活酶时间（ＫＰＴＴ）、总胆固醇（ＴＣ）、甘油三酯（ＴＧ）、高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）、低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）、脂蛋白（ａ）［ＬＰ（ａ）］、载脂蛋白（Ａｐｏ）Ａ１、Ｂ、Ｅ。结果ＴＣ、ＴＧ、ＨＤＬ、ＬＤＬ、ＬＰ（ａ）、ＡｐｏＡ、ＡｐｏＢ各项在急性脑梗塞组与对照组之间比较均有显著性差异，ＢＶ、ＰＶ、ＰＡｇｔ均较对照组明显升高。ＢＶ及ＰＡｇｔ分别与ＴＣ、ＴＧ、ＬＤＬ呈显著正相关，与ＨＤＬ呈显著负相关。结论血脂异常、高凝与高粘度血症构成了老年脑梗塞发病的重要环节，血脂的变化与血液流变学及凝血的改变密切相关     

Fibrin glue in surgery: frequent development of inhibitors of bovine thrombin and human factor V

Summary. We report on a 34-year-old woman whose plasma showed a marked prolongation of thrombin time (TT) (< 200 s) using bovine thrombin. The patient had previously been exposed twice to topical bovine thrombin contained in fibrin glue during cardiac surgery. TT was normal when human thrombin was used as reagent. The patient's purified IgG reacted with bovine prothrombin and bovine thrombin in immunoblotting studies but showed virtually no cross-reaction with human thrombin. In addition, following surgery, factor V clotting activity (FV:C) was reduced to 9% of normal. The inhibitor of bovine thrombin persisted over a period of more than a year, while the level of FV:C progressively returned to normal within this time period.
Development of thrombin and FV:C inhibitors was also investigated in plasma of 34 consecutive patients who had undergone either cardiac surgery or neurosurgery with use of fibrin glue containing bovine thrombin. Eleven of 24 patients after cardiac surgery and two of 10 patients after neurosurgery presented with TT ≥25 s (normal plasma 15s). Two patients had been re-exposed to fibrin glue during cardiac re-operation and showed markedly prolonged TT (> 60 s). All 13 patients who had acquired a thrombin inhibitor also had low FV:C activity (10–60% of normal plasma), whereas FV:C activity remained in the normal range in the 21 patients with normal TT. Our findings indicate that development of inhibitors of bovine thrombin as well as co-immunization to factor V occurs frequently and is associated with the amount of applied fibrin glue and with the type of operation. Re-exposure to fibrin glue seems to enhance formation of inhibitors of bovine thrombin and human factor V.     

The importance of thrombotic risk factors in the development of idiopathic sudden hearing loss

Impaired cochlear blood circulation has been suggested to cause sudden hearing loss. In this study, the role of factor V 1691 G-A (FV 1691 G-A), prothrombin 20210 G-A (PT 20210 G-A), methylene tetrahydrofolate reductase 677 C-T (MTHFR 677 C-T), factor V 4070 A-G (FV 4070 A-G), endothelial cell protein C receptor (EPCR) gene 23-bp insertion, and plasminogen activator inhibitor-1 (PAI-1) 4G/5G mutation was assessed. Fifty-three patients with idiopathic sudden sensorineural hearing loss and 80 individuals comprising the control group were included in this study. The frequency for FV 1691 A was 6.2% in the patient group and 3.7% in the control group, PT 20210 G-A was 1.2% in the patient group and 1.9% in the control group, and FV 4070 A-G was 7.5% in the patient group and 11.3% in the control group. The frequency of MTHFR 677 C-T was significantly higher in the patient group than in the control group, with a P value of .03. PAI-1-675 4G/5G polymorphism was found to be 71.2% and 69.8%, in the control group and the patient group, respectively. The EPCR 23-bp insertion was 0% in the control group and was found in 3 patients (3.7%), which needs further study.     

Coexistence of prothrombic risk factors and its relation to left ventricular thrombus in acute myocardial infarction

OBJECTIVE: Within the last few years a number of thrombophilic mutations have been identified. Pre-symptomatic testing for these established genetic risk factors identifies individuals predisposed to a disease and often allows to select suitable prophylactic interventions in time. We investigated whether or not the prothrombin G20210A allele, the factor V Leiden G1691A, and MTHFR C677T allele are risk factors for left ventricular thrombus (LV) in patients with myocardial infarction (AMI) or not. METHODS AND RESULTS: We analysed clinical, echocardiographic and biochemical data in 183 consecutive patients (aged 58 +/- 12 years; 34 women) with a first anterior acute myocardial infarction. Two-dimensional echocardiographic examination was performed on days 1, 3, 7, 15, and 30. LV thrombi were detected in 42 (23%) of the 183 patients with acute myocardial infarction. We have used multiplex assays based on PCR and DNA hybridization in microtitre plates for the simultaneous analysis of three mutations (FV Leiden G1691A, prothrombin G20210A, and MTHFR C677T). No significant differences in allele frequencies of FV Leiden G1691A (9.5% vs. 8.5%, p = 0.75), prothrombin G20210A (9.5% vs 7.1%, p = 0.74) and MTHFR C677T (47.6% vs. 50.3%, p = 0.74) were found in patients with LV thrombus when compared with those without LV thrombus. No significant differences in haemostatic factor levels were found in patients with LV thrombus when compared with those without LV thrombus. CONCLUSION: FV Leiden, prothrombin 20210 variant, and MTHFR mutation are no risk factors for left ventricular thrombus in patients with myocardial infarction.The presence of multiple mutations did not influence the development and outcome of LV thrombus in patients with myocardial infarction