直肠癌患者手术前后凝血状态变化的研究

目的：通过研究直肠癌患者凝血与纤溶系统的变化，观察其与手术切除与否、淋巴结转移、细胞分化程度等的关系。方法：选取直肠癌患者58例，于术前及术后两周检测PAGT、PT、APTT、TFPI、D－二聚体、t-PA:a等指标；同期52例非肿瘤病人作为对照组。结果：直肠癌患者较对照组血小板聚集增强（P＜0．05），凝血酶原时间、活化部分凝血活酶时间明显缩短，组织因子途径抑制物降低（P＜0．05），D－二聚体和t-PA:a显著升高（P＜0．01），存在淋巴结转移和低分化腺癌者尤为明显（P＜0．05或P＜0．01），手术切除后有所改善。结论：直肠癌患者处于高凝和纤溶亢进状态，在淋巴结转移和癌细胞分化差的病人中尤为明显；应用抗凝和抗纤溶药物可能对直肠癌的预防有一定作用。     

D-dimer >2.785 μg/ml and multiple infarcts ≥3 vascular territories are two characteristics of identifying cancer-associated ischemic stroke patients

ABSTRACT

Background: The patterns and mechanisms underlying stroke in cancer patients differ from those of the conventional etiology. In this study, we further investigated the characteristics distinguishing cancer-associated ischemic stroke (CAIS) and the relationship of D-dimer value with CAIS.

Methods: Sixty-one acute ischemic stroke patients with cancer (cancer group) and 76 stroke patients without cancer (control group) were recruited. Cerebrovascular distribution was divided into 3 circulations and 23 vascular territories, and acute multiple brain infarcts (AMBIs) were defined as discrete MRI diffusion-weighted imaging (DWI) lesions in >1 vascular territory.

Results: Cancer patients had higher average D-dimer and fibrinogen degradation product values, and fewer stroke risk factors. The numbers of infarct-affected vascular territories, AMBIs, and AMBIs in multiple circulations were significantly higher in the cancer group. Receiver operating characteristic analysis showed that the cutoff value of D-dimer was 2.785 μg/ml; and above features were particularly evident in cancer patients whose D-dimer values were >2.785 μg/ml, while those with D-dimer values ≤2.785 μg/ml were similar to controls.

Conclusions: D-dimer >2.785 μg/ml may be an effective cutoff value and a sensitive index for identifying CAIS patients. AMBIs in ≥3 vascular territories and AMBIs in both the anterior and posterior circulations are two imaging characteristics of CAIS.     

冠心病并发Ⅱ型糖尿病患者高凝状态的临床研究

目的探讨冠心病（CHD）并发非胰岛素依赖糖尿病（NIDDM）患者体内凝血功能的变化及临床意义。方法选择病例组CHD并发NIDDM患者24例,CHD患者32例,以及正常对照组20例,分别测定血浆D-二聚体（D-D im er）、纤维蛋白原（Fbg）含量,同时分析Fbg与冠脉病变支数的相关性。结果CHD并发NIDDM患者血浆D-D im er、Fbg水平显著高于CHD患者和正常对照者（P<0.05或P<0.01）,并且CHD患者也显著高于对照者（P<0.05）;冠脉病变严重者血浆Fbg含量显著高于冠脉病变较轻患者（P<0.01）。结论CHD并发NIDDM患者体内存在明显的高凝状态,并与冠状动脉病变程度有关。     

Effect of all-trans-retinoic acid on the hypercoagulable state of patients with breast cancer

To evaluate whether all-trans-retinoic acid (ATRA) is able to modulate the hemostatic system in patients with solid tumors, we studied patients with locally advanced breast cancer who were enrolled in a Phase Ib study of ATRA +/- Tamoxifen (Tam). In this study, two groups of 15 patients/each were treated for 21 days before operation with ATRA at three doses (15, 45, or 75 mg/m(2)/day on alternate days) given alone (group 1) or in combination with Tam (group 2). One additional group received Tam alone. Plasma samples were evaluated for hypercoagulation markers (FVIIa, F1+2, TAT, D-dimer), fibrinolysis proteins (t-PA, PAI-1), and coagulation inhibitors (protein C, AT). At baseline, cancer patients had FVIIa, F1+2, TAT, and PAI-1 significantly greater than control subjects. During treatment, in the patients given ATRA alone, hypercoagulation markers appeared unmodified. Instead, subjects given Tam alone had a significant elevation of FVIIa, F1+2, and TAT versus baseline. However, in the ATRA + Tam groups, hypercoagulation markers were decreased compared with Tam alone. These results suggest that in selected conditions, pre-operative ATRA may modulate the hypercoagulable state of breast cancer patients.     

腔隙性脑梗塞患者的高粘血症与高凝状态

研究腔隙性脑梗塞病人是否并发高粘血症和高凝血症。方法：检测３２例腔隙性脑梗塞患者的血液流变性和血液凝固性。结果：血液流变性指标加、Ｐ、ＥＰＴ、ＨＣＴ、ＥＳＲ和Ｆｉｂ腔隙性脑梗塞病人较对照组有非常显著的差异（Ｐ＜０．０５～０．０１），另外其ＰＡｇＴ、ＶＷＦ：ＡＧ、Ｆｎ增高，ＡＴⅢ：Ａ和ＰＬＧ降低均表现血液有高凝状态。结论：腔隙性脑梗塞患者多伴有高粘血症与高凝血症，因此组织灌注不足，这在腔隙性脑梗塞发病和进程中是一个危险因素。     

血清D二聚体在慢性阻塞性肺病中的动态变化及意义

目的测定慢性阻塞性肺疾病（COPD）急性加重期（AECOPD）和稳定期患者血清D二聚体水平的动态变化,以探讨COPD患者凝血系统的变化及临床意义。方法收集我院2009年9月-2010年9月AECO-PD和社区获得性肺炎（CAP）住院患者各60例,检测治疗前后血清D二聚体含量,设同期60名健康体检者为对照组。结果与对照组比较,CAP患者在治疗前后血清D二聚体含量变化均无统计学意义（P〉0.05）,而AECOPD患者在治疗前后血清D二聚体含量均有明显增加（P〈0.05）,其中治疗前增加更为显著（P〈0.01）。CAP患者治疗前后血清D二聚体水平变化无统计学差别（P〉0.05）,AECOPD患者在有效治疗后D二聚体含量显著减少（P〈0.05）。结论 COPD患者血液系统处于高凝状态下,其严重程度与病情成正相关。     

The relative roles of maternal survival and inter-personal violence as selection pressures on the persistence of Neanderthal hypercoagulability alleles in modern Europeans

Abstract

Background: Simonti et al. reported variation in the frequency of Neanderthal alleles found in modern humans and argued that they may have provided an evolutionary advantage. One such allele is SNP rs3917862, associated with hypercoagulability. rs3917862 can be deleterious, but can also help prevent blood loss.

Aim: To investigate two possible selective pressure hypotheses for rs3917862 surviving to higher frequencies: deaths from interpersonal violent trauma and childbirth.

Subjects and methods: Mortality data from modern hunter-gatherers models the living conditions and causes of death of humans and Neanderthals at the point of admixture.

Results: National census data indicates a positive correlation between the presence of rs3917862 and decreased maternal mortality ratios. When the maternal mortality ratio is modelled using GDP, births attended by skilled assistants and the presence of rs3917862, women are 0.1% more likely to die in childbirth in populations lacking rs3917862. Deaths due to violence show no correlation with rs3917862.

Conclusion: These findings challenge the idea that Neanderthal admixture has negatively impacted the overall health of modern humans. Maternal survival may have acted as a selective pressure for the persistence of hypercoagulability alleles in modern Europeans. Understanding the role of hypercoagulability in childbirth, and the role of rs3917862, could help to reduce maternal mortality ratios.     

Effect of thymoptin on hemostasis and fibrinolysis in rats with experimental nephritis

Immune nephritis in rats was induced by administration of nephrotoxic rabbit antiserum. The development of severe renal inflammation (proteinuria, edema, lipemia, increased erythrocyte sedimentation rate, and 30% mortality) was accompanied by hypercoagulation and inhibition of fibrinolysis. Repeated subcutaneous injections of thymoptin in a low dose of 0.1 μg/200 g (5 injections every other day) increased the severity of inflammation and prethrombotic state of the blood. Lengthening the period between injections (5 injections at 5-day intervals) was followed by a tendency toward attenuation of nephritis and correction of hypercoagulation. In healthy rats, thymoptin produced an opposite effect on hemostasis, which was manifested in moderate stimulation of fibrinolysis and hypocoagulation. Translated from Byulleten' Eksperimental'noi Biologii i Meditsiny, Vol. 146, No. 7, pp. 8–12, July, 2008     

凝血-纤溶动态图在脓毒症凝血纤溶失衡检测中的应用

目的 探讨凝血-纤溶动态图(CF)在检测脓毒症患者凝血和纤溶失衡中的作用.方法 对24例脓毒症患者和20例健康人的凝血、纤溶变化,进行常规方法检测和凝血-纤溶动态图检测.对比分析常规检测和凝血-纤溶动态图的特点.结果 在常规检测方法中,与对照组比较脓毒症凝血酶原时间(PT)缩短,纤维蛋白元含量(Fbg)增加,差异有统计学意义(P<0.05),提示血液处于高凝状态.与对照组比较脓毒症D-二聚体(D-D),纤溶酶原含量(Plg)增加,差异有统计学意义(P<0.05),提示血液处于继发纤溶亢进状态.在CF检测中,与对照组比较脓毒症反应时间(CST)、凝固时间(CT)缩短,最大振幅(ME)、聚合速度(ACE)增加,差异有统计学意义(P<0.05),提示血液处于高凝状态.与对照组比较,虽然脓毒症组溶解时间(FT)延长,但溶解速度(AFE)增加,差异有统计学意义(P<0.05),提示血液处于纤溶亢进状态.脓毒症组中平衡时间(BLT)、平衡指数(BLE) 2.55±0.39、2.05±0.21与对照组2.25±0.34、1.70±0.19比较增加,差异有统计学意义(P<0.05),显示脓毒症凝血-纤溶的平衡被打破,凝血为主.结论 凝血-纤溶动态图既有凝血和纤溶的参数,又有平衡参数,在检测脓毒症患者凝血纤溶的不平衡中,比常规方法更敏感、特异.     

Performance of wells score to predict deep vein thrombosis and pulmonary embolism in endurance athletes

Introduction: There are an increasing number of reports describing deep vein thrombosis (DVT) and/or pulmonary embolism (PE) in otherwise healthy endurance athletes. The Wells score is the most commonly used clinical prediction rule to diagnose DVT/PE in clinical populations. However, the Wells score may have limited utility for recognition of DVT/PE in athletes, contributing to missed or delayed diagnosis.

Objective: We performed an analysis of the ability of the Wells score to identify DVT/PE events in athletes through a review of published case reports.

Methods: A systematic search of the literature yielded 11 case reports.

Results: The Wells score had a 100% failure rate in identifying athletes with DVT (0/6) and PE (0/5), resulting in a delayed diagnosis for DVT of 20 ± 14 days. Retrospectively removing ‘differential diagnosis’ from the clinical prediction rule for DVT changed the Wells score median from 0 (range: ?1 to 0) to 2 (range: 1 to 2); the threshold for predicting DVT as ‘likely’. There were limited clinical characteristics captured in the Wells score for PE that were applicable to athletes, highlighting the need for reappraisal. Although the Wells score failed to accurately triage athletes with known DVT and/or PE, the addition of a D-dimer value (mean: 1566 ± 758ng/dL) to the Wells score correctly identified 9/9 athletes.

Conclusions: The Wells score had a 100% failure rate for triaging athletes with known DVT/PE. When performed, D-dimer adequately facilitated the additional diagnostic testing required for a timely diagnosis of DVT/PE in athletes. Improving awareness of an atypical presentation of thrombotic events in athletes may reduce the widespread underestimation of DVT/PE among athletes and facilitate the additional testing required for a timely diagnosis.