A Convenient Synthesis of the Substituted 2,3-Diarylindole the Potent Selective COX-2 Inhibitors

Phenyl sulfone-containing 2, 3-diarylindole derivatives were designed and identified to be selective COX-2 inhibitors. A convenient synthetic route was also developed for the synthesis of the novel inhibitors.

Development and structure-activity relationships of tanshinones as selective 11β-hydroxysteroid dehydrogenase 1 inhibitors

11β-Hydroxysteroid dehydrogenase 1(11β-HSD1)represents a promising drug target for metabolic syndrome,includ-ing obesity and type 2 diabetes.Our initial screen of a collection of natural products from Danshen led to the identi-fication of tanshinones as the potent and selective 11β-HSD1 inhibitors.To improve the druggability and explore the structure-activity relationships(SARs),more than 40 derivatives have been designed and synthesized using tanshinone IIA and cryptotanshinone as the starting materials.More than 10 derivatives exhibited potent in vitro 11β-HSD1 inhibitory activity and good selectivity over 11β-HSD2 across human and mouse species.Based on the biological results,SARs were further discussed,which was also partially rationalized by a molecular docking model of 1 bound to the 11β-HSD1.Remarkably,compounds 1,17 and 30 significantly inhibited 11β-HSD1 in 3T3-L1 adipocyte and in livers of ob/ob mice,which merits further investigations as anti-diabetic agents.This study not only provides a series of novel selective 11β-HSD1 inhibitors with promising therapeutic potentials in metabolic syndromes,but also expands the boundaries of the chemical and biological spaces of tanshinones.

Health Related Quality of Life among Osteoarthritis Patients: A Comparison of Traditional Non-Steroidal Anti-Inflammatory Drugs and Selective COX-2 Inhibitors in the United Arab Emirates Using the SF-36

Objectives: Osteoarthritis (OA) has a dramatic impact on patients’ health related quality of life (HRQoL). Chronic use of analgesics and anti-inflammatory medications for pain management may improve symptoms but on long term may affect HRQoL negatively. The objective of the present study was to compare the impact of two different classes of analgesics, traditional non-steroidal anti-inflammatory drugs (NSAIDs) and selective cyclo-oxygenase-2 (COX-2) inhibitors on HRQoL among osteoarthritis patients using the SF-36 questionnaire. Methods: Clinic based cross-sectional study conducted at Al-Qassimi Hospital, Sharjah, United Arab Emirates (UAE), over a period of six months. Ethical Approval was obtained from the ethics committee at Al-Qassimi Clinical Research Center. Total of 200 osteoarthritis patients fulfilling the inclusion and exclusion criteria were involved in the study. Patients’ demographics were collected from their medical records. The Medical Outcome Study Short-Form 36 (SF-36) questionnaire was used to measure patients’ HRQoL. SF-36 data were scored using health outcomes scoring software 4.5. Results: Mean age of the subjects was 62.19 ± 9.81 years with females constituting 151 (75.5%) of the patients. In general, females scored lower in most of the HRQoL domains compared to males and there was significant difference between the two groups in the mental health (p = 0.005) & mental component (p = 0.042) domains. Compared to selective COX-2 inhibitors, patients on NSAIDs scored higher on all domains of SF-36 except physical functioning. There was significant difference in mental health domain for patients treated with NSAIDs (p = 0.02). Celecoxib was only better than NSAIDs in osteoarthritis patients with more than one musculoskeletal disorders in the domain of bodily pain (p = 0.009). Conclusion: NSAIDs-treated patients did not differ significantly from celecoxib-treated patients in all domains of the SF-36 except for the mental health domain.

HDAC I/IIb selective inhibitor Purinostat Mesylate combined with GLS1 inhibition effectively eliminates CML stem cells

Purinostat Mesylate(PM)is a novel highly selective and active HDAC I/IIb inhibitor,and the injectable formulation of PM(PMF)based on the compound prescription containing cyclodextrin completely can overcome PM’s poor solubility and improves its stability and pharmacokinetic properties.Here,we showed that PM effectively repressed the survival of Ph+leukemia cells and CD34+leukemia cells from CML patients in vitro.In vivo studies demonstrated that PMF significantly prevented BCR-ABL(T315I)induced CML progression by restraining leukemia stem cells(LSCs),which are insensitive to chemotherapy and responsible for CML relapse.Mechanism studies revealed that targeting HDAC I/IIb repressed several important factors for LSCs survival including c-Myc,β-Catenin,E2f,Ezh2,Alox5,and mTOR,as well as interrupted some critical biologic processes.Additionally,PMF increased glutamate metabolism in LSCs by increasing GLS1.The combination of PMF and glutaminase inhibitor BPTES synergistically eradicated LSCs by altering multiple key proteins and signaling pathways which are critical for LSC survival and self-renewal.Overall,our findings represent a new therapeutic strategy for eliminating LSCs by targeting HDAC I/IIb and glutaminolysis,which potentially provides a guidance for PMF clinical trials in the future for TKI resistance CML patients.

环氧合酶-1及其抑制剂的研究进展

传统的非甾体抗炎药(NSAIDs)是一类广泛用于抗炎、解热、镇痛的药物,但由于胃肠道毒副作用和肾毒性使它的应用受到很大限制。而近年研究开发的新一代NSAIDs选择性/特异性COX-2抑制剂出现了增加心血管疾病的发病率(包括心脏病和中风)等安全性问题。随着对COX-1生理、病理机制的深入研究,发现其与多种疾病之间有密切的关系,如疼痛、血栓症、动脉粥样硬化、神经炎症和癌症等,而选择性地抑制COX-1为治疗上述多种疾病提供了新的思路。因此,COX-1及选择性COX-1抑制剂成为现代研究的热点。本文对COX-1的结构、生理病理功能及选择性COX-1抑制剂的发展现状和构效关系进行了综述。

MMP-2和ICAM-1在裸鼠体内塞来昔布抑制肝癌组织中的表达

目的:研究机体内部选择性环氧合酶-2(COX-2)抑制剂对肝细胞癌的抑制作用.方法:将三种肝癌细胞株HepG2、BEL-7402和SMMC-7721分别接种于6周龄裸鼠肝脏被膜下;将接种了不同肝癌细胞株的裸鼠分别分为3组,阴性对照组给予生理盐水灌胃,实验组给予塞来昔布灌胃,阳性对照组进行生理盐水灌胃的同时使用阿霉素腹腔注射;3wk后对裸鼠肝脏肿瘤取材、免疫组织化学法观察肿瘤组织中基质金属蛋白酶-2(MMP-2)及其抑制剂(TIMP-2)以及细胞间黏附因子-1(ICAM-1)的表达.结果:在肝脏被膜下接种了HepG2、BEL-7402和SMMC-7721肝癌细胞株的裸鼠中,应用塞来昔布的裸鼠肿瘤组织中MMP-2的表达下降(P<0.05),MMP-2的表达增加(P<0.05),TIMP-2/MMP-2比值增加.在肝脏被膜下接种了BEL-7402和SMMC-7721肝癌细胞株的裸鼠中,应用塞来昔布的裸鼠肿瘤组织中ICAM-1表达下降.结论:塞来昔布在机体内部可能具有抑制肝癌细胞转移和改善预后的作用.

选择性PARP-1抑制剂的研究进展

目前,已上市或处于临床阶段的PARP-1抑制剂普遍缺乏选择性,在抑制PARP-1同时也抑制PARP-2,从而带来较为严重的副作用。因此,选择性PARP-1抑制剂具有很大的开发前景。本文对选择性PARP-1抑制剂的研发现状作一介绍。

选择性Janus激酶1抑制药Upadacitinib和Filgotinib治疗类风湿性关节炎疗效和安全性的Meta分析

目的:系统评价两种选择性Janus激酶1(JAK-1)抑制药Upadacitinib和Filgotinib治疗类风湿性关节炎的疗效和安全性,为临床治疗提供循证参考。方法:计算机检索PubMed、Medline、Embase、Cochrane图书馆、中国生物医学文献数据库、中国期刊全文数据库、万方数据和中文科技期刊数据库,检索时限均为自建库起至2019年1月,收集在甲氨蝶呤或其他抗风湿类药物的基础上,安慰剂(对照组)对比Upadacitinib或Filgotinib(试验组)治疗类风湿性关节炎的随机对照试验(RCT),进行资料提取并采用Cochrane系统评价员手册5.1.0进行质量评价后,采用Rev Man 5.3统计软件对疗效[按美国风湿病协会标准判断病情缓解20%的患者比例(ACR20)、ACR50、ACR70、28个关节疾病活动度评分(DAS28)<3.2的患者比例]和安全性[不良事件(AE)发生率、严重不良事件(SAE)发生率、感染发生率、严重感染发生率、带状疱疹发生率、肝损害发生率]进行Meta分析。结果:共纳入8项RCT,合计2 738例患者。Meta分析结果显示,试验组患者ACR20[OR=3.37,95%CI(2.80,4.05),P<0.001]、ACR50[OR=3.78,95%CI(2.98,4.78),P<0.001]、ACR70[OR=4.31,95%CI(3.05,6.09),P<0.001]、DAS28<3.2分的患者比例[OR=3.86,95%CI(2.98,5.00),P<0.001]、AE发生率[OR=1.33,95%CI(1.11,1.61),P=0.002]和感染发生率[OR=1.43,95%CI(1.12,1.81),P=0.004]均显著高于对照组,其余指标比较差异均无统计学意义(P>0.05)。结论:JAK-1抑制药Upadacitinib和Filgotinib在提高类风湿性关节炎患者的ACR20、ACR50、ACR70、DAS28<3.2的患者比例等疗效指标方面较好;不会增加SAE、严重感染、带状疱疹与肝损害的发生率,但会增加患者AE与感染的风险。

Anti-apoptotic protein BCL-XL as a therapeutic vulnerability in gastric cancer

Background: New therapeutic targets are needed to improve the outcomes for gastric cancer(GC) patients with advanced disease. Evasion of programmed cell death(apoptosis) is a hallmark of cancer cells and direct induction of apoptosis by targeting the pro-survival BCL2 family proteins represents a promising therapeutic strategy for cancer treatment. Therefore, understanding the molecular mechanisms underpinning cancer cell survival could provide a molecular basis for potential therapeutic interventions. Method: Here we explored the role of BCL2L1 and the encoded anti-apoptotic BCL-XL in GC. Using Droplet Digital PCR(ddPCR) technology to investigate the DNA amplification of BCL2L1 in GC samples and GC cell lines, the sensitivity of GC cell lines to selective BCL-XL inhibitors A1155463 and A1331852, pan-inhibitor ABT-263, and VHL-based PROTAC-BCL-XL was analyzed using(CellTiter-Glo) CTG assay in vitro. Western Blot(WB) was used to detect the protein expression of BCL2 family members in GC cell lines and the manner in which PROTAC-BCL-XL kills GC cells. Coimmunoprecipitation(Co-IP) was used to investigate the mechanism of A1331852 and ABT-263 kills GC cell lines. DDPCR, WB, and real-time PCR(RTPCR) were used to investigate the correlation between DNA, RNA, protein levels, and drug activity. Results: The functional assay showed that a subset of GC cell lines relies on BCL-XL for survival. In gastric cancer cell lines, BCL-XL inhibitors A1155463 and A1331852 are more sensitive than the pan BCL2 family inhibitor ABT-263, indicating that ABT-263 is not an optimal inhibitor of BCL-XL. VHL-based PROTAC-BCL-XL DT2216 appears to be active in GC cells. DT2216 induces apoptosis of gastric cancer cells in a time-and dose-dependent manner through the proteasome pathway. Statistical analysis showed that the BCL-XL protein level predicts the response of GC cells to BCL-XL targeting therapy and BCL2L1 gene CNVs do not reliably predict BCL-XL expression.Conclusion: We identified BCL-XL as a promising therapeutic target in a subset of GC cases with high levels of BCL-XL protein expression. Functionally, we demonstrated that both selective BCL-XL inhibitors and VHL-based PROTAC BCL-XL can potently kill GC cells that are reliant on BCL-XL for survival. However, we found that BCL2L1 copy number variations(CNVs) cannot reliably predict BCL-XL expression, but the BCL-XL protein level serves as a useful biomarker for predicting the sensitivity of GC cells to BCL-XL-targeting compounds. Taken together, our study pinpointed BCL-XL as potential druggable target for specific subsets of GC.

环氧酶选择性抑制剂筛选模型的建立

目的 建立COX1和COX2活性检测模型 ,为COX2选择性抑制剂的筛选及抗炎作用机制研究提供可靠方法。方法 COX1抑制剂筛选模型用新生小公牛主动脉内皮细胞为酶源 ,6 keto PGF1α的含量变化评价化合物对COX1的抑制作用。COX2抑制剂筛选模型用激活的小鼠腹腔巨噬细胞 ,PGE2 含量变化评价化合物对COX2的抑制作用。结果 Indomethacin可显著地抑制COX1的活性 ,Meloxicam可显著地抑制COX2的活性 ,其对COX2的选择性抑制作用高于前者。结论 COX1和COX2抑制剂筛选模型可用于COX2选择性抑制剂的筛选和机制研究。

急性心肌梗死PCI中Percusurge远端保护装置对P-选择素和纤溶活性的影响

目的探讨Percusurge远端保护装置(DPD)在急性心肌梗死(AM I)PC I中对P-选择素(Ps)、纤溶酶原激活剂(t-PA)、纤溶酶原激活剂抑制物-1(PAI-1)的影响及作用机制。方法接受急诊PC I治疗的AM I患者72例,DPD组39例,对照组33例,经股静脉将6F右冠状动脉造影导管置入冠状静脉窦于PTCA前、DPD后即刻、0.5、2、6 h采血分别检测血中Ps,t-PA,PAI-1水平。结果①DPD组术后6 h Ps含量降低(P<0.05)与对照组比较在术后6 h有显著性差异(P<0.05);术后即刻至术后6 h血浆t-PA活性降低(P<0.05)与PAI-1含量升高(P<0.05),与对照组比较无统计学差异。②两组住院期间心血管病事件发生率无明显统计学差异。结论Percusurge远端保护装置能有效保护远端血管,减轻PTCA术后血小板的激活,减少再灌流后无复流的发生。

冠状动脉造影和PTCA术对冠心病纤溶活性的影响

目的 :观察选择性冠状动脉造影 (SCA)和 PTCA对冠心病纤溶活性的影响。方法 :对接受 SCA的 45例患者和 PTCA术后 19例患者的血浆组织型纤溶酶原激活物抗原 (t- PA:Ag)、纤溶酶原激活物抑制物 (PAI1 )和纤维蛋白二聚体 (DD)含量进行动态观测。结果 :1SCA后 SCA正常组、稳定型和不稳定型心绞痛组 t- PA:Ag含量均显著升高 (P<0 .0 1) ,前者 2 4h,后者 72 h内恢复 ;活性无显著变化 ;t- PA:Ag升高程度以 SCA正常组最明显 ,显著高于稳定和不稳定型心绞痛组。 2 PTCA术后 t- PA:Ag,DD含量和 PAI1 活性均显著升高 ,PAI1 活性 3d内、t- PA :Ag 7d内恢复 ,DD含量 7d内仍高于术前。结论 :冠心病患者有 t- PA:Ag储存和释放障碍 ,SCA和 PTCA术后纤溶活性有增加趋势 ,可能与术前、术后抗血小板药物及术中、术后肝素应用有关。

DH-2催化C4烯烃选择性叠合的研究

以炼厂FCC裂解气(混合C4)为原料,对磺酸树脂DH-2催化剂催化C4烯烃选择性叠合进行工艺条件等方面的评价。结果表明,反应温度降低、空速增大和催化剂酸量降低均导致异丁烯和1-丁烯转化率下降,C8烯烃(C8^=)选择性升高,C8^=中三甲基戊烯(TMP^=)的质量分数增多,二甲基己烯(DMH^=)的质量分数减少。另外,添加乙醇抑制剂可大大降低1-丁烯转化率,提高C8^=选择性,在50℃、2h^-1、乙醇与异丁烯物质的量比(简称醇烯物质的量比)为50%的条件下,异丁烯转化率为75.63%,1-丁烯转化率为6.48%,C8^=选择性为88.64%。

Development of small molecule extracellular signal-regulated kinases(ERKs) inhibitors for cancer therapy

The mitogen-activated protein kinase(MAPK)/extracellular signal-regulated kinase 1/2(ERK1/2) signaling pathway is widely activated by a variety of extracellular stimuli, and its dysregulation is associated with the proliferation, invasion, and migration of cancer cells. ERK1/2 is located at the distal end of this pathway and rarely undergoes mutations, making it an attractive target for anticancer drug development. Currently, an increasing number of ERK1/2 inhibitors have been designed and synthesized for antitumor therapy, among which representative compounds have entered clinical trials. When ERK1/2 signal transduction is eliminated, ERK5 may provide a bypass route to rescue proliferation, and weaken the potency of ERK1/2 inhibitors. Therefore, drug research targeting ERK5 or based on the compensatory mechanism of ERK5 for ERK1/2 opens up a new way for oncotherapy. This review provides an overview of the physiological and biological functions of ERKs, focuses on the structure-activity relationships of small molecule inhibitors targeting ERKs, with a view to providing guidance for future drug design and optimization, and discusses the potential therapeutic strategies to overcome drug resistance.

1,5-二芳基吡唑类环氧合酶-1选择性抑制剂的CoMFA研究

目的:应用比较分子力场法(CoMFA)研究一系列1,5-二芳基吡唑类对环氧合酶-1选择性抑制剂三维定量构效关系,为进一步药物设计提供理论依据.方法和结果:在研究的14个化合物中,用比较分子力场法得到1个CoMFA模型,交叉验证系数q2为0.818,具有较高的预测能力及合理性,非交叉验证模型相关系数r2为0.958,标准偏差为0.077,F为79.834;并依据模型设计,预测了几个具有较高活性的化合物.结论:此模型对设计和预测高活性的1,5-二芳基吡唑类环氧合酶-1选择性抑制剂有一定可靠性.

小分子MPS1抑制剂的研究进展

单极纺锤体1(MPS1)是一种双特异性蛋白激酶,在细胞有丝分裂过程中起着非常重要的作用,是参与着丝粒定位和纺锤体组装检查点(SAC)的主要激酶之一。癌细胞通常因细胞周期SAC功能失调而导致染色体不稳定。MPS1在多种癌细胞中过度表达,从而调控异常的染色体和中心体。因此,MPS1是一种潜在的癌症治疗新靶点。目前,部分MPS1抑制剂已被批准开展晚期非血液系统恶性肿瘤(如三阴性乳腺癌)治疗的临床试验。本文作者介绍了MPS1蛋白的生物学功能,并综述了近年来典型的小分子MPS1抑制剂的研究进展,以期为更多潜在的MPS1抑制剂的探索提供参考。

选择性PARP-1抑制剂的研究进展

聚腺苷二磷酸核糖聚合酶[Poly(ADP-ribose)polymerase,PARP]作为一种参与DNA修复的关键酶,已成为抗肿瘤药物开发的重要靶点。PARP抑制剂通过抑制DNA修复及协同致死作用可有效杀死肿瘤细胞,已被广泛应用于多种肿瘤的治疗。但大部分已被批准的PARP抑制剂因在抑制PARP-1的同时对PARP-2也有抑制作用而产生不良反应。因此,提高PARP-1抑制剂的选择性是解决这一问题的重要策略。本文综述已报道的选择性PARP-1抑制剂的研究进展,包括研究方法、构效关系、药理作用等。

QSAR Studies on the COX-2 Inhibition by 3,4-Diarylcycloxazolones Based on MEDV Descriptor

Selective inhibition of cyclooxygenase-2 (COX-2) might avoid the side effects of current available nonsteroidal antiinflammatory drugs while retaining their therapeutic efficacy. A novel variable selection and modeling method based on prediction is developed to construct the quantitative structure-activity relationships (QSAR) between the molecular electronegativity distance vector (MEDV) based on 13 atomic types and the biological activities of a set of selective cyclooxygenase-2 inhibitory molecules,3,4-diarylcycloxazolones (DAA) plus indomethacin,naproxen,and celecoxib. Using multiple linear regression,a 5-variable linear model is developed with the calibrated correlation coefficient of 0.9271 and root mean square error of 0.17 in modeling stage and the validated correlation coefficient of 0.9030 and root mean square error of 0.20 in leave-one-out validation step,respectively. To further test the predictive ability of the model,20 DAA compounds are picked up to construct a training set which is used to build a QSAR model and then the model is employed to predict the biological activities of the balance compounds. The predicted correlation coefficient and root mean square error are 0.9332 and 0.19, respectively.

组蛋白甲基转移酶EZH2调控脓毒症诱导的T细胞功能障碍的作用及分子机制

目的探讨组蛋白甲基转移酶果蝇zeste基因增强子同源物2(EZH2)调控脓毒症T淋巴细胞功能失调的作用及机制。方法按随机数字表法将24只雄性C57BL/6小鼠分为假手术组、脓毒症模型组〔盲肠结扎穿孔术(CLP)+二甲基亚砜(DMSO)组〕及EZH2选择性抑制剂干预组(CLP+GSK126组),每组8只。采用CLP法制备脓毒症小鼠模型;假手术组小鼠不结扎穿刺盲肠,其余操作同CLP+DMSO组。CLP+DMSO组及CLP+GSK126组小鼠术后立即分别腹腔注射DMSO或GSK126(10 mg/kg)。术后24 h处死小鼠取肠系膜淋巴结,采用流式细胞仪检测T淋巴细胞EZH2表达、T淋巴细胞凋亡率、细胞增殖标志物ki-67抗原阳性T淋巴细胞(ki-67^(+))比例、γ-干扰素阳性T淋巴细胞(IFN-γ^(+))比例、程序性死亡受体-1阳性T淋巴细胞(PD-1+)比例及程序性死亡配体-1阳性T淋巴细胞(PD-L1^(+))比例。结果与假手术组相比,CLP+DMSO组小鼠肠系膜淋巴结T淋巴细胞EZH2表达升高。与CLP+DMSO组相比,CLP+GSK126组小鼠肠系膜淋巴结CD3+比例升高(0.70±0.02比0.50±0.07,P<0.01),表明抑制EZH2可增加脓毒症小鼠淋巴结T淋巴细胞数量;同时,CLP+GSK126组淋巴结CD4^(+)及CD8^(+)细胞中ki-67^(+)比例显著上升(CD4^(+):0.74±0.05比0.63±0.04,CD8^(+):0.82±0.06比0.70±0.04,均P<0.05),表明抑制EZH2可增加脓毒症小鼠淋巴结增殖活性较高的T淋巴细胞比例;另外,CLP+GSK126组小鼠肠系膜淋巴结T淋巴细胞凋亡率与CLP+DMSO组比较差异无统计学意义〔CD4^(+):(21.53±2.87)%比(20.48±3.21)%,CD8^(+):(8.34±1.02)%比(7.71±1.38)%,均P>0.05〕,表明抑制EZH2对脓毒症小鼠淋巴结T淋巴细胞凋亡无明显影响。与CLP+DMSO组相比,CLP+GSK126组小鼠肠系膜淋巴结IFN-γ^(+)CD4^(+)、IFN-γ^(+)CD8^(+)比例也显著增加(IFN-γ^(+)CD4^(+):0.31±0.11比0.14±0.06,IFN-γ^(+)CD8^(+):0.30±0.10比0.13±0.06,均P<0.05),表明抑制EZH2可增强脓毒症小鼠淋巴结T淋巴细胞IFN-γ分泌能力;同时,CLP+GSK126组小鼠肠系膜淋巴结PD-1+CD8^(+)比例较CLP+DMSO组显著下降(0.092±0.006比0.135±0.004,P<0.01),表明抑制EZH2可降低脓毒症小鼠淋巴结CD8^(+)细胞PD-1的表达量,但对PD-L1^(+)比例无明显影响。结论EZH2参与了脓毒症诱导的T淋巴细胞功能障碍的调控,该作用可能部分通过调节PD-1表达介导。

缺血性心肌病心力衰竭患者P-选择素及纤溶酶原激活抑制物的表达及与左心室功能的关系

目的 :探讨缺血性心肌病患者心力衰竭时血小板功能、血凝状态及与左室大小、功能状态的关系。方法 :应用放射免疫法测定 35例缺血性心肌病心力衰竭患者 (A组 )和 35例冠心病心绞痛患者 (B组 )的血小板膜表面P 选择素、纤溶酶原激活抑制物 (PAI 1)及纤维蛋白原 (Fbg) ,彩色多普勒超声心动图检测左室射血分数 (LVEF)及左室舒张期内径 (LVEDd)。结果 :A组血小板活化程度比B组更明显 ,血液高凝 ,A组左心室明显大于B组 (P <0 .0 0 1) ,心功能明显低于B组 (P <0 .0 0 1) ;A组P 选择素活性 ,PAI 1浓度及Fbg均大于B组 (P值分别为 <0 .0 0 1、<0 .0 5及 <0 .0 5 ) ;A组不同程度心力衰竭的P 选择素、PAI 1、LVEDd、LVEF存在明显差异。结论 :血小板的高度活化和血液高凝与缺血性心肌病心力衰竭的病程及预后有密切关系。