血浆D-二聚体水平对伴腹痛急性主动脉夹层的诊断价值

目的探讨血浆D-二聚体（D-dimer）在急诊鉴别诊断伴腹痛急性主动脉夹层（AAD）中的临床价值。方法选取伴腹痛的ADD患者（ADD组）、急性胰腺炎患者（胰腺炎组）及其他外科急腹症患者（急腹症组）各22例,检测血浆D-二聚体水平并进行比较。结果 AAD组的血浆D-二聚体水平（5678±459ng/ml）明显高于胰腺炎组（987±235ng/ml）和急腹症组（673±104ng/ml）（P〈0.01）。结论血浆D-二聚体水平有助于伴腹痛AAD患者的诊断。     

Effects of activated protein C on coagulation and fibrinolysis in rabbits with endotoxin induced acute lung injury

Background Sepsis induced acute lung injury （ALI） as a common syndrome in clinical practice has a high mortality. Recombinant human activated protein C （APC） can significantly reduce the mortality of patients with severe sepsis. Several studies have implicated that APC may be protective in ALI. Methods Twenty-one rabbits were operatively prepared and randomly divided into sham, control, or APC groups （n=7 in each group）. After a tracheotomy had been performed, ALI was produced in the control and APC groups by infusion of Escherichia coil endotoxin 100 μg/kg per hour intravenously for 1 hour. The sham group received only the vehicle, infusion of 20 ml of 0.9% saline. The rabbits were studied under anesthesia for 6 hours and were ventilated with 40% oxygen. Bovine APC （25 μg·kg^-1·h^-1） was intravenously administered. The infusion was initiated half an hour post-injury and lasted for 4 hours. The animals were resuscitated with Ringer＇s lactate solution. Results In comparison with nontreatment in the control group, the infusion of APC significantly reduced the increase of thrombomodulin level （TM; control group was （0.68±0.06） ng/ml, vs APC group of （0.62±0.07） ng/ml at 6 hours, P 〈0.05）, and significantly attenuated the fall in protein S （PS; control group was （2.32±0.03） μg/ml at 2 hours, （2.24±0.06） μg/ml at 4 hours and （2.21±0.09）μg/ml at 6 hours, vs APC group （2.46±0.04） μg/ml at 2 hours, （2.40±0.05） μg/ml at 4 hours and （2.39±0.07） μg/ml at 6 hours, P 〈0.01）. In addition, APC limited the increase in plasminogen activator inhibitor-1 （PAI-1） both in plasma （control group was （0.68±0.12） ng/ml at 1 hour, （0.84±0.06） ng/ml at 2 hours, （0.87±0.08） ng/ml at 4 hours and （0.91±0.05） ng/ml at 6 hours, vs APC group （0.42±0.16） ng/ml at 1 hour, （0.43±0.04） ng/ml at 2 hours, （0.45±0.09） ng/ml at 4 hours and （0.45±0.14） ng/ml at 6 hours, P 〈0.01） and in bronchoalveolar lavage fluid （at 6 hour     

D-二聚体检测在小儿肺部感染性疾病诊断中的价值

目的 分析小儿肺部感染性疾病中D-二聚体检测的诊断价值。方法 选取2017年6月至2018年6月在汉中市中心医院治疗的80例肺部感染疾病患儿为观察组,另取同期于本院体检的健康儿童80例为对照组,均接受血清D-二聚体检测,比较两组D-二聚体水平及不同肺部感染疾病的D-二聚体水平。结果 观察组血清D-二聚体含量为(1.64±0.26)mg/L比对照组(0.15±0.04)mg/L高(P＜0.05);观察组上呼吸道感染组的血清D-二聚体含量(1.45±0.16)mg/L比支气管肺炎组、支气管炎组均低(P＜0.05),而支气管肺炎组的血清D-二聚体含量(1.82±0.38)mg/L比支气管炎组(1.65±0.24)mg/L高(P＜0.05)。结论 血清D-二聚体水平检测能帮助小儿诊断肺部感染疾病,并用于区分不同种类肺部感染疾病。     

血浆IGF-1水平与糖尿病神经病变关系的研究

目的　了解血浆IGF -1水平与 2型糖尿病神经病变 (DNP)的关系。方法　观察 2型DM患者 115例 ,并依据合并神经病变的严重程度分为 0级DNP组 2 2例 ,1级DNP组 5 6例 ,2级DNP组 2 5例 ,3级DNP组 12例。观察对象分别测定体重指数、FBS、空腹C肽 (CP0 )、餐后 2hC肽 (CP2 )、糖化血红蛋白 (GHbA1C)及IGF -1,并行肌电图检查。血浆IGF -1采用放免法测定 ,各组间差异显著性使用单因素方差分析。结果　血浆IGF -1水平与DNP的严重程度呈显著负相关 (P <0 0 5 ) ;1,2 ,3级DNP组血浆IGF -1水平 [分别为 ( 117 48± 40 3 4 ) μm/ml,( 115 .61± 3 5 .48) μg/ml,( 10 0 .87± 2 0 .42 ) μg/ml]显著低于 0级DNP组 [( 14 5 42± 5 7.70 ) μg/ml,分别为P <0 .0 5 ,P <0 .0 5 ,P <0 .0 1] ;而 1,2 ,3级DNP组间血浆IGF -1水平差异无显著性。结论　循环中IGF -1水平降低可能参与了DNP的发生及发展。     

天麻素对大鼠离体胸主动脉血管环的作用及机制研究

目的：观察天麻素对大鼠离体胸主动脉环的作用,并探讨其作用机制。方法采用离体动脉环灌流方法,观察累加浓度天麻素对大鼠离体胸主动脉环的直接作用;同法观察不同浓度天麻素(5μmol/L、50μmol/L、100μmol/L、150μmol/L、200μmol/L、250μmol/L)对10-6 mol/L去氧肾上腺素(PE)预收缩有内皮和去内皮血管环的作用;用无Ca2+K-H液和不同浓度天麻素孵育对PE收缩去内皮血管环的作用;观察200μmol/L天麻素对60 mmol/L KCl预收缩血管环的作用。结果天麻素直接作用于血管环时,天麻素组与对照组血管紧张度比较差异无统计学意义(P>0.05);天麻素(≥50μmol/L)作用于PE预收缩血管环时,有内皮天麻素组血管环舒张率分别高于有内皮对照组[(41.9±8.9）%、(57.6±9.1)%、(65.0±10.2)%、(75.6±11.7)%、(81.9±12.0)%vs (10.5±1.6)%、(19.4±5.9)%、(22.6±7.2)%、(24.9±6.8)%、(25.1±7.3)%、P<0.05],去内皮天麻素组血管环舒张率分别高于去内皮对照组[(20.6±2.9)%、(36.5±8.2)%、(43.7±9.3)%、(55.7±9.6)%、(58.7±9.6)%vs (9.8±2.1)%、(15.8±4.7)%、(18.6±6.5)%、(20.3±5.0)%、(21.5±5.1)%,P<0.05],且均有浓度依赖性,多组间比较F值分别为5.67,5.99,6.11,6.47,7.05,P<0.05;天麻素作用于无钙K-H液中PE收缩去内皮血管环时,实验组舒张率[(5.1±1.2)%]小于对照组[(12.8±3.7)%],差异有统计学意义(t=5.599,P<0.05)。天麻素处理作用于60 mmol/L KCl预收缩的血管环时,天麻素组[（96.7±8.6）%]与对照组[(98.6±7.9)%]张力变化差异无统计学意义(t=0.581,P>0.05)。结论天麻素对正常血管无舒张作用;天麻素能舒张PE预收缩的血管,其机制是通过抑制血管平滑肌IP3受体介导的内钙释放;它不能抑制α1受体依赖性钙通道和电压依赖性钙通道;天麻素舒张PE收缩的血管的作用有内皮依赖性和浓度剂量依赖效应。     

急性主动脉夹层420例回顾性分析

目的:探讨湖北省随州市近10年急性主动脉夹层病例的临床特征及变化趋势。方法:收集2001年1月-2010年12月在随州市中心医院住院首次入院确诊的420例急性主动脉夹层病例进行回顾性研究。结果:急性主动脉夹层病例逐年增加。老年组心率明显低于年轻组[(72.1±13.6)次/min比(83.1±17.4)次/min],年轻组的就诊时间及确诊时间明显早于老年组。女性患者确诊时间却明显迟于男性患者。Stanford A型病例发生胸痛的几率明显大于Stanford B型病例,而Stanford B型病例发生腹痛的几率明显大于Stanford A型病例。Stanford B型病例确诊时间明显迟于Stanford A型病例。急性主动脉夹层住院总死亡率为18.1%。结论:急性主动脉夹层病例逐年增多,临床工作中应高度重视胸痛、腹痛、后背痛、转移痛等症状,注意监测患者血压、心率,并高度警惕老年、女性、A型主动脉夹层的患者。     

降主动脉支架血管置入治疗Stanford B型主动脉夹层

目的 总结降主动脉人工支架血管置入术治疗Stanford B型主动脉夹层的临床治疗经验,并评价近期治疗效果.方法 对112例急性Stanford B型主动脉夹层患者,利用无名动脉插管、深低温停循环、顺行性脑灌注,实施降主动脉真腔人工支架血管置入术.结果 体外循环时间平均(89.3±5.8)min,主动脉阻断时间(35.9±4.7 )min,停循环顺行性脑灌注时间(14.7±2.1)min.1例76岁患者于术后1d死于多器官功能衰竭,其余111例患者均痊愈出院.术后出现一过性神经系统并发症23例,至出院时全部恢复正常;未发生截瘫病例;随访74例,6～52月,全部患者支架血管无移位和滑脱;47例患者降主动脉远端夹层假腔明显缩小、血栓形成.另外27例患者假腔没有明显变化,或仅有部分血栓形成.结论 降主动脉支架血管置入术治疗急性Stanford B型主动脉夹层,能够有效准确的封闭血管内膜破口,实现血管壁重建.     

螺旋CT检查在食管癌侵犯胸主动脉诊断中的应用

目的:探讨螺旋CT检查在食管癌侵犯胸主动脉诊断中的价值。方法:100例食管癌患者术前进行胸部螺旋CT检查,分别以食管与胸主动脉之间的脂肪间隙是否存在、食管壁的厚度、食管接触胸主动脉的夹角为标准判断胸主动脉是否受侵,并与手术及术后病理学检查结果进行比较。结果:(1)脂肪间隙消失18例,14例(77.78%)外侵,4例(22.22%)无外侵;(2)食管壁厚度<1 cm 12例,3例(25.00%)外侵,9例(75.00%)无外侵; 食管壁厚度>2 cm 23例,19例(82.61%)外侵,4例(17.39%)无外侵;食管壁厚度1～2 cm 6s例,8例(12.31%) 外侵,57例(87.69%)无外侵;准确度为80.00%(28/35);(3)食管肿瘤与胸主动脉之间的夹角<45°43例,4例(9.30%)外侵,39例(90.70%)无外侵;两者之间夹角>90°17例,12例(70.59%)外侵,5例(29.41%)无外侵;两者之间夹角45°-90°40例,17例(42.50%)外侵,23例(57.50%)无外侵;准确度达85.00%(51/60)。结论:术前螺旋CT检查对判断食管癌有无胸主动脉受侵有较大的应用价值。     

Determination of drug concentration in aqueous humor of cataract patients administered gatifloxacin ophthalmic gel

Background Ophthalmic gel has been developed to increase the drug concentration in aqueous humor and to retard the loss of drug from the conjunctival sac.The research was to compare the drug concentration in aqueous humor of cataract patients administered 0.3% gatifloxacin ophthalmic gel with that in patients administered 0.3% gatifloxacin ophthalmic solution.Methods Ninety-six patients with cataract （96 eyes） were randomly assigned to 8 groups.The patients in groups 1-4received topical gatifloxacin 0.3% ophthalmic gel and those in groups 5-8 received gatifloxacin 0.3% ophthalmic solution.The dose regimen was 1 drop, 4 times a day for 3 consecutive days prior to cataract surgery.On the day of surgery, 1drop was applied at 15, 30, 60 or 120 minutes before commencement of cataract surgery in groups 1 and 5, groups 2 and 6, goups 3 and 7, and groups 4 and 8, respectively.Aqueous humor was extracted during the cataract surgery for the analysis of gatifloxacin concentration..Results The concentrations of gatifloxacin in aqueous humor were （0.24±0.25） μg/ml, （1.11±0.74） μg/ml, （2.32±2.01）μg/ml and （1.85±1.14） μg/ml in groups 1 to 4, and （0.16±0.25） μg/ml, （0.31±0.24） μg/ml, （0.75±0.28） μg/ml and （0.33±0.22） μg/ml in groups 5 to 8, respectively.Patients receiving gatifloxacin ophthalmic gel showed greater mean values of gatifloxacin concentration in aqueous humor than those receiving gatifloxacin solution, and such differences were significant with P 〈0.05 for all comparisons except that between groups 1 and 5.Conclusion Topical gatifloxacin ophthalmic gel can attain significantly greater drug concentrations in human aqueous humor than gatifloxacin ophthalmic solution.     

Antagonistic Effects of Tranilast on Proliferation and Collagen Synthesis Induced by TGF-β2 in Cultured Human Trabecular Meshwork Cells

Whether tranilast had antagonistic effect on proliferation inhibition and collagen synthesis promotion induced by TGF-β2 in cultured human trabecular meshwork cells was investigated. Suspension of 1 × 104 cultured human trabecular meshwork cells of 3-5 passage was distributed in each well of a 96-well disk and divided into control group and experimental group. After 24 h, 0 μg/ml (control), 12.5 μg/ml, 25 μg/ml, 50 μg/ml tranilast with 3.2 ng/ml TGF-β2 were added into the incubation medium. Another 24 h later, proliferation and collagen synthesis in cultured human trabecular meshwork cells were examined respectively by using tetrazolium-based semiautomated colormetric (MTT) assay and 3 H-proline incorporation with liquid scintillation technique. The results showed absorbance (A) values of the experimental groups were 0. 9036 ± 0. 3017, 1.1361 ±0.1352, 1.2457 ±0.1524 according to the different concentrations of tranilast, and 0. 8956 ±0. 1903 of the control group. In comparison with the control group, 25 μg/ml (q′= 3. 23, P＜0.05), 50 μg/ml (q=4.70, P＜0.01) tranilast significantly antagonized the decrease of the A values induced by TGF-β2 in the cultured human trabecular meshwork cells. In comparison with the control group [817.37±124.21 cpm/104 cells], 12.5 μg/ml (620.33±80.46 cpm/104 cells, q′=4.26, P＜0.05),25 μg/ml (594. 58±88.13 cpm/104 cells, q′=4. 81, P＜0.01), 50 μg/ml (418. 64±67.90 cpm/104 cells, q′=8.62, P＜0.01) tranilast significantly inhibited the incorporation of 3 H-proline into the cultured human trabecular meshwork cells promoted by TGF-β2 in a dose-dependent manner. It was concluded that tranilast had the antagonistic effect on the proliferation inhibition and collagen synthesis promotion induced by TGF-β2 in the cultured human trabecular meshwork cells.     

脊柱退行性变患者围手术期D-二聚体的变化及其对深静脉血栓栓塞症的预测价值

目的 探讨脊柱退行性变围手术期D-二聚体的变化情况及其对深静脉血栓栓塞症的预测价值。 方法 选择浙江萧山医院骨科2013年1月-2015年12月住院手术治疗的脊柱退变性疾病患者200例作为研究对象,根据术后是否发生深静脉血栓栓塞症分为观察组(深静脉血栓栓塞症组)和对照组(无深静脉血栓栓塞症组),测定血浆D-二聚体水平,彩色多普勒超声测定深静脉血栓形成。 结果 观察组和对照组术后1 d、术后3 d、术后7 d血浆D-二聚体水平(1.76±0.23)μg/ml、(2.32±0.41)μg/ml、(1.67±0.35)μg/ml;(1.28±0.31)μg/ml、(1.26±0.27)μg/ml、(1.31±0.23)μg/ml均高于术前(0.68±0.14)μg/ml;(0.74±0.15)μg/ml(P>0.05);2组术前血浆D-二聚体水平比较差异无统计学意义(P<0.05),观察组术后1 d、术后3 d和术后7 d血浆D-二聚体水平明显高于对照组,差异均有统计学意义(P<0.05)。D-二聚体水平诊断深静脉血栓栓塞症的ROC曲线结果显示:诊断截断值为1.17 μg/ml,ROC曲线下面积为0.928,95%可信区间下限为0.890,上限为0.966。以D-二聚体 ≥ 1.17 μg/ml为深静脉血栓栓塞症阳性,D-二聚体<1.17 μg/ml为深静脉血栓栓塞症阴性诊断深静脉血栓栓塞症的灵敏度为92.9%,特异度为79.1%,误诊率为20.9%,漏诊率为7.1%,总符合率为13.0%+68.0%=81.0%,Youden指数为72.0%,阳性预测值为41.9%,阴性预测值为98.6%。 结论 脊柱退行性变患者术后D-二聚体水平升高,D-二聚体水平对深静脉血栓栓塞症有一定的预测价值。      

没食子儿茶素没食子酸酯诱导人肝癌细胞凋亡

目的 探讨没食子儿茶素没食子酸酯(EGCG)诱导人肝癌细胞株凋亡的作用和机制.方法 以不同浓度EGCG处理人肝癌细胞株HepG2和SMMC-7721细胞24 h和48 h.四甲基偶氮唑蓝比色法和锥虫蓝染色细胞计数评价细胞生长情况;流式细胞术检测细胞凋亡和环氧合酶-2(COX-2)、Bcl-2蛋白;比色法测定天冬氨酸蛋白酶-9和caspase-3活性;RT-PCR检测COX-2和Bcl-2家族mRNA的表达.结果 EGCG(50、100、200、400μg/ml)处理48 h后,HepG2细胞活性下降至93.8%±2.8%,62.3%±5.4%,33.9%±2.5%和17.6%±3.2%,与对照组(100.0%±2.8%)比较差异均有统计学意义(均P＜0.05);SMMC-7721细胞活性下降至49.6%±3.5%,30.3%±3.8%,17.7%±2.2%和13.0%±2.5%,与对照组(100.0%±0.8%)比较差异均有统计学意义(均P＜0.05);100 μg/ml EGCG处理细胞24、48、72和96 h后,HepG2活细胞计数(×104)分别是8.0±1.5,22.0±3.1,37.0±5.4和61.0±8.7,与对照组(15.0±2.5,45.0±5.3,86.0±11.0和210.0±23.0)相比明显减少,差异均有统计学意义(均P＜0.05);SMMC-7721活细胞计数(×104)分别是7.0±2.2,13.0±2.5,20.0±3.7和31.0±4.0,与对照组(14.0±2.2,40.0±4.3,75.0±8.8和182.0±28.0)相比明显减少,差异均有统计学意义(均P＜0.05).EGGG(50、100、200μg/ml)处理细胞12 h后,HepG2细胞凋亡率分别是8.7%±0.4%,18.1%±1.1%和22.1%±1.8%;SMMC-7721细胞凋亡率分别是5.9%±0.3%,7.8%±0.6%和12.2%±0.8%,与对照组(3.3%±0.3%)和(3.7%±0.4%)比较,差异均有统计学意义(P＜0.05);EGCG(100、200μg/ml)处理细胞12 h后,HepG2细胞caspase-9活性为1.8±0.4和2.5±0.4;caspase-3活性为2.0±0.4和2.8±0.5,两者与对照组(1.0±0.1和1.0±0.2)比较差异均有统计学意义(均P＜0.05);SMMC-7721细胞caspase-9活性为1.7±0.4和2.5±0.4,caspase-3活性为1.9±0.4和2.6±0.3,均显著高于对照组(1.0±0.1和1.0±0.2,P＜0.05).EGCG(200μg/ml)下调COX-2和Bcl-2的表达,而对Bcl-2家族其他成员表达无明显影响.结论 EGCG可能通过下调COX-2和Bcl-2的表达,激活caspase-9和caspase-3诱导肝癌细胞凋亡.     

临床控制的哮喘患者小气道功能和诱导痰炎性标志物测定的临床意义

目的 检测临床控制的哮喘患者小气道功能和诱导痰嗜酸细胞（Eos）、嗜酸细胞阳离子蛋白（ECP）和IL-5水平,探讨其临床意义.方法 对62例临床控制的哮喘患者做肺功能测定,并分别采用瑞氏染色、荧光免疫法和ELISA检测诱导痰Eos数量、ECP和IL-5水平.选择30例急性发作期哮喘患者和20例健康者作为对照组.结果 62例临床控制哮喘患者中,小气道功能异常43例（69.4%）,正常19例（30.6%）,诱导痰Eos数量（5.6±2.9）%、ECP（129±100）μg/L、IL-5（21±12）μg/L,显著低于急性发作期哮喘组（P＜0.01）,但显著高于健康对照组（P＜0.01）.小气道功能异常哮喘患者诱导痰Eos数量（6.9±3.1）%、ECP（148±90）μg/L、IL-5（24±12）μg/L,显著高于小气道功能正常患者[痰Eos（2.0 ±1.1）%,ECP（54 ±29）μg/L、IL-5（13 ±5）μg/L,P＜0.01].结论 临床控制的哮喘患者小气道功能异常和气道炎症持续存在,测定患者小气道功能和诱导痰炎性标志物有助于指导哮喘治疗.     

炎症及凝血指标与急性脑梗死预后关系的临床分析

目的探讨炎症和凝血指标对急性脑梗死预后和病情判断的临床价值。方法检测160例急性脑梗死患者超敏C反应蛋白（hs-CRP）炎症指标及凝血酶原时间、活化部分凝血活酶时间、凝血酶时间、纤维蛋白原、D二聚体凝血指标。根据1个月随访结果将患者分为恢复良好组和恢复不佳组,同时根据随访过程中的病情变化将患者分成进展性脑梗死组和非进展性脑梗死组。结果恢复不佳组hs-CRP水平[（4.9±1.6）mg/L]显著高于恢复良好组[（1.9±0.9）mg/L）]（P〈0.01）,恢复不佳组D二聚体水平[（402±67）μg/L]显著高于恢复良好组[（195±51）μg/L]（P〈0.01）;进展性脑梗死组hs-CRP水平[（3.9±1.5）mg/L]显著高于非进展性脑梗死组[（2.5±0.7）mg/L]（P=0.03）,进展性脑梗死组D二聚体水平[（415±78）μg/L]显著高于非进展性脑梗死组[（177±56）μg/L]（P〈0.01）。结论早期检测hs-CRP和D二聚体等炎症和凝血指标有助于判断急性脑梗死预后和疾病进展。     

节段性阻断选择性腹腔灌注全胸腹主动脉替换术

目的小结应用节段性阻断、选择性腹腔灌注全胸腹主动脉替换体外循环（CPB）管理经验。方法自2007年1月至2011年6月,连续行全胸腹主动脉替换术11例（男8例,女3例）,年龄35～53（46±11）岁,其中马凡综合征合并慢性Stanford B型夹层4例（均为支架术后）,马凡综合征合并慢性Stanford A型夹层3例（其中1例Bentall术后）,慢性Stanford B型夹层3例（支架术后）,慢性Stanford A型夹层1例。其中仅3例上半身停循环,降温至膀胱温25℃左右,余采用浅低温（鼻咽温33℃左右）节段性阻断,停循环期间行选择性腹腔脏器灌注（双泵双管）,四分支人工血管行全胸腹主动脉替换。结果全组CPB时间145～201（167±51）min,住院时间20～35（27±7）d。3例采用了上半身停循环,停循环时间分别为16 min、19min、21 min;余8例上半身未停循环,选择性腹腔脏器灌注时间为26～37（平均32±4）min。术后出现暂时性神经功能障碍3例;肾功能衰竭1例,透析后痊愈;出现液气胸1例,治疗后痊愈;术后1年出现巨大腹壁切口疝1例。术后无死亡病例,无下肢截瘫及腹腔其他脏器功能不全病例。结论应用节段性阻断、选择性腹腔灌注CPB是要特别注意上、下肢不同血压的维持、引流差与容量不足的判断、选择性腹腔脏器灌注中流量与压力维持等问题。     

血浆D-二聚体及纤维蛋白（原）降解产物检测的临床意义

目的 探讨血浆D-二聚体和纤维蛋白（原）降解产物在临床不同血栓性疾病的诊断、疗效观察和预后判断中的应用价值.方法 选取2013年6-11月兰州大学第一医院住院病人257例作为疾病组,健康对照组34例,用酶联免疫荧光法、胶乳免疫比浊法对不同疾病患者的血浆D-二聚体和纤维蛋白（原）降解产物进行检测.结果 过敏性紫癜、脑梗死、肝硬化、原发性肝癌、急性粒细胞白血病、肺栓塞、静脉血栓形成等疾病患者血浆D-二聚体和纤维蛋白（原）降解产物增高,与健康对照组比较差异有统计学意义（P＜0.01）.结论 D-二聚体、纤维蛋白（原）降解产物检测有助于临床对患者高凝和纤溶状态的判断与治疗.     

Endovascular stent-grafts for acute and chronic type B aortic dissection: comparison of clinical outcomes

Background Endovascular stent-graff treatment has emerged as an alternative for patients with type B aortic dissection （AD）, either at acute or chronic phase, in selected patients. This study aimed to investigate the results of endovascular stent-graft repair for acute and chronic type BAD. Methods From May 2002 to July 2007, 67 patients with type BAD were treated by endovascular stent-graft placement. There were 32 patients in the acute phase （AAD group） and 35 patients in the chronic phase （CAD group）. The patients were followed up from 1 to 65 months （average, 17_＋16 months）. The immediate and follow-up clinical outcomes were documented and compared between the 2 groups. Results Placement of endovascular stent-grafts across the primary entry tears was technically successful in all 67 patients. Compared with patients in the CAD group, those in the AAD group had higher percentages of pleural effusion （15.6% vs 0, P=-0.02） and visceral/leg ischemia （21.9% vs 2.9%, P=0.02）. Procedure related complications, including endoleak and post-implantation syndrome occurred more frequently in AAD group than in CAD group （21.9% vs 2.9% and 31.3% vs 8.6%, respectively; P=0.02 and P=0.02）. Kaplan-Meier analysis showed no significant difference in survival rate at 4 years between the 2 groups （86.4% vs 92.3%, P=0.42 by Log-rank test）. But the 4-year event-free survival rate was higher in patients with chronic dissection than in patients with acute dissection （96.2% vs 73.9%; P=0.02 by Log-rank test）. Conclusions Endovascular repair with stent-graff was safe and effective for the treatment of both acute and chronic type BAD. However, both immediate and long term major complications occurred more frequently in patients with acute dissection than in those with chronic dissection.     

Semaphorin 3A在系统性红斑狼疮合并血小板减少患者中的水平及意义

目的:通过测定血清Semaphorin 3A(Sema3A)的水平,分析Sema3A与系统性红斑狼疮(systemic lupus erythematosus,SLE)血小板减少的相关性。方法: 应用酶联免疫吸附法检测170例SLE患者、50例干燥综合征(Sjögren’s syndrome,SS)患者、19例脾功能亢进(hypersplenism,HS)患者及150例健康对照(healthy controls,HC)血清中Sema3A的水平,收集患者及健康对照的临床资料及实验室检查,实验室检查主要为患者的血常规及骨髓穿刺活检结果。根据是否合并血小板减少及血小板减少是否缓解,将SLE患者分为SLE合并血小板减少组(41例)、SLE合并血小板减少缓解组(28例)及SLE未合并血小板减少组(101例)。根据是否合并血小板减少,将SS患者分为SS合并血小板减少组(18例)及SS未合并血小板减少组(32例)。将28例进行骨髓穿刺活检的SLE患者,根据骨髓象结果从骨髓增生情况方面将其分为骨髓增生正常组(19例)和增生减低组(9例),从巨核细胞成熟方面将其分为有巨核细胞成熟障碍组(8)和无巨核细胞成熟障碍组(20例)。比较各组Sema3A水平差异,并分析各组患者血清Sema3A水平与血小板的相关性及不同骨髓象间血清Sema3A的水平。结果: (1)SLE患者血清Sema3A水平较HC显著降低[(3.84±2.76) μg /L vs. (6.96±2.62) μg/L,P<0.001],SS患者血清Sema3A水平亦较HC显著降低[(4.35±3.57) μg/L vs. (6.96±2.62) μg/L,P<0.001],HS患者血清Sema3A水平较HC也明显降低[(5.67±2.26) μg/L vs. (6.96±2.62) μg/L,P=0.041]。(2)SLE患者血清Sema3A水平较SS患者降低,但差异无统计学意义[(3.84±2.76) μg/L vs. (4.35±3.57) μg/L,P=0.282],SLE患者血清Sema3A水平与HS患者相比显著降低,差异有统计学意义[(3.84±2.76) μg/L vs. (5.67±2.26) μg/L,P=0.006]。(3)SLE合并血小板减少组Sema3A水平显著低于SLE合并血小板减少缓解组[(1.28±1.06) μg/L vs. (3.83±2.65) μg/L,P<0.001]和SLE未合并血小板减少组[(1.28±1.06) μg/L vs. (4.87±2.60) μg/L,P<0.001],而SLE合并血小板减少缓解组与SLE未合并血小板减少组相比,差异无统计学意义[(3.83±2.65) μg/L vs. (4.87±2.60) μg/L,P=0.123]。SLE合并血小板减少组患者Sema3A水平与SS合并血小板减少组患者相比降低,但差异无统计学意义[(1.28±1.06) μg/L vs. (1.68±1.11) μg/L,P=0.189]。(4)相关性分析显示SLE患者的Sema3A水平与血小板显著相关(r=0.600,P<0.001), SS患者的Sema3A水平与血小板亦呈明显的正相关(r=0.573,P<0.001),但HS患者与Sema3A却没有表现出明显的相关性(P=0.393)。(5)血清Sema3A在骨髓增生正常和减低的SLE患者,及有和无巨核细胞成熟障碍的SLE患者中的水平差异无统计学意义(P>0.05)。结论:血清Sema3A在多种合并血小板减少的疾病中水平普遍下降,SLE患者血清Sema3A水平显著降低,并与血小板呈明显正相关,在SS患者中亦可得出类似结论,提示Sema3A与结缔组织病的血小板减少相关。     

急性Stanford B型主动脉夹层腔内修复术后远端主动脉负性重塑危险因素分析

  目的  应用计算机断层扫描及影像分析软件评估Stanford B型主动脉夹层胸主动脉腔内修复术(thoracic endovascular aortic repair, TEVAR)后支架远端主动脉形态学变化,探讨术后发生支架远端主动脉负性重塑的危险因素。  方法  回顾性分析2005年10月至2015年12月于我院接受TEVAR手术的急性Stanford B型主动脉夹层患者的临床资料和影像学数据,结合既往Criadol分区原则将主动脉归纳分为胸降主动脉区、肾上腹主动脉区、肾下腹主动脉区及髂动脉区,评估不同区域主动脉真假腔形态及破口分布情况。利用单因素和多元logistic回归分析发生支架远端主动脉负性重塑的危险因素。  结果  共完整收集216例于我院进行定期随访的患者资料,平均随访（3.9±2.1）年,随访期内47例(21.8%)患者支架远端主动脉出现负性重塑。单因素logistic线性回归分析发现主动脉壁结构异常(马凡综合征病史)和假腔持续通畅(远端破口存在、假腔血栓化不全)是本组患者TEVAR术后支架远端主动脉负性重塑的危险因素;多元logistic回归分析显示,胸降主动脉区破口多[比值比(OR)=1.36, 95%可信区间(CI)=1.12-1.58, P=0.005]以及肾下腹主动脉区破口少(OR=0.49, 95%CI=0.22-0.71, P<0.001)是患者术后支架远端主动脉负性重塑的独立危险因素。  结论  主动脉壁结构异常、假腔持续通畅、胸降主动脉区破口多及肾下腹主动脉区破口少是急性Stanford B型主动脉夹层患者TEVAR术后支架远端主动脉负性重塑的独立危险因素。     

代谢综合征患者葡萄糖代谢率与血浆脂联素及瘦素水平变化的关系

目的 探讨代谢综合征(MS)患者葡萄糖代谢率与血浆脂联素、瘦素水平的关系.方法 筛选30例MS患者和20名健康者为对照组.所有受试者均行高胰岛素-正常血糖钳夹试验;检测血浆脂联素与瘦素浓度及空腹胰岛素(FTNS)、血糖、血脂等生化指标;测定血压、腰围、身高、体重等人体参数.结果 (1)高胰岛素-正常血糖钳夹试验稳态时(120～150 min),MS组的葡萄糖代谢率显著低于对照组[(8.33±1.59)与(4.13±1.34)mg·kg-1·min-1],差异有统计学意义(P＜0.01).(2)MS组的血浆脂联素水平显著低于对照组[(5.15±2.54)mg/L比(10.28±5.50)mg/L,P＜0.01],瘦素水平显著高于对照组[(189±90)μg/L比(127±73)μg/L,P＜0.01].(3)在MS组,腰围、体质指数、甘油三酯、高密度脂蛋白胆固醇、FINS、脂联素、瘦素等与葡萄糖代谢率相关(均P＜0.05).结论 提示MS患者的胰岛素抵抗可能与血浆脂联素降低及瘦素升高有关.

Abstract：

Objective To investigate the relationship of glucose metabolic rate (GMR) and plasma levels of adiponectin and leptin in patients with metabolic syndrome (MS). Methods A total of 30 MS subjects aged 36 -60 years old were selected as MS group. And 20 normal adults were selected as control group. The GMR was evaluated by the technique of hyperinsulinemic euglycemia clamp. The plasma concentrations of adiponectin and leptin were detected by enzyme-linked immunosorbent assay (ELISA). Blood pressure, waist circumference (WC), body weight and body height were measured.Results ( 1 ) During the steady state ( last 30 min), the GMR was significantly lower in MS group than that in control Group [ (4. 13 ± 1.34) mg· kg- 1 · min -1 vs ( 8.33 ± 1.59 ) mg · kg- 1 · min -1, P ＜ 0. 01 ].(2) The plasma level of adiponectin was significantly lower in MS group than that in control group [ (5. 15 ±2. 54) μg/ml vs ( 10. 28 ±5.50 ) μg/ml, P ＜0. 01 ]. The plasma level of leptin were significantly higher in MS group than that in control group [(189.37 ±90.48) nng/ml vs(126.55 ±72.70) ng/ml, P ＜0.01].(3) In MS group, glucose metabolic rate was associated with WC, BMI, TG, HDL-C FINS, leptin, and adiponectin, ( all P ＜ 0. 05 ). Conclusion The technique of hyperinsulinemic euglycemic clamp shows that the BMR of MS patients significantly decreases. It may be associated with their lowered plasma levels of adiponectin and leptin.