奥扎格雷钠对脑梗死急性期患者血小板膜糖蛋白表达和临床疗效的影响

目的研究奥扎格雷钠对患者血小板膜GPⅡb/Ⅲa复合物和P-选择素、NIHSS评分的影响,探讨奥扎格雷钠对血小板活化的影响及与临床疗效的关系。方法对脑梗死急性期患者入院第1天和第14天进行NIHSS评分,并应用流式细胞术检测血小板膜GPⅡb/Ⅲa复合物和P-选择素。将患者分为阿司匹林组、奥扎格雷钠组,对比两组患者NIHSS评分和血小板膜GPⅡb/Ⅲa复合物和P-选择素的差异。结果两组治疗第14天奥扎格雷钠组的血小板膜NIHSS、GPⅡb/Ⅲa复合物和P-选择素均比阿司匹林组下降更明显(P<0.05)。结论阿司匹林和奥扎格雷钠均可降低血小板活化程度,从而缓解脑梗死病情,而奥扎格雷钠作用更强,取得的临床疗效更为明显。     

AoGDW肽抑制血小板聚集的作用机制

目的研究RGD(精氨酸-甘氨酸-天门冬氨酸)肽衍生物-AoGDW(ω-氨基辛酸-甘氨酸-天门冬氨酸-色氨酸)抑制血小板聚集的作用机制。方法采用双色荧光标记以及流式细胞技术检测AoGDW肽对CD41抗体与血小板GPⅡb/Ⅲa受体结合的抑制作用以及对血小板膜上P-选择素表达的影响。结果随着AoGDW肽浓度的增加,CD41抗体与活化血小板GPⅡb/Ⅲa受体结合率呈现下降趋势,相对于阴性对照组,P<0.01。但CD41抗体与静止血小板GPⅡb/Ⅲa受体的结合率以及CD62p抗体与静止血小板P选择素的结合率与阴性对照组相比,P>0.05。结论AoG-DW肽是通过占据血小板上纤维蛋白原的结合位点即活化的GPⅡb/Ⅲa受体而发挥抑制血小板聚集的作用,并且不具有活化血小板的作用,是一种选择性的GPⅡb/Ⅲa受体拮抗剂。     

益气活血中药对老年冠心病患者血小板活化率的作用分析

目的观察益气活血中药对老年冠心病患者血小板活化率的作用,以供临床工作参考。方法以2009年10月至2012年9月在我院接受治疗的老年冠心病患者150例为研究对象,根据患者意愿分组,均给予西医常规治疗,观察组在此基础上给予益气活血类中药汤剂口服。连续用药8周,观察两组患者治疗前后血小板膜糖蛋白GPⅡb/Ⅲa和P-选择素(P-selectin)等指标的变化,并比较总有效率的差异。结果与治疗前相比较,两组患者GPⅡb/Ⅲa和P-selectin均有一定程度的下降,有显著的统计学差异(P<0.05);与对照组相比较,观察组下降幅度较大,有显著的统计学差异(P<0.05)。两组总有效率比较,观察组明显高于对照组,有显著的统计学差异(P<0.05)。结论采用益气活血中药辅助治疗老年冠心病,可明显降低血小板活化率,提高治疗效果,对康复具有促进作用。     

奥扎格雷钠对急性脑梗死患者血小板膜糖蛋白Ⅱb／Ⅲa的影响

目的 探讨奥扎格雷钠对血小板活化功能的影响.方法 将所有入选病人随机分为A组:奥扎格雷钠加活血化淤治疗组和B组:单纯活血化淤治疗组,每组均为30人.用ELISA法分别检测两组治疗前后血小板膜糖蛋白Ⅱb/Ⅲa(GPⅡb/Ⅲa)含量.结果 治疗前A、B两组间的GPⅡb/Ⅲa含量无明显差异,治疗后A、B两组间的GPⅡb含量仍无明显差异,而GPⅢa有明显差异.结论 奥扎格雷钠对GPⅡb/Ⅲa有不完全的影响,对GPⅢa有影响而对GPⅡb无影响,即奥扎格雷钠未能最终阻断血小板的激活.     

急诊PCI联合远端保护装置或GP Ⅱb/Ⅲa治疗血栓负荷过重的ST段抬高型心肌梗死

目的 探讨直接经皮冠状动脉介入治疗(PCI)联合远端保护装置(DPD)或血小板Ⅱb/Ⅲa受体拮抗剂(GPⅡb/Ⅲa)治疗血栓负荷过重的急性ST段抬高型心肌梗死(STEMI).方法 冠状动脉造影(CAG)显示冠脉内富含大量血栓者106例,按时间及介入治疗方法分常规PCI组(37例)、DPD组(34例)和GPⅡb/Ⅲa组(35例),回顾性分析二组PCI术后即刻梗死相关血L管(IRA)的TIMI血流分级、梗死部位心肌灌注水平(TMP)分级、术后72 h内出血、输血比例及术后30 d、1年内主要心脏小良事什(MACE)发生情况.结果 常规PCI组、DPD组和GPⅡb/Ⅲa组术后即刻IRA的TIMI血流分级分别为(2.41±0.50)、(2.65±0.48)和(2.68±0.47),TMP分级分别为(2.03±0.65)、(2.31±0.48)和(2.37±0.54),术后30 d,1年MACE发生率分别为(16.2±37.4)%、(8.6±28.4)%和(7.9±2.7)%.(29.7±46.3)%、(14.3±35.5)%和(18.4±39.3)%.DPD组和GPⅡb/Ⅲa组以上指标均优于常规PCI组(P<0.05).术后72 h内出血、输血情况三组间差异无统计学意义.结论 冠脉内血栓负荷过重的STEMI患者急诊PCI中使用DPD或GPⅡb/Ⅲa安全、有效,即刻获得的TIMI血流和心肌灌注优于常规PCI.     

血小板膜糖蛋白GPⅡb／Ⅲa受体拮抗剂的进展与临床评价

目的:本文介绍血小板膜糖蛋白GPⅡb/Ⅲa受体拮抗剂的进展与评价。方法:采用国内、外文献综述方法。结果及结论:作为抗血小板药中的一支奇葩,血小板膜糖蛋白GPⅡb/Ⅲa受体拮抗剂进展十分迅速,对膜糖蛋白GPⅡb/Ⅲa受体选择性高,在治疗血栓、急性心肌梗死、急性冠脉综合征、非ST段抬高心肌梗死者方面展现了良好的治疗前景。     

噻氯匹定对2型糖尿病患者血小板膜糖蛋白表达的影响

目的：为进一步阐明糖尿病(DM)患者血小板活化状态及抗血小板药物噻氯匹定的治疗作用。方法：采用流式细胞术检测了45例2型糖尿病患者及26例健康志愿者(对照组)血小板表面血小板膜糖蛋白(GP)Ⅰb，GPⅡb，P-选择素及血小板激活复合物-1(PAG-1)表达，并对其中20例2型DM患者应用噻氯匹定治疗(0．25g，qd)2wk，观察对上述指标的影响。结果：DM患者P-选择索及PAG-1表达的荧光强度较对照组明显升高，而GPⅠb表达的荧光强度较对照组下降(P=0．014)，GPⅡb表达则无明显改变(P=0．285)。噻氯匹定治疗2wk可使DM患者P-选择素及PAC-1的表达明显下降，对GPⅡb表达则无明显影响(P=0．815)，GPⅠb表达则上升(P=0．011)。结论：2型DM患者血小板活化增强，出现高凝倾向。噻氯匹定治疗能明显缓解血栓前状态。PAG-1的表达可作为GPⅡb-Ⅲa激活更敏感的新型特异性标志。     

糖蛋白Ⅱb/Ⅲa受体拮抗剂的研究进展

血小板膜糖蛋白IIb/IIIa(GPⅡb/Ⅲa)是血小板聚集的最终共同途径中的关键因素,特别是在动脉血栓形成过程中起着重要作用,因此阻断GP IIb/IIIa受体是治疗和预防血栓性疾病的重要措施。本文针对药物的作用途径及作用靶点,综述了近年来作用于血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂的抗血小板聚集作用药物的研究进展。     

替罗非班应用于急性心肌梗死PCI后无复流患者的临床效果观察

目的探讨急性心肌梗死经皮冠状动脉介入治疗(PCI)后无复流患者行替罗非班治疗的临床效果。方法选取68例急性心肌梗死PCI后无复流患者作为研究对象,根据术前抗凝药物的不同分为对照组和观察组,每组34例。对照组患者接受硝酸甘油治疗,观察组患者接受替罗非班治疗。对比两组患者治疗前后TIMI血流分级、血小板活化情况[膜糖蛋白(GP)Ⅲa、GPⅡb/Ⅲa、GPⅠb血小板活化]及治疗后左室射血分数。结果治疗后,两组患者的TIMI血流分级均显著高于治疗前,且观察组患者的TIMI血流分级显著高于对照组,差异具有统计学意义(P<0.05)。治疗后,对照组患者的GPⅢa、GPⅡb/Ⅲa、GPⅠb血小板活化分别为(67.59±3.19)×10^3/血小板、(65.79±3.15)×10^3/血小板以及(36.44±1.80)×10^3/血小板,观察组患者的GPⅢa、GPⅡb/Ⅲa、GPⅠb血小板活化分别为(37.29±3.11)×10^3/血小板、(35.66±2.88)×10^3/血小板以及(26.11±1.77)×10^3/血小板;两组患者的GPⅢa、GPⅡb/Ⅲa、GPⅠb血小板活化均显著低于治疗前,且观察组患者的GPⅢa、GPⅡb/Ⅲa、GPⅠb血小板活化均显著低于对照组,差异具有统计学意义(P<0.05)。两组患者治疗后左室射血分数比较差异无统计学意义(P>0.05)。结论给予急性心肌梗死PCI后无复流患者行替罗非班治疗可有效改善血液状态,但对心功能的恢复无显著改善作用。     

蛇毒抗补体蛋白atrase B抑制补体活化引起的血小板聚集

目的观察眼镜蛇毒抗补体蛋白atrase B抑制补体活化引起的血小板聚集。方法采用眼镜蛇毒因子激活补体诱导血小板聚集,观察atrase B对补体活化引起人凝胶过滤血小板聚集的影响,并采用流式细胞仪测定血小板膜P-选择素和GPⅡb/Ⅲa表达情况。结果Atrase B能抑制补体激活引起的血小板聚集和P-选择素、GPⅡb/Ⅲa在血小板膜上的表达。结论眼镜蛇毒抗补体蛋白atrase B能有效抑制补体激活引起的血小板活化、聚集。     

卡马西平联用尼美舒利相关粒细胞缺乏症

1例78岁男性患者因带状疱疹神经痛、慢性阻塞性肺疾病合并感染,给予头孢唑肟钠（2.25 g静脉滴注,1次/d）、卡马西平（0.2 g口服,2次/d）、尼美舒利（100 mg口服,2次/d）、二羟丙茶碱（0.5 g静脉滴注,1次/d）、甲钴胺（0.5 mg口服,3次/d）、地塞米松（5 mg,静脉滴注1次）、盐酸哌替啶（25 mg,肌内注射1次）和盐酸布桂嗪（100 mg,肌内注射3次）等药物治疗。第7天,停用头孢唑肟钠,改为磷霉素钠（8 g静脉滴注,1次/d）。第11天,血常规检查示白细胞计数1.6×10^9/L,中性粒细胞0.03,中性粒细胞绝对值0.1×10^9/L,淋巴细胞绝对值0.9×10^9/L。立即停用所有药物,给予对症支持治疗。第15天,外周血白细胞计数0.9×10^9/L,中性粒细胞0.02,中性粒细胞绝对值0.1×10^9/L,淋巴细胞绝对值0.7×10^9/L。行骨髓穿刺检查,诊断为粒细胞缺乏症。第17天患者出现右肺气胸、肺不张。第20天出现急性呼吸衰竭、多脏器衰竭合并重症感染,经抢救无效死亡。     

颅脑损伤患者并发肺部感染的护理体会

目的：为了使并发肺部感染的病人更多、更好、更早的痊愈。方法：通过对32例颅脑外伤并发肺部感染病人的严密观察,采取更换体位、超声雾化、有效排痰训练等有效的护理措施干预,从而控制了肺部感染。结果：痊愈17例,占53.1%;显效12例,占37.5%,无效2例,占6.2%;死亡1例,占3.1%;实践证明,有效的护理干预对提高患者治疗成功率有着重要意义。     

Satisfaction with information and its relationship with adherence in patients with chronic pain

□ Due to the nature of chronic pain it would be expected that patients are highly adherent to their pain medication. However, results from this study have shown that 23 per cent of patients often or always avoid using their pain medication, 13.4 per cent often or always alter dosages, and 10.3 per cent often or always stop taking their medication for a while. This suggests intentional non‐adherence to pain medication □ Less than 50 per cent of respondents were satisfied with information provided on side effects, what to do if side effects occur, and possible interactions with other medication □ Patients' satisfaction with information about their medication was related to self‐reported adherence; greater satisfaction was associated with higher self‐reported adherence     

Genomic profiling associated with recurrence in patients with rectal cancer treated with chemoradiation

PURPOSE: Stage II and III adenocarcinoma of the rectum has an overall 5-year survival rate of approximately 50%, and tumor recurrence remains a major problem despite an improvement in local control through chemotherapy and radiation. The efficacy of chemoradiation therapy may be significantly compromised as a result of interindividual variations in clinical response and host toxicity. Therefore, it is imperative to identify those patients who will benefit from chemoradiation therapy and those who will develop recurrent disease. In this study, we tested whether a specific pattern of 21 polymorphisms in 18 genes involved in the critical pathways of cancer progression (i.e., drug metabolism, tumor microenvironment, cell cycle regulation, and DNA repair) will predict the risk of tumor recurrence in rectal cancer patients treated with chemoradiation. PATIENTS AND METHODS: A total of 90 patients with Stage II or III rectal cancer treated with chemoradiation were genotyped using polymerase chain reaction (PCR)-based techniques for 21 polymorphisms. RESULTS: A polymorphism in interleukin (IL)-8 was individually associated with risk of recurrence. Classification and regression tree analysis of all polymorphisms and clinical variables developed a risk tree including the following variables: node status, IL-8, intracellular adhesion molecule-1, transforming growth factor-beta, and fibroblast growth factor receptor 4. CONCLUSION: Genomic profiling may help to identify patients who are at high risk for developing tumor recurrence, and those who are more likely to benefit from chemoradiation therapy. A larger prospective study is needed to validate these preliminary data using germline polymorphisms on tumor recurrences in rectal cancer patients treated with chemoradiation.     

甘草酸单铵结合氦-氖激光治疗银屑病62例

目的用甘草酸单铵结合低能量氦-氖激光,观察治疗银屑病患者。方法62例寻常型银屑病患者,分为两组,A组用低能量氦-氖激光血管内照射,同时用甘草酸单铵静脉滴注,共36例;B组仅用甘草酸单铵,共26例。通过30d治疗。结果总有效率82.2%,其中A组有效率88.9%,B组73.1%(经Ridit检验,U＝2.76,P＜0.01),两组差异有极显著性意义。结论甘草酸单铵结合氦-氖激光治疗银屑病,比单用甘草酸单铵效果好。     

A fetus with meckel-gruber syndrome associated with isomerism

Abstract. Meckel-Gruber syndrome (MKS) is an autosomal recessive lethal malformation. As far as we know, the rate of incidence for the syndrome is 0.02 per 10,000 births. It is estimated that Meckel-Gruber syndrome accounts for 5% of all neural tube defects in Finland. Objective. The aim of this study is to present a case of a fetus with Meckel-Gruber syndrome associated with complete left isomerism. Method. The fetus was obtained after medical interruption of the pregnancy during the fifteenth gestational week. The mother was 36 years old and in a consanguineous marriage. The antenatal ultrasound examination revealed a polymalformative syndrome, leading to a postmortem examination. The fetopathological study of the fetus was conducted at the Centre for Maternity and Neonatology, Tunis, Tunisia, in 2008. Results. The female fetus had a significantly deformed ballooning abdomen, pes equinovarus, flexion of the wrist and a total posterior cleft palate. The central nervous system abnormalities were occipital encephalocele, cystic dilatation of the fourth ventricle, agenesis of corpus callosum and hydrocephalus. The study of the internal organs found dextrocardia, irregular lobulation of the lungs, left isomerism, and polysplenia. The microscopic examination revealed bilateral cystic dilation of the kidneys, fibrous proliferation of the liver and ectasic dilatation of the billiary ducts, representing a ductal plate malformation of the liver. Conclusion. The case is diagnosed with Meckel-Gruber syndrome associated with complete left isomerism, cleft palate and possibly Dandy-Walker syndrome.