血浆D-二聚体和超敏C反应蛋白检测在急性脑梗死中的临床价值

目的探讨血浆D-二聚体(D-dimer,D-D)及超敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)水平与急性脑梗死(acute cerebral infarct,ACI)的关系。方法采用免疫透射比浊法检测102例ACI患者和50例正常对照者血浆D-D和hs-CRP水平。根据梗死灶大小102例ACI患者分为大梗死灶组、中梗死灶组和小梗死灶组,并进行相关统计分析。结果 ACI组患者血浆D-D和hs-CRP水平显著高于正常对照组(P0.01);大梗死灶组D-D和hs-CRP水平明显高于中、小梗死灶,而中梗死灶组D-D和hs-CRP水平高于小梗死灶组。结论监测血浆D-D和hs-CRP能为ACI的临床诊断、病情判断提供重要的参考依据。     

Validation of an immunoturbidimetric D-dimer assay in canine citrated plasma

Abstract: D-dimer is a neoantigen formed when thrombin initiates the transformation of fibrinogen to fibrin; it is derived from plasmin digestion of cross-linked fibrin. In human medicine, the usefulness of this analyte in diagnosing disseminated intravascular coagulation (DIC) has been assessed in patients fulfilling the clinical and laboratory requirements for this disorder. In canine medicine, the use of D-dimer is relatively new. Detailed studies are needed to understand the relationship between D-dimer concentration in plasma and DIC status in dogs. We validated a D-dimer immunoturbidimetric assay (Tina-quant [a] D-Dimer, Boehringer Mannheim) in canine citrated plasma samples. Intra-assay and interassay variability (coefficient of variation) was 5.63% and 8.82%, respectively. The assay was linear, using 2 samples with low and high D-dimer concentrations (r = .996 and .998). Accuracy was 102.2% and 95.7% based on a recovery study in which 2 samples were assessed. Reference values for D-dimer were established using 70 healthy dogs that were assessed clinically and evaluated on the basis of a complete laboratory workup. The reference range was set between 0.02 and 0.28 μg/mL (chi-square test for normal distribution, P > .05).     

Thrombolytic properties of a conjugate of liposomal urokinase with a monoclonal antibody specific for cross-linked fibrin in the model of rabbit artery thrombosis

AIM: To observe the targeting thrombolytic effect of a monoclonal antibody specific for cross-linked fibrin connected with liposomal urokinase（UK） in the model of rabbit artery thrombosis.METHODS: Preparation of thrombolytic solutions: with the method of controllable dialysis eradicator in liposomat,empty liposomes,liposomally entrapped urokinase and liposomally entrapped urokinase linked with D-dimer antibody were made.Experiment in vivo: a rabbit thrombosis model of abdominal aorta was induced by ferric chloride.When the blood pressure fall to the lowest,5 different solutions were separately imported (PBS,maximal-level UK,Ab/Lip/UK,Ab/UK-Lip,Ab-UK-Lip) and observed for 40 min continuously.RESULTS: The varieties of 5 groups blood pressures were analyzed with q-test.Significant differences were observed among Ab-UK-Lip group,maximal-level UK group and others (P<0.01).There were marked differences between Ab-UK-Lip group and others in wet weight of thrombuses (P<0.05).However,the quantity of UK in Ab-UK-Lip group was 1/3 of that in maximal-level of UK group.CONCLUSION: The thrombolytic effect on Ab-UK-Lip group is similar to that on maximal-level of UK group,but the dosage of UK is less,and the side-effect is light.This shows,as a homing-device of liposomal urokinase,the D-dimer antibody has targeting effect and the agent of Ab-UK-Lip will be attached importance by-and-by.     

D-二聚体在卵巢癌预后评估中的价值

目的研究D-二聚体对卵巢癌患者的预后评估价值。方法回顾性地分析了130名卵巢癌患者就诊时的血浆D-二聚体水平以及在确诊后8 a内的生存状况。采用受试者工作特征（ROC）曲线分析法、Kaplan-Meier生存曲线和Cox风险比例模型分析了D-二聚体对卵巢癌患者的预后评估价值。结果 D-二聚体水平随着卵巢癌患者国际妇产科联盟（FIGO）分期的递进而增加。D-二聚体预测卵巢癌患者死亡的曲线下面积为0.72,与CA125相似。D-二聚体≥355.0μg/L的患者,预后较差。在校正了CA125水平后,D-二聚体≥355.0 g/L对卵巢癌的预后仍然独立相关。结论 D-二聚体可能是卵巢癌患者独立的预后标志物。     

Evaluation of plasma antithrombin activity and D-dimer concentration in populations of healthy cats, clinically ill cats, and cats with cardiomyopathy

BACKGROUND: Current coagulation tests lack sensitivity and detect disseminated intravascular coagulation (DIC) only when it is severe. Measurement of antithrombin (AT) activity and D-dimer concentration permits early diagnosis and more precise classification of coagulopathies in some species. OBJECTIVES: The objectives of this study were to validate and determine the diagnostic utility of a chromogenic AT assay and an immunoturbidimetric D-dimer assay for the diagnosis of DIC in cats. METHODS: Citrated plasma samples were collected from 30 healthy cats, 30 ill cats, and 13 cats with cardiomyopathy. Partial thromboplastin time, prothrombin time, fibrin(ogen) degradation products, platelet concentration, and erythrocyte morphology were determined on all samples to document the presence or the absence of DIC. AT activity and D-dimer concentration were then measured. RESULTS: The chromogenic AT assay was linear and precise. Mean AT activity was higher in ill cats and cats with cardiomyopathy compared with healthy cats, but the difference was only significant in ill cats (P = .003). Seven cats met the criteria for DIC. Of the cats with DIC, 2 had decreased AT activity, 1 had increased AT activity, and 4 had AT activities within normal limits. The immunoturbidimetric D-dimer assay did not appear to accurately measure feline D-dimer. CONCLUSIONS: The chromogenic AT assay appeared to measure AT in cats but was not useful for the diagnosis of DIC. AT may be an acute phase reactant in cats. The immunoturbidimetric D-dimer assay was not useful for the diagnosis of DIC in cats.     

补阳还五汤防治急性缺血性脑卒中早期神经功能恶化的临床研究

目的 研究补阳还五汤防治急性缺血性脑卒中早期神经功能恶化的疗效。方法 选取本院2012年3月至2016年8月急性缺血性脑卒中患者60例,按照入院顺序编号,采取随机数字表法将患者分为观察组与对照组,每组30例,给予对照组患者常规西药治疗,观察组患者在对照组治疗基础上联合补阳还五汤治疗,比较两组患者临床治疗有效率,比较治疗前后血液流变学指标、血同型半胱氨酸（Hcy）、C反应蛋白（CRP）、D-二聚体水平以及美国国立卫生院神经功能缺损评分（NIHSS）、日常生活活动能力（Barthel）评分变化情况。结果 观察组临床治疗总有效率为86.67%,显著高于对照组63.33%（P<0.05）;治疗后,观察组血小板聚集率、纤维蛋白原水平、全血粘度、血浆粘度较对照组显著降低（P<0.05）;观察组Hcy、CRP、D-二聚体水平较对照组显著降低（P<0.05）;观察组NIHSS评分较对照组显著降低（P<0.05）,Barthel评分较对照组显著升高（P<0.05）。结论 补阳还五汤联合西药防治缺血性脑卒中早期神经功能恶化疗效确切,能通过改善患者血液流变学指标水平降低血脂、降低炎性水平达到提高脑神经功能水平的目的,值得临床推广应用。     

Effects of agglutination on tissue factor,D-dimer and endothelial cells in rats

ATM: to explore the effects of agglutination on tissue factor (TF), D-dimer and endothelial cells in vivo. METHODS: Forty-two SPF SD rats (male and female, 180~200 g) were randomly divided into normal saline control group, and different concentrations (5, 10 and 20 g/L) of phytohemagglutinin (PHA) groups and inactivated PHA groups, with 6 rats in each group. The rats were injected with normal saline, PHA and inactivated PHA through the tail vein respectively. The plasma contents of TF and D-dimer were detected by ELISA. The pulmonary capillary endothelial cells of the rats were observed under electron microscope. RESULTS: The plasma levels of TF and D-dimer were significantly higher in all PHA groups than those in normal saline group and 3 corresponding inactivated PHA groups. Compared with normal saline group, the pulmonary capillary endothelial cells of the rats in each PHA group were damaged, characterized by endothelial cell swelling and dissolution, cytoplasm osteoporosis, unclear boundary, mitochondrial swelling and thick basement membrane. In all inactivated PHA-groups, the structures of the endothelial cells were normal. CONCLUSION: PHA-induced agglutination damages capillary endothelial cells and causes the disorders of the coagulation-fibrinolysis system.     

Use of human immunoglobulin in addition to glucocorticoids for the initial treatment of dogs with immune-mediated hemolytic anemia

Objective – To determine the utility of human intravenous immunoglobulin (hIVIG) for the initial treatment of canine immune-mediated hemolytic anemia (IMHA).
Design – Blinded, randomized, clinical trial.
Setting – Veterinary teaching hospital.
Animals – Twenty-eight, client-owned dogs with primary IMHA.
Interventions – At enrollment, after diagnosis of IMHA, dogs were randomly assigned to receive either hIVIG or placebo, in a blinded fashion. For the next 14 days, all dogs received glucocorticoids as the sole immunosuppressant agent. All dogs received low-molecular-weight heparin as an anticoagulant. D-dimer concentrations were evaluated at the beginning and end of the study protocol to monitor for thromboembolic complications.
Measurements and Main Results – Twenty-five of 28 dogs (89%) were discharged from the hospital. Thirteen of those received hIVIG and 12 received placebo. Twenty-four dogs (86%) were alive 14 days after enrollment, and of these 13 received hIVIG and 11 received placebo. D-dimer concentrations were elevated in 86% of all dogs at the time of diagnosis.
Conclusions – For initial treatment of dogs with IMHA, the addition of hIVIG to corticosteroid treatment did not improve initial response, nor did it shorten hospitalization.     

小剂量肝素对危重新生儿伴全身炎症反应综合征的早期干预作用

目的观察小剂量肝素对危重新生儿全身炎症反应综合征(SIRS)的治疗效果及预后的影响。方法对我科2005年6月至2007年6月间符合诊断标准的94例新生儿SIRS患儿随机分组进行前瞻性对照研究,对照组46例采用常规治疗,治疗组48例在常规治疗基础上每次加用小剂量肝素(5u/kg)皮下注射,每6h 1次,连用3d,观察两组C-反应蛋白(CRP)、血小板计数(PLT)、D-二聚体(D-D)治疗前后的变化。结果治疗组SIRS持续时间>3d者16例(33.3%),明显少于对照组的28例(60.9%),MODS发生率和病死率也明显低于对照组(10.4%、4.2%vs34.8%、17.4%)(P<0.01或0.05);两组治疗后的PLT、CRP及D-D水平均明显改善,且以治疗组更为明显(P<0.01)。治疗组使用肝素后凝血指标均恢复正常或趋于正常。结论早期应用小剂量肝素可有效缩短SIRS持续时间,MODS的发生率及病死率明显降低。     

肝病患者纤维蛋白溶解系统关键因子检测的意义

目的研究肝病患者血浆中继发性纤维蛋白溶解系统中重要标志物D-二聚体（D-D）和纤维蛋白原（FIB）指标的变化及其临床意义.方法采用美国ACL-ELITEPRO全自动凝血仪检测35例健康体检者和94例不同肝病患者血浆中FIB和D-D含量.结果与健康体检正常组相比,各肝病组FIB含量降低,顺序为急性肝炎组〉健康对照组〉慢性肝炎组〉肝癌组〉肝硬化组.急性肝炎组和慢性肝炎组差别不显著,肝硬化组和肝癌组差别显著,差异有统计学意义（P〈0.05）;D-D含量升高顺序为健康对照组〈急性肝炎组〈慢性肝炎组〈肝癌组〈肝硬化组,各肝病组差异均有统计学意义.肝癌组和肝硬化组分别与急性肝炎组、慢性肝炎组和肝硬化组FIB和D-D含量比较均有显著差异,差异有统计学意义.结论血浆FIB和D-D可客观地反映肝病的严重程度.这为临床肝脏疾病的诊断、治疗以及判断预后提供了重要依据.