Diagnostic value of lead corrected Vt and V6 in patients with acute pulmonary thromboembolism

Objective: To investigate the diagnostic value of lead corrected Vt and V6 in patients with acute pulmonary thromboembolism. Methods: A total of 89 patients with suspected acute PTE were examined in our hospital from January to December 2017. A baseline 12-lead ECG was recorded on admission, with a gain of 10 mm/mV and a paper velocity of 25 mm/s. Results: Of the 89 suspected PTE patients enrolled in this study, 45 patients with acute PTE and 44 patients without PTE were identified by CTA. The chief complaint of most patients in both groups was dyspnea or dyspnea, with no significant difference between the two groups. The levels of d-dimer and high-sensitivity troponin in patients with PTE were significantly higher than those without PTE. QT and QTc in the V1 lead in the PTE group were significantly greater than those in the non-PTE group, but QT and QTc in the V6 lead were not significantly different between the two groups. The QTc difference (V1-V6) in the PTE group was significantly greater than that in the non-PTE group. In the morphological analysis, T wave inversion in lead III of PTE group, T wave inversion of V1 or V1 and V2 was significantly higher than that of non-PTE group. There was no significant difference in the incidence of S1Q3T3 between the two groups. For the prediction of acute PTE, the maximum accuracy of the maximum QTc difference (V1-V6)≥20 ms, the sensitivity was 83.2%, and the specificity and positive predictive value was 100%. T-wave inversion in V1 leads is the most sensitive morphological abnormality associated with PTE with a sensitivity of 80.06% and a specificity of 62.29%. T-wave inversion in lead III is a sub-sensitive predictor with a sensitivity of 51.20%. The specificity is 70.53%. Conclusions: The QTC difference (V1-V6) is a distinct feature of acute PTE, and QTC difference (V1-V6)≥20 ms as an important indicator of acute PTE in emergency settings.

Triple rule-out computed tomography angiography:Evaluation of acute chest pain in COVID-19 patients in the emergency department

BACKGROUND The aim of this study was to define clinical evidence supporting that triple ruleout computed tomography angiography(TRO CTA)is a comprehensive and feasible diagnostic tool in patients with novel coronavirus disease 2019(COVID-19)who were admitted to the emergency department(ED)for acute chest pain.Optimizing diagnostic imaging strategies in COVID-19 related thromboembolic events,will help for rapid and noninvasive diagnoses and results will be effective for patients and healthcare systems in all aspects.AIM To define clinical evidence supporting that TRO CTA is a comprehensive and feasible diagnostic tool in COVID-19 patients who were admitted to the ED for acute chest pain,and to assess outcomes of optimizing diagnostic imaging strategies,particularly TRO CTA use,in COVID-19 related thromboembolic events.METHODS TRO CTA images were evaluated for the presence of coronary artery disease,pulmonary thromboembolism(PTE),or acute aortic syndromes.Statistical analyses were used for evaluation of significant association between the variables.A two tailed P-value<0.05 was considered statistically significant.RESULTS Fifty-three patients were included into the study.In 31 patients(65.9%),there was not any pathology,while PTE was diagnosed in 11 patients.There was no significant relationship between the rates of pathology on CTA and history of hypertension.On the other hand,the diabetes mellitus rate was much higher in the acute coronary syndrome group,particularly in the PTE group(8/31=25.8%vs 6/16=37.5%,P=0.001).The rate of dyslipidemia was significantly higher in the group with pathology on CTA while compared to those without pathology apart from imaging findings of the pneumonia group(62.5%vs 38.7%,P<0.001).Smoking history rates were similar in the groups.Platelets,D-dimer,fibrinogen,C-reactive protein,and erythrocyte sedimentation rate values were higher in COVID-19 cases with additional pathologies.CONCLUSION TRO CTA is an effective imaging method in evaluation of all thoracic vascular systems at once and gives accurate results in COVID-19 patients.

Acute testicular ischaemia following aortoiliac stenting for aortoiliac occlusive disease

Endovascular treatment is increasingly employed as the treatment for symptomatic aortoiliac occlusive disease.One of the possible complications of aortoiliac stenting is the development of emboli.We present a case of a 60-year-old patient presenting with right scrotal pain immediately following aortoiliac stenting for right common iliac,proximal external iliac and proximal internal iliac arteries thrombosis.He was found to have testicular ischaemia with absent blood flow on duplex ultrasonography.The patient was managed expectantly and reduced blood flow spontaneously returned to the testis over the next few weeks.

Acute myelomonocytic leukemia and T-lymphoblastic lymphoma as simultaneous bilineage hematologic malignancy treated with decitabine:A case report

BACKGROUND Simultaneous bilineage hematologic malignancies are rare;however,several cases of acute myeloid leukemia(AML)and T-lymphoblastic lymphoma(T-LBL)cooccurrence have been reported.A standard treatment for simultaneous AML and T-LBL has not yet been established,and its prognosis is very poor.Further studies to develop standard treatments are required to increase patient survival rates.CASE SUMMARY A 69-year-old man complaining of pleuritic chest pain visited the emergency room.Computed tomography revealed multiple enlarged lymph nodes(LNs)in the neck and groin and pulmonary thromboembolism with pulmonary infarction.Furthermore,a peripheral blood smear performed due to leukocytosis revealed circulating blasts.Acute myelomonocytic leukemia(AMML)was diagnosed after bone marrow examination,and T-LBL positivity for terminal deoxynucleotidyl transferase,cluster of differentiation(CD)34,and CD4 was confirmed by cervical LN biopsy.Decitabine and dexamethasone were administered because he could not receive intensive chemotherapy due to poor performance status.Complete remission of AMML and T-LBL was achieved after 4 cycles of decitabine plus dexamethasone.CONCLUSION We report the therapeutic effect of decitabine,a hypomethylating agent(HMA),in patients with concurrent bilineage hematologic malignancies and suggest that further studies are required to evaluate the therapeutic effect of HMAs on both lymphoid and bilineage hematologic malignancies.

Effects of thrombolytic drugs and a selective endothelin-1 receptor antagonist on acute pulmonary thromboembolism in dogs

Background It has been shown that neurohumoral factors other than mechanical obstruction are involved in the pathophysiology of acute pulmonary thromboembolism （APTE）. The aim of this study was to investigate the effects of thrombolytic drugs, a selective endothelin-1 receptor （ET-1 R） antagonist alone or their combination on APTE in a canine model. Methods Twenty dogs were randomly assigned to five groups： sham, model, urokinase （UK）, BQ123, and combination （UK plus BQ123）. The dogs in the sham group underwent sham surgery. APTE was induced in the other four groups by intravenous injection of autologous blood clots. Dogs in the UK, BQ123 and combination groups received UK, BQ123 （a selective ET-1R antagonist）, or UK plus BQ123, respectively. The dogs in the model group were given saline. Mean pulmonary artery pressure （mPAP）, serum concentrations of ET-1, thromboxane （TXB2）, and tumor necrosis factor （TNF）-α were determined at different time points following the induction of APTE. Results UK and BQ123 alone markedly decreased mPAP in APTE. By comparison, the reduction was more significant in the combination group. Compared with the sham group （（-0.90±0.61） mmHg）, mPAP increased by （7.44±1.04）, （3.42±1.12） and （1.14±0.55） mmHg in the model group, UK alone and BQ123 alone groups, respectively, and decreased by （2.24±0.67） mmHg in the combination group （P 〈0.01）. Serum ET-1 concentrations in the BQ123 and combination groups were （52.95±8.53） and （74.42±10.27） pg/ml, respectively, and were significantly lower than those in the model and UK groups （（84.56±7.44） and （97.66±8.31） pg/ml respectively; P 〈0.01）. Serum TNF-α concentrations were significantly lower in the BQ123 group than in the model, UK and combination groups （P 〈0.05）. Conclusions Our results indicate that the selective ET-1R antagonist BQ123 not only reduces the increase of mPAP and serum ET-1 level, but also inhibits the production of TNF-α, and attenuates the local inflammatory response induced by APTE. Selective ET-1R antagonists may be beneficial to the treatment of APTE, particularly when used in combination with a thrombolytic agent.

Venous thromboembolism in children with acute lymphoblastic leukemia in China:a report from the Chinese Children’s Cancer Group-ALL-2015

Venous thromboembolism(VTE)is a complication in children with acute lymphoblastic leukemia(ALL).The Chinese Children’s Cancer Group-ALL-2015 protocol was carried out in China,and epidemiology,clinical characteristics,and risk factors associated with VTE were analyzed.We collected data on VTE in a multiinstitutional clinical study of 7640 patients with ALL diagnosed in 20 hospitals from January 2015 to December 2019.First,VTE occurred in 159(2.08%)patients,including 90(56.6%)during induction therapy and 108(67.92%)in the upper extremities.T-ALL had a 1.74-fold increased risk of VTE(95%CI 1.08–2.8,P=0.022).Septicemia,as an adverse event of ALL treatment,can significantly promote the occurrence of VTE(P<0.001).Catheter-related thrombosis(CRT)accounted for 75.47%(n=120);and,symptomatic VTE,58.49%(n=93),which was more common in patients aged 12–18 years(P=0.023),non-CRT patients(P<0.001),or patients with cerebral thrombosis(P<0.001).Of the patients with VTE treated with anticoagulation therapy(n=147),4.08%(n=6)had bleeding.The VTE recurrence rate was 5.03%(n=8).Patients with VTE treated by non-ultrasoundguided venous cannulation(P=0.02),with residual thrombus(P=0.006),or with short anticoagulation period(P=0.026)had high recurrence rates.Thus,preventing repeated venous puncture and appropriately prolonged anticoagulation time can reduce the risk of VTE recurrence.

Acute venous thromboembolism in acute pancreatitis based on the severity:a retrospective cohort study

Objective: Acute pancreatitis (AP) results in systemic inflammatory responses and activates coagulation pathways. We intend to investigate the risk and hospital outcomes of acute venous thromboembolisms (VTE) in patients with AP.Methods: We retrospectively analyzed patients with AP from 2016 to 2019 using the National Inpatient Sample database. Primary outcome was the effect of VTE on the length of stay, inpatient costs, and mortality. Hierarchical multivariate logistic regression models were built using univariate screens.Results: The study included 909,354 weighted discharges with AP. 2.1% of cases had an acute VTE. The length of stay was 5.9 days longer in the hospital of AP patients with VTE compared to AP with no VTE (P <.001). Total hospital charge per patient was $71,914 in patients with VTE compared to AP with no VTE (P < .001). Mortality was higher in AP patients with VTE compared to AP with no VTE (adjusted odds ratio [AOR] 4.2, 95% confidence interval [CI]: 3.4-5.3,P <.001). AP was associated with an increased VTE risk during inpatient stay (AOR 1.06, 95% CI 1.04-1.1,P <.001) There was an increased association of lower and upper extremity deep venous thrombosis with AP without necrosis (AOR 6.9, 95% CI 6.4-7.4,P <.001) and AP with infected necrosis (AOR 12.2, 95% CI 10.6-14.1,P <.001) but not in AP without necrosis (AOR 0.77, 95% CI 0.74-0.81,P <.001).Conclusion: VTE in AP increases length of stay and inpatient costs. The prognosis is poor in such patients, with increased inpatient mortality compared to no VTE. AP with necrosis can increase chances of all VTE subtypes;however, AP without necrosis does not increase upper and lower extremity VTE risk.

对比肺通气/灌注显像和CT肺动脉造影对急性肺栓塞患者发生慢性血栓栓塞性肺动脉高压的预测价值

目的:比较肺通气/灌注(ventilation/perfusion,V/Q)显像和CT肺动脉造影(pulmonary angiography,PA)预测急性肺栓塞(acute pulmonary embolism,APE)后慢性血栓栓塞性肺动脉高压(chronic thromboembolic pulmonary hypertension,CTEPH)发生的价值。方法:回顾性收集了2012年1月至2020年8月,确诊为APE患者的资料,所有患者经至少3个月规范化抗凝后复查肺V/Q显像和CTPA。分别评估并计算肺V/Q显像和CTPA图像中的残余肺栓塞,并分别记录为肺灌注缺损百分比(percentage of pulmonary defect scores,PPDs%)和CT肺动脉阻塞指数(pulmonary artery obstruction index,PAOI)。评价PPDs%和CTPAOI预测CTEPH发生的一致性。绘制受试者工作特征(ROC)曲线,评估PPDs%和CTPAOI对APE后CTEPH发生的预测效能。结果:共纳入224例APE患者,1年内随访,共有26例进展为CTEPH。Bland-Altman图示两检查评估APE治疗后残余肺栓塞的一致性较好。ROC分析示PPDs%的AUC>CTPAOI(0.958 vs.0.868,P=0.03);预测CTEPH发生的阈值分别为20.5%和15.0%,相应的敏感性和特异性分别为92.3%、88.9%和76.9%、89.4%,差异均无统计学意义(敏感性:P=0.13;特异性:P>0.999)。结论:肺V/Q显像预测APE后CTEPH发生率比CT PA更敏感,但特异性略低。

康北高原慢性阻塞性肺疾病急性加重患者发生静脉血栓栓塞症风险预测模型的构建及预测效能

目的筛选康北高原慢性阻塞性肺疾病急性加重患者发生静脉血栓栓塞症风险的预测因素,建立AECOPD发生VTE风险的联合预测模型并分析其预测效能。方法选择2018年1月-2022年9月因慢性阻塞性肺疾病急性加重在甘孜县人民医院住院治疗的患者71例,根据是否发生VTE分为血栓组35例,对照组36例。收集患者的基本资料和检查、检验资料等相关参数数据,选出两组之间具有显著差异的指标。将上述单因素分析中有显著差异的指标纳入多因素分析,筛选出AECOPD发生VTE风险的独立影响因素,并构建预测模型。利用受试者工作特征(receiver operating characteristic,ROC)曲线评价各独立因素及预测模型的应用价值,计算曲线下面积及其敏感度与特异度,分析其预测效能,霍斯默-莱梅肖检验评价拟合度。结果单因素分析显示血栓组PPS评分、乳酸脱氢酶(LDH)、D-二聚体、降钙素原(PCT)均高于对照组(均P<0.05)。Logistic回归分析显示PPS评分、乳酸脱氢酶(LDH)、D-二聚体为AECOPD发生VTE的独立预测因素。三者联合构建的预测模型曲线下面积(area under curve,AUC)为0.944(95%CI:0.893~0.996),灵敏度、特异度均明显优于各单一指标(灵敏度为94.3%、特异度为83.3%),霍斯默-莱梅肖检验拟合度好(χ^(2)=11.915,P=0.155)。结论PPS评分、乳酸脱氢酶(LDH)、D-二聚体可能是预测康北高原AECOPD发生VTE的因素,且三者联合构建的预测模型对VTE风险预测具有很好效能,可为预测AECOPD发生VTE的风险提供参考。

血清DUSP1表达对急性肺血栓栓塞患者的预后价值研究

目的 探究血清双特异性磷酸酶1(DUSP1)表达水平对急性肺血栓栓塞(APTE)患者的预后价值。方法 选取该院2020年3月至2022年7月收治的112例APTE患者作为观察组,并选取同期在该院行体检的健康者50例作为对照组。治疗后随访6个月,根据预后状况将APTE患者分为预后良好组(90例)和预后不良组(22例)。比较入院前各组间的血清DUSP1相对表达水平及肺栓塞严重程度指数(PESI)评分;采用Spearman相关性分析血清DUSP1相对表达水平与PESI评分之间的关系;采用受试者工作特征(ROC)曲线分析血清DUSP1相对表达水平及PESI评分对APTE患者预后的预测价值。结果 与对照组比较,观察组血清DUSP1相对表达水平升高(P<0.05);不同危险度患者血清DUSP1相对表达水平及PESI评分比较差异有统计学意义(P<0.05),高危APTE患者血清DUSP1相对表达水平及PESI评分均高于中危患者(P<0.05),中危患者均高于低危患者(P<0.05);Spearman相关性分析显示,血清DUSP1相对表达水平与PESI评分呈正相关(r=0.561,P<0.05);ROC曲线结果显示,DUSP1、PESI评分单独预测APTE患者预后不良的曲线下面积(AUC)分别为0.789、0.867,灵敏度分别为65.8%、86.8%,特异度分别为44.2%、67.2%,二者联合预测APTE患者预后不良的AUC为0.952,其灵敏度、特异度分别为92.1%、75.6%。结论 APTE患者血清DUSP1相对表达水平升高,且随着病情的加重,血清DUSP1相对表达水平逐渐增加,DUSP1是预测APTE患者预后不良的有效指标。

慢性阻塞性肺疾病急性加重期合并肺栓塞的危险因素及诊断价值

目的 分析急性加重慢性阻塞性肺疾病(AECOPD)人群合并肺血栓栓塞症(PE)的临床特征和危险因素,并探讨合并PE相关因素的临床诊断价值。方法 回顾性选取2020年1月至2022年5月的265例AECOPD住院患者,根据肺动脉造影结果将患者分为合并PE组(n=65)和无PE组(n=200),比较两组患者的临床特征,分析合并PE的相关因素,并探讨其临床诊断价值。结果 和无PE组比较,合并PE组心功能不全(23例,35.38%)、使用利尿剂(34例,52.31%)和接受机械通气(23例,35.38%)的比例更高;降钙素原[0.068(0.038,0.133)ng/mL]、D-二聚体水平[1660(1006,3584)ug/L]和PaCO_(2)水平[42.70(38.20,53.33)mmHg]更高,血红蛋白含量[129(107,143)g/L]和PaO_(2)水平[76.90(61.00,91.75)mmHg]更低(P<0.05)。经多变量Logistic回归分析,使用利尿剂、机械通气、Padua评分、D-二聚体和PaCO_(2)水平均为发生PE的危险因素(P均<0.05);PaO_(2)水平为PE发生的保护因素(P<0.05)。Padua评分(OR=2.626,P=0.001,95%CI:1.478~4.667)、D-二聚体(OR=2.028,P=0.010,95%CI:1.183~3.477)和PaO_(2)(OR=0.899,P<0.001,95%CI:0.850~0.950)水平对诊断PE具有良好的诊断价值,三者联合指标的临床诊断价值更高(AUC=0.977,95%CI:0.959~0.994)。结论 使用利尿剂、机械通气、Padua评分、D-二聚体、PaO_(2)和PaCO_(2)水平是PE发生的重要相关因素,Padua评分联合D-二聚体和PaO_(2)对诊断PE具有很高的临床价值,早期识别、积极干预可降低病死率。

60岁以上急性肺血栓栓塞症近期死亡危险因素及预测模型构建

目的探讨60岁以上急性肺血栓栓塞症近期死亡危险因素并构建预测模型,旨在为近期预后不良高危人群早期识别及综合治疗方案制定提供参考。方法回顾性纳入2018年1月-2023年1月于我院诊治60岁以上急性肺血栓栓塞症患者284例,根据发病后30d是否死亡分为死亡组(31例)和存活组(253例),比较两组临床特征资料,采用单因素和多因素法评估60岁以上急性肺血栓栓塞症近期死亡独立危险因素;构建该类患者近期死亡风险的预测模型并进行效能分析。结果死亡组合并感染比例、肺栓塞严重程度指数评分均显著高于存活组(P<0.05);同时死亡组血清钙水平均显著低于存活组(P<0.05)。多因素分析显示,合并感染比例、低血钙水平及肺栓塞严重程度指数评分是发病30d内死亡独立危险因素(P<0.05)。利用感染、血钙水平、肺栓塞严重程度指数评分、Logistic回归模型P值对于发病30d内死亡进行预测,约登指数为43.57%、53.83%、44.82%和71.75%。结论60岁以上急性肺血栓栓塞症近期死亡与是否合并感染、血钙水平及肺栓塞严重程度指数评分等多种因素有关;基于上述指标构建预测模型可早期准确识别预后不良高危人群。

Clinical Study of Acute Vasoreactivity Testing in Patients with Chronic Thromboembolic Pulmonary Hypertension

Background： The clinical significance of acute vasoreactivity testing （AVT） in patients with chronic thromboembolic pulmonary hypertension （CTEPH） remains unclear. We analyzed changes in hemodynamics and oxygenation dynamics indices after AVT in patients with CTEPH using patients with pulmonary arterial hypertension （PAH） as controls. Methods： We analyzed retrospectively the results of AVT in 80 patients with PAH and 175 patients with CTEPH registered in the research database of Beijing Chao-Yang Hospital between October 2005 and August 2014. Demographic variables, cardiopulmonary indicators, and laboratory findings were compared in these two subgroups. A long-term follow-up was conducted in patients with CTEPH. Between-group comparisons were performed using the independent-sample t-test or the rank sum test, within-group comparisons were conducted using the paired t-test or the Wilcoxon signed-rank test, and count data were analyzed using the Chi-squared test. Survival was estimated using the Kaplan-Meier method and log-rank test. Results： The rates of positive response to AVT were similar in the CTEPH （25/175, 14.3%） and PAH （9/80, 11.3%） groups （P 〉 0.05）. Factors significantly associated a positive response to AVT in the CTEPH group were level of N-terminal pro-brain natriuretic peptide （〈1131.000 ng/L）, mean pulmonary arterial pressure （mPAE ≤44.500 mmHg）, pulmonary vascular resistance （PVR, 〈846.500 dyn＇s-1·m-5）, cardiac output （CO,≥3.475 L/rain）, and mixed venous oxygen partial pressure （PvO2, ≥35.150 mmHg）. Inhalation of iloprost resulted in similar changes in mean blood pressure, mPAE PVR, systemic vascular resistance, CO, arterial oxygen saturation （SaO2）, mixed venous oxygen saturation, partial pressure of oxygen in arterial blood （PaO2）, PvO2, and intrapulmonary shunt （Qs/Qt） in the PAH and CTEPH groups （all P 〉 0.05）. The survival time in patients with CTEPH with a negative response to AVT was somewhat shorter than that in AVT-responders although the difference was not statistically significant （X2= 3,613, P = 0.057）. The survival time of patients with CTEPH who received calcium channel blockers （CCBs） was longer than that in the group with only basic treatment and not shorter than that of patients who receiving targeted drugs or underwent pulmonary endarterectomy （PEA） although there was no significant difference between the four different treatment regimens （X2 = 3.069, P = 0.381 ）. Conclusions： The rates of positive response to AVT were similar in the CTEPH and PAH groups, and iloprost inhalation induced similar changes in hemodynamics and oxygenation dynamics indices. A positive response to AVT in the CTEPH group was significantly correlated with milder disease and better survival. Patients with CTEPH who cannot undergo PEA or receive targeted therapy but have a positive response to AVT might benefit from CCB treatment.

血清D-二聚体及心肌酶谱对急性肺血栓栓塞的诊断价值分析

目的 分析血清D-二聚体及心肌酶谱在急性肺血栓栓塞诊断中的价值。方法 简单随机选取2018年2月—2023年11月苏州大学附属第二医院收治的50例急性肺血栓栓塞患者纳入观察组,选择同期的50例健康体检者纳入对照组。对比两组的天门冬氨酸氨基转移酶(Aspartate Transaminase, AST)、乳酸脱氢酶(Lactate Dehydrogenase, LDH)、肌酸激酶(Creatine Kinase, CK)、肌酸激酶同工酶(Creatine Kinase IsoenzymeMB, CK-MB)水平及血清中D-二聚体的水平和诊断效果。结果 观察组的AST、LDH、CK、CK-MB水平及血清中D-二聚体的水平高于对照组,差异有统计学意义(P均<0.05)。AST、LDH、CK、CK-MB联合D-二聚体诊断急性肺血栓栓塞的特异度为90.00%、灵敏度为90.00%、准确度为90.00%,kappa值为0.8。结论 心肌酶谱联合血清中D-二聚体对于急性肺血栓栓塞的诊断价值较高,可在临床诊断工作中加以应用。

原发性肝癌肝切除术后预防性抗凝对术后并发症的影响

目的探究原发性肝癌(PLC)患者术后预防性抗凝治疗能否降低术后并发症的发生风险,并探讨术后并发症的影响因素。方法收集2019年2月至2021年5月在海军军医大学(第二军医大学)第三附属医院接受PLC肝切除手术治疗的495例患者的临床资料,根据术后是否进行预防性抗凝将患者分为抗凝组(287例,术后接受预防性低分子肝素抗凝治疗)和常规治疗组(208例)。对比两组患者术后并发症发生情况,并采用logistic回归模型分析并发症发生的影响因素。结果495例患者肝切除术后总体并发症发生率为30.7%(152/495),按照发生率由高到低依次为感染(9.1%,45/495)、急性呼吸窘迫综合征(ARDS;6.5%,32/495)、出血(6.3%,31/495)、肝切除术后肝功能衰竭(PHLF;6.1%,30/495)、静脉血栓栓塞症(VTE;2.8%,14/495)。抗凝组术后VTE、ARDS、PHLF发生率均低于常规治疗组[1.4%(4/287)vs 4.8%(10/208)、3.8%(11/287)vs 10.1%(21/208)、3.8%(11/287)vs 9.1%(19/208),均P<0.05],但两组间术后出血的发生率差异无统计学意义(P>0.05)。多因素logistic回归分析显示,年龄、门静脉高压、肿瘤数量是VTE的独立危险因素,门静脉高压、术中出血、术中输血、术前降钙素原是PHLF的独立危险因素,腹水、术前胆红素是ARDS的独立危险因素,而术后预防性抗凝是VTE、ARDS的独立保护因素(均P<0.05)。结论PLC患者肝切除术后预防性抗凝可以降低VTE、PHLF、ARDS的发生风险,且不会增加术后出血风险。年龄、门静脉高压、肿瘤数量、术中出血、术中输血、腹水、术前降钙素原、术前胆红素是PLC患者肝切除术后并发症发生的危险因素。

溃疡性结肠炎合并多发动脉血栓栓塞1例报道

多发动脉血栓栓塞是溃疡性结肠炎患者较为罕见的肠外表现。本文报道1例36岁年轻女性,因“间断腹痛,伴黏液脓血便9个月,加重20 d”就诊。该患者住院期间突发左侧肢体无力,问答不切题,完善头颅CT检查提示急性脑血管病、考虑脑梗死,联系神经内科行“经导管颅内血管血栓去除术”,术中股动脉造影见左侧股动脉血栓影,股动脉以远闭塞。联系血管外科行“股动脉取栓术”,术后予以抗凝、调节血脂治疗,症状好转已出院。电话随访,患者腹痛、腹泻症状明显缓解,自主活动不受限。本文对该例患者的临床特点,检验、检查,诊疗方案,预后转归情况等方面进行报道。为及早诊治该病提供参考,以降低患者的致残率和病死率,提高患者生活质量。

急性颈动脉血栓性闭塞形成后巨噬细胞浸润行为的动态演变研究

目的探索急性颈动脉血栓性闭塞(ACTO)形成后,血栓动态演变过程中巨噬细胞的浸润行为变化。方法选用健康雄性新西兰大白兔15只,通过使用氯化铁处理后的外科缝合线对兔颈动脉造成损伤来建立ACTO模型。采用随机数字表法将所有兔按照实验终点时间分为5组;术后24 h组及术后1、4、8、12周组,每组3只。术后24 h,使用DSA检查ACTO模型建立情况。到达实验时间终点时对该组3只兔进行血栓栓塞段动脉取材并用石蜡包埋。采用苏木素-伊红(HE)染色和马休黄猩红蓝(MSB)对血栓样本进行染色,分析血栓形态和血栓组成(包括红细胞、纤维蛋白和胶原纤维)的变化,使用Orbit Imaging Analysis软件对血栓组成成分进行半定量分析。使用免疫组织化学对血栓中M0和M2型巨噬细胞的分布进行检测,依据检测结果总结ACTO发生后不同时期血栓的形态、组成及血栓中巨噬细胞浸润行为的动态演变规律。结果术后24 h DSA结果显示,所有的实验兔均成功建立了ACTO模型。(1)HE染色结果显示,在术后24 h至1周的时间段内,血栓呈持续增大趋势;术后4周时,血栓开始出现溶解现象;术后8周时,血栓内部观察到了新生血管的形成;而术后12周时,血栓开始呈现出纤维化的迹象。(2)MSB染色结果显示,在血栓形成的急性期(术后24 h内),红细胞为主要成分;在此之后,以纤维蛋白和胶原纤维为主要成分。(3)M0型巨噬细胞(细胞表面标志物为CD206)检测结果显示,术后24 h,血栓中M0型巨噬细胞并未均匀分布于整个血栓中,而主要聚集于血栓边缘;术后1周时,血栓内M0型巨噬细胞阳性面积百分比相较于术后24 h增加[血栓边缘:(41.7±27.0)%比(24.6±16.7)%,血栓核心:(35.7±19.6)%比(11.1±10.4)%,均P<0.001],且均匀分布于血栓内;术后4周时,血栓内M0型巨噬细胞的阳性面积百分比相较于术后1周减少[血栓边缘:(10.7±6.1)%比(41.7±27.0)%,血栓核心:(12.1±8.5)%比(35.7±19.6)%,均P<0.001],差异均有统计学意义。术后4、8、12周,血栓内M0型巨噬细胞阳性面积百分比随时间延长无明显变化[血栓边缘的阳性面积百分比分别为(10.7±6.1)%、(8.0±7.7)%、(8.9±5.3)%;血栓核心的阳性面积百分比分别为(12.1±8.5)%、(9.5±4.2)%、(15.7±11.0)%],差异均无统计学意义(均P>0.05)。此外,术后12周血栓边缘M0型巨噬细胞的阳性面积百分比少于血栓核心处[(8.9±5.3)%比(15.7±11.0)%,P<0.01)]。M2型巨噬细胞(细胞表面标志物为CD206)检测结果显示,术后24 h,血栓中M2型巨噬细胞广泛分布于整个血栓内;术后1周时,血栓内M2型巨噬细胞的阳性面积百分比相较于术后24 h增加[血栓边缘:(22.1±11.3)%比(11.4±8.7)%,P<0.001;血栓核心:(24.5±9.8)%比(7.6±6.0)%,P<0.001];术后4周,血栓内M2型巨噬细胞阳性面积百分比相较于术后1周减少[血栓边缘:(10.6±3.7)%比(22.1±11.3)%,P<0.001;血栓核心:(9.2±4.3)%比(24.5±9.8)%,P<0.001];术后8周血栓核心处M2型巨噬细胞的阳性面积百分比相较于术后4周时又增加[(17.9±8.8)%比(9.2±4.3)%,P<0.001],差异均有统计学意义。而术后8周至12周血栓内M2巨噬细胞的阳性面积百分比无明显变化[血栓边缘:(9.4±6.3)%比(8.5±5.3)%,P>0.05;血栓核心:(17.9±8.8)%比(14.4±10.0)%,P>0.05]。此外,术后8、12周时血栓核心M2型巨噬细胞阳性面积百分比均多于血栓边缘处[术后8周:(17.9±8.8)%比(9.4±6.3)%,P<0.001;术后12周:(14.4±10.0)%比(8.5±5.3)%,P<0.001]。结论本研究成功构建了ACTO动物模型,首次展示了血栓形成后12周内巨噬细胞的动态演变规律。巨噬细胞在血栓形成和血栓纤维化过程中发挥着重要作用,并可能促进了血栓溶解和血栓内新生血管形成,进而促进闭塞血管自发再灌注的发生。本研究结果有待进一步验证。

急性肺血栓栓塞症介入治疗现状

急性肺血栓栓塞症(pulmonary thromboembolism, PTE)的危险分层是治疗的导向,针对不同的危险分层采取相应的治疗方案。抗凝治疗是急性PTE治疗的基石,但单纯抗凝治疗与中、高危人群中早期血流动力学失代偿和死亡的风险增加相关;系统溶栓能够快速减轻血栓负荷,缓解右心室功能障碍,可以更早地改善血流动力学,但存在出血的高风险。目前,导管介入治疗正在迅速发展,并发展出了不少与之匹配的装置,旨在更好地完善急性PTE治疗方案,以满足肺栓塞治疗的临床需求。该文虽未对其临床相关应用优势展开对照研究,但是却基于危险分层的治疗思路,对机械性血栓清除装置、吸入性血栓清除装置、裂解性血栓清除装置等不同类型进行了综述,并论述其在各自应用范围内的优势及发展趋势,旨在为当前学术研究进行系统性总结。

血清同型半胱氨酸检测联合Wells评分对慢性阻塞性肺疾病急性加重期患者发生静脉血栓栓塞症的预测价值研究

目的探究血清同型半胱氨酸(Hcy)检测联合Wells评分对慢性阻塞性肺疾病急性加重期患者发生静脉血栓栓塞症(VTE)的预测价值。方法选取2021年4月-2023年4月我院收治的94例慢性阻塞性肺疾病急性加重期患者,根据是否发生VTE分为VTE组20例和非VTE组74例。采用酶联免疫吸附测定(ELISA)法检测血清中Hcy水平。对全部患者进行Wells评分。Spearman相关性分析Hcy表达水平与Wells评分的关系;ROC曲线分析血清Hcy检测联合Wells评分对慢性阻塞性肺疾病急性加重期患者发生VTE的预测价值;Logistic回归分析影响慢性阻塞性肺疾病急性加重期患者VTE发生的因素。结果与非VTE组相比,VTE组患者C-反应蛋白(CRP)、D-二聚体(D-D)、Hcy水平以及Wells评分水平显著升高,动脉血氧分压(PaO_(2))水平显著降低(P<0.05)。Pearson相关性分析显示,慢性阻塞性肺疾病急性加重期患者Hcy表达水平与Wells评分呈正相关关系(r=0.491,P<0.05)。二者联合预测慢性阻塞性肺疾病急性加重期患者发生VTE的AUC高于血清Hcy表达水平与Wells评分单独预测的AUC值(Z=5.303,P<0.001;Z=9.151,P<0.001)。Logistic回归分析结果显示Hcy、Wells评分为VTE发生的影响因素(P<0.05)。结论慢性阻塞性肺疾病急性加重期发生VTE患者血清Hcy水平和Wells评分显著上升,二者联合检测对慢性阻塞性肺疾病急性加重期发生VTE的预测价值优于单一指标检测。

基于logistic回归分析急性脑出血患者发生静脉血栓栓塞的影响因素及护理措施探讨

目的:基于logistic回归分析急性脑出血患者发生静脉血栓栓塞的影响因素及护理措施探讨。方法:选取2019年10月—2022年10月驻马店市中心医院收治的174例急性脑出血患者作为研究对象。比较发生静脉血栓栓塞的患者与未发生静脉血栓栓塞患者的基线资料及指标等。经logistic回归分析急性脑出血患者发生静脉血栓栓塞的影响因素。结果:174例急性脑出血患者中,有30例患者发生静脉血栓栓塞,占比17.24%,其中25例发生在患侧肢体,5例发生在双下肢;静脉血栓栓塞组中年龄≥60岁、有高血压病史、有糖尿病史、左侧瘫痪、深静脉置管、卧床时间≥72 h、未进行下肢主动活动的患者占比均高于非静脉血栓栓塞组,静脉血栓栓塞组患者D-二聚体(D-D)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、凝血酶时间(TT)均高于非静脉血栓栓塞组,差异有统计学意义(χ^(2)=11.053、44.862、43.449、7.624、49.309、12.141、22.290,t=26.865、13.842、4.108、5.854、7.316;P<0.05);logistic回归分析结果显示,糖尿病史、高血压病史、深静脉置管、卧床时间≥72 h、D-D水平高均为急性脑出血患者发生静脉血栓栓塞的危险因素(OR=4.568、4.572、1.772、1.791、1.685,P<0.05)。结论:糖尿病史、高血压病史、深静脉置管、卧床时间≥72 h、D-D水平高均为急性脑出血患者发生静脉血栓栓塞的危险因素,临床应针对上述因素制定相应的护理措施,以降低下肢深静脉血栓栓塞的发生率。