When Glanzmann thrombasthenia encounters antithrombin defi ciency: how do we balance the risk and benefi t of antithrombotic therapy?

Glanzmann’s thrombasthenia(GT)is an inherited autosomal recessive bleeding disorder,resulting from mutations in the ITGA2B and ITGB3 genes,that lead to a defect in the platelet membrane integrinαIIbβ3.[1]As integrinαIIbβ3 plays an important role in thrombus formation,the clinical manifestation of GT includes bleeding(mostly mucocutaneous)and purpura.For this reason,patients with GT are typically thought to be unlikely to suffer from thromboembolic incidents.Antithrombin is an anticoagulant that inhibits thrombin and is activated factor X and other serine proteases in the coagulation cascade.[2]Antithrombin deficiency is an autosomal dominant hereditary disease with an approximate prevalence of 1/500 in the overall population.[3]In contrast to the hemorrhagic tendency of GT,patients with antithrombin deficiency are at increased risk of thromboembolism,especially in the venous system.Herein,we describe a rare case of GT and antithrombin deficiency coexisting in a single patient.Rivaroxaban was used for the treatment of pulmonary embolism(PE)and deep vein thrombosis(DVT).

PULSBD DYE LASER THROMBOLYSIS IN VITRO AND ITS EFFECTS ON VASCULAR FUNCTION AND STRUCTURE IN VIVO

The purpose of the study is to evatuate the feasibility of pulsed dye laser(PDL)throm bolysis In vitro and the effect of PDL on vascular function and structure invivo.In vitro,fifty hum an throm biwere divided into laser treated group(n=35),irritation group(n=11),and controgroup(n=4).In the laser treated group thethrom biwere irradiated by PDL with 300 pulses at 100m J/pulse.No irradiation wasgiven to the throm bi in the irritation group,while the catheter was put to and frointo the throm bi for there times,Neither irradintion nor irritation was given to thethrom bi in the controlgroup.Sixteen healthy dogs were studied in vivo.Under theguidance of the guide-w ire PDL catheter was put into the left coronary arteries(n=16)from which PDL was em itted for 1380±60 pulses at 100m J/pulse,whereasthe rightcoronary srteries(n=16)which did not receieve PDL em ission were servedas irritation group.Then the PDL were irradiated directly to the right coronaryarterial wall in the irritation group without the guidance of the guide-wire.AfterPDL irradiation.the weight of the throm bi was reduced from 1.79±0.23g to0.61±0.12g while in the irritation group theweight of the throm biwas only reducedfrom 1.65±0.19 to 1.42±0.15g.In these two aroups the reduction of throm biweightwere 68%±6% and 15%±7% resoectively(P【0.001).No self-dissolution of thethrom bi occurred in the control group.The finding under the contrast phasem icroscope indicated 91% of the debris size were smaller than the size of redcells.In vivo study,coronary angiography showed that no changes in luminalduam eter of both groups.Nomechanicalor thermal in jury to the coronary arterieswas found excepta light irregularity of the intima.PDL Throm bolysis was effectivein vitro.There was no mechanicaldam age or therm al in jury to the vessels during theprocedure of intracoronary PDL irradiation in vivo.

Perinatal arterial ischemic stroke and multiple thrombo-emboli in a term newborn

The etiology of perinatal arterial ischemic strokes may be maternal, fetal or both. Venous thrombo-embolism is almost always catheter associated in new-borns. Preliminary guidelines for management of perinatal arterial ischemic strokes exist but are mostly based on adult studies. We report a unique case of perinatal arterial ischemic stroke, lower extremity arterial and inferior vena-caval thrombosis. Our patient was treated with unfractionated heparin for 10 days then switched to low molecular heparin to complete 6 months of therapy. The patient responded well to therapy and shows minimal signs of permanent neurologic deficits after 6 months.

Theromboeyte and thrombocyte function

950384 Observation of the effectiveness of heparintherapy in patients with chronic idiopathic thrombocy-topenic purpura.SHEN Zhixiang(沈志祥),et al.RuijinHosp,Shanghai 2nd Med Univ,Shanghai,200025.ChinJ Hematol 1995:16(4)196-197.Fourteen cases (5 males and 9 females,mean age 47years) of chronic idiopathic thrombocytopenic purpura(CITP) were treated with0 low dose of heparin.The ill-ness courses of patients were 6 months to 20 years(mean 6.3years).and all of them were resistant to theconventional corticoth,rapy and other immunosuop-pressive drugs.Heparin was given subcutaneously in

Thrombocyte and thrombocyte function

930164 Molecular pathology study on intherit-ed Glanzmann’s thrombasthenia:A report of 11cases.RUAN Changgeng(阮长耿),et al.InstitHematol,Thrombosis & Hemostasis Res Unit,Suzhou Med Coll,215007.Chin J Intern Med1992;31(10):639-641.Glycoprotein Ⅱb-Ⅲa(GPⅡb-Ⅲa)concen-tration was studied in 11 patients withGlanzmann’s thrombasthenia(GT)with sensi-tive Western blotting technique.7 patients withsevere GPⅡb-Ⅲa deficiency(less than 10% ofthe normals)were designated as type Ⅰ(64%

Thrombus migration in patients with acute ischaemic stroke undergoing endovascular thrombectomy

Objective The impact of thrombus migration(TM)prior to endovascular thrombectomy(EVT)on clinical outcomes and revascularisation rates remains unknown.We aimed to examine whether preinterventional TM modifies the treatment effects of direct EVT versus bridging EVT in acute large vessel occlusion patients.Methods All patients undergoing catheter angiography in the Direct Intra-arterial thrombectomy in order to Revascularise acute ischaemic stroke patients with large vessel occlusion Efficiently in Chinese Tertiary hospitals:A Multicentre randomised clinical Trial were included.TM was determined by radiologists unaware of the study by analysing discrepancies between computed tomographic angiography at baseline and first-run digital subtraction angiography before EVT.The primary outcome was the score on the modified Rankin scale(mRS)assessed at 90 days.Results Of 627 included patients,the TM rate was 11.3%(71/627).In the multivariable logistic regression model,baseline National Institutes of Health Stroke Scale score(adjusted OR 0.956,95%CI 0.916 to 0.999;p=0.043)and intravenous thrombolysis(adjusted OR 2.614,95%CI 1.514 to 4.514;p<0.001)were independently associated with TM.The patients with TM were less likely to be completely recanalised than those without TM(21.27%vs 36.23%,p=0.040).The interaction of TM and the EVT treatment effect did not significantly affect mRS shift analysis(p=0.687)or mRS scores of 0 to 1(p=0.436).Conclusion Preinterventional TM does not modify the treatment effects of direct versus bridging EVT on functional outcomes in patients with acute ischaemic stroke with anterior large vessel occlusion.TM leads to a lower complete recanalisation rate.

Randomised study of bailout intracranial angioplasty following thrombectomy for acute large vessel occlusion(ANGEL-REBOOT):protocol of a multicentre randomised controlled trial

Rationale Unsuccessful thrombectomy of acute large vessel occlusions(LVOs)has been associated with unfavourable outcomes.Multiple randomised controlled trials(RCTs)have reported a failure rate of 12%–41%for thrombectomy procedures.Various factors contribute to failed thrombectomy,including technical difficulties in accessing the occlusion,unsuccessful thrombus retrieval,thrombotic reocclusion and pre-existing intracranial atherosclerotic stenosis.Although some studies have explored balloon dilation or permanent stenting as rescue intracranial angioplasty for failed thrombectomy in individual cases,there is currently no evidence from RCTs on this specific topic.Aim To evaluate the potential superiority of bailout angioplasty over standard treatment in cases of unsuccessful recanalisation(eTICI 0 to 2a)or residual severe stenosis(>70%)after thrombectomy in acute LVO patients within 24 hours of stroke onset.Design This study is a multicentre,prospective,randomised,controlled clinical trial designed by investigators.It compares bailout angioplasty with standard therapy and follows an open-label treatment approach while maintaining a blinded outcome assessment(PROBE design).Our objective is to allocate 348 patients in a 1:1 ratio to either receive bailout angioplasty as an intervention or standard therapy as a control,following unsuccessful thrombectomy.Outcome The main measure of interest is the modified Rankin Scale(mRS)Score,which will be assessed in a blinded manner at 90(±14)days following randomisation.The primary effect size will be determined using ordered logistic regression to calculate the common OR,representing the shift on the six-category mRS Scale at the 90-day mark.Additionally,the safety outcomes will be evaluated,including symptomatic intracranial haemorrhage within 18–36hours,severe procedure-related complications and mortality within 90(±14)days,among others.Discussion The ANGEL-REBOOT study aims to generate substantial evidence regarding the efficacy and safety of bailout intracranial angioplasty as a treatment option for patients with LVO who have experienced unsuccessful thrombectomy.Trial registration number NCT05122286.

Mechanical thrombectomy with combined stent retriever and contact aspiration versus stent retriever alone for acute large vessel occlusion:data from ANGEL-ACT registry

Background and purpose An analysis of the ASTER 2 trial revealed similar final recanalisation levels and clinical outcomes in acute large vessel occlusion(LVO)stroke between stent retrieval(SR)alone as a first-line mechanical thrombectomy(MT)technique(SR alone first-line)and concomitant use of contact aspiration(CA)plus SR as a first-line MT technique(SR+CA first-line).The purpose of the present study was to compare the safety and efficacy of SR+CA first-line with those of SR alone first-line for patients with LVO in China.Methods We conducted the present study by using the data from the ANGEL-ACT registry.We divided the selected patients into SR+CA first-line and SR alone first-line groups.We performed logistic regression and generalised linear models with adjustments to compare the angiographic and clinical outcomes,including successful/complete recanalisation after the first technique alone and all procedures,first-pass successful/complete recanalisation,number of passes,90-day modified Rankin Scale,procedure duration,rescue treatment and intracranial haemorrhage within 24 hours.Results Of the 1233 enrolled patients,1069(86.7%)received SR alone first-line,and 164(13.3%)received SR+CA first-line.SR+CA first-line was associated with more thrombectomy passes(3(2-4)vs 2(1-2);β=1.77,95%CI=1.55 to 1.99,p<0.001),and longer procedure duration(86(60-129)min vs 80(50-122)min;β=10.76,95%CI=1.08 to 20.43,p=0.029)than SR alone first-line group.Other outcomes were comparable(all p>0.05)between the two groups.Conclusions Patients undergoing SR+CA first-line had more thrombectomy passes and longer procedure duration than patients undergoing SR alone first-line.Additionally,we suggested that SR+CA first-line was not superior to SR alone first-line in final recanalisation level,first-pass recanalisation level and 90-day clinical outcomes in the Chinese population.

Intra-arterial thrombolytics during endovascular thrombectomy for acute ischaemic stroke in the MR CLEAN Registry

Introduction The efficacy and safety of local intra-arterial(IA)thrombolytics during endovascular thrombectomy(EVT)for large-vessel occlusions is uncertain.We analysed how often IA thrombolytics were administered in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands(MR CLEAN)Registry,whether it was associated with improved functional outcome and assessed technical and safety outcomes compared with EVT without IA thrombolytics.Methods In this observational study,we included patients undergoing EVT for an acute ischaemic stroke in the anterior circulation from the MR CLEAN Registry(March 2014-November 2017).The primary endpoint was favourable functional outcome,defined as an modified Rankin Scale score≤2 at 90 days.Secondary endpoints were reperfusion status,early neurological recovery and symptomatic intracranial haemorrhage(sICH).Subgroup analyses for IA thrombolytics as primary versus adjuvant revascularisation attempt were performed.Results Of the 2263 included patients,95(4.2%)received IA thrombolytics during EVT.The IA thrombolytics administered were urokinase(median dose,250000 IU(IQR,193750-250000))or alteplase(median dose,20 mg(IQR,12-20)).No association was found between IA thrombolytics and favourable functional outcome(adjusted OR(aOR),1.16;95%CI 0.71 to 1.90).Successful reperfusion was less often observed in those patients treated with IA thrombolytics(aOR,0.57;95%CI 0.36 to 0.90).The odds of sICH(aOR,0.82;95%CI 0.32 to 2.10)and early neurological recovery were comparable between patients treated with and without IA thrombolytics.For primary and adjuvant revascularisation attempts,IA thrombolytics were more often administered for proximal than for distal occlusions.Functional outcomes were comparable for patients receiving IA thrombolytics as a primary versus adjuvant revascularisation attempt.Conclusion Local IA thrombolytics were rarely used in the MR CLEAN Registry.In the relatively small study sample,no statistical difference was observed between groups in the rate of favourable functional outcome or sICH.Patients whom required and underwent IA thrombolytics were patients less likely to achieve successful reperfusion,probably due to selection bias.

Efficacy and safety of bridging therapy and direct mechanical thrombectomy in large vessel occlusions:a meta-analysis

To the Editor:Acute large vessel occlusion(LVO)is responsible for most acute ischemic stroke(AIS),a common cause of disability and death worldwide.Randomized controlled clinical trials(RCTs)provided evidence endorsing intravenous thrombolysis(IVT,also termed bridging therapy[IVT])and endovascular thrombectomy over IVT alone as the current standard treatment for people with LVO in the anterior circulation.[1]The current American and European guidelines recommend using IVT for all eligible individuals with LVO before direct mechanical thrombectomy(d-MT)(class of recommendation-I).Recent RCTs suggest that MT was noninferior to BT in terms of efficacy and safety,[2,3]which contradict the results from multiple meta-analyses favoring BT over d-MT.[4]The benefit of routine IVT for eligible individuals before thrombectomy has become controversial.BT is associated with complications,including the risk of vasospasm,distal emboli,or symptomatic intracranial hemorrhage.

Outcomes of allograft from donor kidney microthrombi and secondary recipient thrombotic microangiopathy: should we consider loosening the belt?

There is currently a huge worldwide demand for donor kidneys for organ transplantation.Consequently,numerous marginal donor kidneys,such as kidneys with microthrombi,are used to save patients'lives.While some studies have shown an association between the presence of microthrombi in donor kidneys and an increased risk for delayed graft function(DGF)(McCall et al.,2003;Gao et al.,2019),other studies have demonstrated that microthrombi negatively impact the rate of DGF(Batra et al.,2016;Hansen et al.,2018),but not graft survival rate(McCall et al.,2003;Batra et al.,2016;Gao et al.,2019).In contrast,Hansen et al.(2018)concluded that fibrin thrombi were not only associated with reduced graft function six months posttransplantation but also with increased graft loss within the first year of transplantation.On the other hand,Batra et al.(2016)found no significant differences in the DGF rate or one-year graft function between recipients in diffuse and focal microthrombi groups.To date,however,the overall influence of donor kidney microthrombi and the degree of influence on prognosis remain controversial,necessitating further research.

Comparing a novel Catfish flow restoration device and the Solitaire stent retriever for thrombectomy revascularisation in emergent largevessel occlusion stroke:a prospective randomised controlled study

Background The Catfish stent retriever is a newly developed mechanical thrombectomy device for rapid recanalisation in emergent large vessel occlusion(ELVO)stroke.The current trial aimed to assess whether the Catfish stent retriever is non-inferior to the Solitaire stent retriever in terms of outcomes in ELVO stroke.Methods This was a randomised,prospective,parallel-group,multicentre,open-label,non-inferiority study conducted at 18 sites in China.The primary outcome was the proportion of cases with successful recanalisation(modified thrombolysis in cerebral infarction score of 2b or 3)following the procedure.Secondary efficacy outcomes included the National Institutes of Health Stroke Scale scores at 24 hours and 7 days or discharge if earlier,time from artery puncture to successful recanalisation and good clinical outcome(modified Rankin scale score≤2)at 90 days.Safety outcomes included symptomatic intracranial haemorrhage,all cause-death and severe adverse events at 90 days.Results Between 3 March 2019 and 5 June 2021,118 and 120 patients were randomly allocated to the Catfish and Solitaire groups,respectively.The primary endpoint after all endovascular procedures was non-inferior in the Catfish group(88.5%,100/113)than in the Solitaire group(87.7%,100/114),with a rate difference(RD)of 0.78%(95%CI-7.64 to-9.20;p=0.001).Sensitivity analysis only considering the per-protocol set also yielded similar results,with an RD of 0.83%(95%CI-7.03 to-8.70;p<0.001).Additionally,the proportions of cases with good clinical outcomes(47.8%vs 50.0%,p=0.739)and all-cause death rates(17.7%vs 18.8%,p=0.700)were similar in both groups at 90 days.Conclusions The Catfish stent retriever is an effective and safe device for endovascular recanalisation in ELVO stroke..

急性脑梗死患者溶栓后网膜素1水平对早期神经功能恶化的评估价值

目的探讨急性脑梗死患者溶栓后外周血网膜素1表达对早期神经功能恶化(early neurological deterioration,END)的评估价值。方法选取2021年2月至2022年2月郴州市第一人民医院神经内科明确诊断为急性脑梗死并行溶栓治疗的患者210例,根据溶栓后网膜素1水平分为低水平组70例(网膜素1<150μg/L),中水平组70例(150μg/L≤网膜素1≤200μg/L),高水平组70例(网膜素1>200μg/L),比较3组END发生情况。采用Pearson相关性分析网膜素1与END的相关性,用Cox回归分析发生END的影响因素,ROC曲线分析网膜素1对END的预测价值。结果210例急性脑梗死患者发生END 60例(28.6%)。低水平组、中水平组、高水平组END发生率比较,差异有统计学意义(45.7%vs 25.7%vs 14.3%,P<0.01),其中高水平组END发生率明显低于低水平组和中水平组,差异有统计学意义(P<0.01)。Pearson相关性分析显示,网膜素1与END发生呈负相关(r=-0.635,P<0.05)。多因素Cox回归分析显示,发病至溶栓时间、糖尿病、白细胞计数、网膜素1与急性脑梗死患者溶栓后发生END独立相关(P<0.05,P<0.01)。ROC曲线分析显示,网膜素1预测END发生的截断值为162.36μg/L,曲线下面积为0.868(95%CI:0.811~0.925),敏感性和特异性分别为73.3%、88.0%。结论急性脑梗死患者溶栓后外周血网膜素1水平与END的发生密切关联,网膜素1可作为评估END发生的生物标志物。

Characterising acute ischaemic stroke thrombi:insights from histology,imaging and emerging impedance-based technologies

Treatment of acute ischaemic stroke(AIS)focuses on rapid recanalisation of the occluded artery.In recent years,advent of mechanical thrombectomy devices and new procedures have accelerated the analysis of thrombi retrieved during the endovascular thrombectomy procedure.Despite ongoing developments and progress in AIS imaging techniques,it is not yet possible to conclude definitively regarding thrombus characteristics that could advise on the probable efficacy of thrombolysis or thrombectomy in advance of treatment.Intraprocedural devices with dignostic capabilities or new clinical imaging approaches are needed for better treatment of AIS patients.In this review,what is known about the composition of the thrombi that cause strokes and the evidence that thrombus composition has an impact on success of acute stroke treatment has been examined.This review also discusses the evidence that AIS thrombus composition varies with aetiology,questioning if suspected aetiology could be a useful indicator to stroke physicians to help decide the best acute course of treatment.Furthermore,this review discusses the evidence that current widely used radiological imaging tools can predict thrombus composition.Further use of new emerging technologies based on bioimpedance,as imaging modalities for diagnosing AIS and new medical device tools for detecting thrombus composition in situ has been introduced.Whether bioimpedance would be beneficial for gaining new insights into in situ thrombus composition that could guide choice of optimum treatment approach is also reviewed.

Mechanical thrombectomy in patients with M1 occlusion and NIHSS score≤5:a single-centre experience

Background:The recent success of several mechanical thrombectomy trials has resulted in a significant change in management for patients presenting with stroke.However,it is still unclear how to manage patients that present with stroke and low National Institutes of Health Stroke Scale(NIHSS)≤5.We sought to review our experience of mechanical thrombectomy in patients with low NIHSS and confirmed M1 occlusion.Methods:We retrospectively analysed our prospectively maintained database of all patients undergoing mechanical thrombectomy between January 2008 and August 2016.We identified 41 patients with confirmed M1 occlusion and low NIHSS(≤5)on admission to our hospital.We collected demographic,radiological,procedural and outcome data.Results:The mean age of patients was 72±14,with 20 male patients.Associated medical conditions were common with hypertension seen in∼80%.Just over 50%presented with NIHSS 4 or 5.The average ASPECTS score on admission was 8.8(range 6–10),and the average clot length 10 mm.Angiographically Thrombolysis in Cerebral Infarction(TICI)≥2b was obtained in 87.8%of patients.7 patients had haemorrhage on follow-up,2 of which were symptomatic.Of 40 patients with 90-day follow-up,75%had modified Rankin Scale(mRS)score 0–2.There were 3 deaths at 90 days.Conclusions:Mechanical thrombectomy in patients with low NIHSS and proximal large vessel occlusion is technically possible and carries a high degree of success with good safety profile.Patients with low NIHSS and confirmed occlusion should be considered for mechanical thrombectomy.

Advances in mechanical thrombectomy for acute ischaemic stroke from large vessel occlusions

Advances in endovascular treatment of acute ischaemic stroke from intracranial large vessel occlusions have continued in the past decade.Here,we performed a detailed review of all the new trials and studies that had the highest evidence,the guidelines for mechanical thrombectomy,the selection of the particular population outside the guidelines and endovascular therapeutic strategies for acute ischemic stroke from occluded intracranial arteries.

Mobile stroke care expedites intravenous thrombolysis and endovascular thrombectomy

Background The number of mobile stroke programmes has increased with evidence,showing they expedite intravenous thrombolysis.Outstanding questions include whether time savings extend to patients eligible for endovascular therapy and impact clinical outcomes.Objective Our mobile stroke unit(MSU),based at an academic medical centre in upstate New York,launched in October 2018.We reviewed prospective observational data sets over 26 months to identify MSU and non-MSU emergency medical service(EMS)patients who underwent intravenous thrombolysis or endovascular thrombectomy for comparison of angiographic and clinical outcomes.Results Over 568 days in service,the MSU was dispatched 1489 times(2.6/day)and transported 300 patients(20%of dispatches).Intravenous tissue plasminogen activator(tPA)was administered to 57 MSU patients and the average time from 911 call-to tPA was 42.5 min(±9.2),while EMS transported 73 patients who received tPA at 99.4 min(±35.7)(p<0.001).Seven MSU patients(12%)received tPA from 3.5 hours to 4.5 hours since last known well and would likely have been outside the window with EMS care.Endovascular thrombectomy was performed on 21 MSU patients with an average 911 call-to groin puncture time of 99.9 min(±18.1),while EMS transported 54 patients who underwent endovascular thrombectomy(ET)at 133.0 min(±37.0)(p=0.0002).There was no difference between MSU and traditional EMS in modified Rankin score at 90-day clinic follow-up for patients undergoing intravenous thrombolysis or endovascular thrombectomy,whether assessed as a dichotomous or ordinal variable.Conclusions Mobile stroke care expedited both intravenous thrombolysis and endovascular thrombectomy.There is an ongoing need to show improved functional outcomes with MSU care.

肝细胞癌潜在血清标志物GRO-1和Thrombin的蛋白鉴定及其临床特征分析

目的寻找有效的早期诊断及判断肝细胞癌（HCC）预后的血清标志物。方法利用表面增强激光解吸离子化-飞行时间质谱（SELDI-TOF-MS）技术确定HCC患者血清蛋白表达谱。对HCC81例、肝炎82例和健康志愿者80例血清标本蛋白表达谱进行比较，经高效液相色谱分离和质谱鉴定蛋白质序列。另取48例HCC、54例肝硬化、62例大肠癌、55例鼻咽癌、36例肺癌和42例健康志愿者血清，利用PS20免疫芯片和SEI-DI技术对候选标志物进行验证。荧光定量PCR技术检测55例HCC患者癌和癌旁组织，13例正常肝组织中候选标志物基因的表达情况，探讨它们与HCC患者临床预后的相关性。结果检出两个HCC候选标志物凝血酶轻链（Thrombinlightchain）和生长相关性癌基因编码蛋白（GRO1）。以这两个因子建立的HCC诊断模型敏感性和特异性均为89．6％，显著高于甲胎蛋白（AFP）单独检测敏感性和特异性（69％，83％）。它们与AFP联合使用后的灵敏度和特异度更高（91．7％，92．7％），而对大肠癌、鼻咽癌、肺癌的敏感性均不超过50Vo。HCC患者癌组织的GRO-1与Thrombin的表达具有显著相关性（r=0．73，P〈0．01），GRO-1表达与肝外转移及术后复发显著相关（P〈0．05），Thrombin的表达量与术后复发及AFP升高相关（P〈0．05）。GRO1和Thrombin高表达的患者术后5年生存率明显低于GRO-1低表达的患者。GRO-1表达量是影响HCC预后的独立影响因素。结论Thrombinlightchain和GRO-1是HCC的潜在血清标志物，并有希望成为HCC患者术后复发转移的预测指标。

重组组织型纤溶酶原激活剂动脉溶栓联合依达拉奉右莰醇的临床疗效分析

目的分析老年后循环穿支动脉型脑梗死患者在接受重组组织型纤溶酶原激活剂(recombinant tissue plasminogen activators,rt-PA)动脉溶栓治疗的基础上使用依达拉奉右莰醇的临床治疗效果。方法纳入2021年8月至2023年8月于武威市凉州医院接受治疗的老年急性脑梗死患者68例,根据随机数字表法分为溶栓组和联合组,每组各34例,溶栓组使用rt-PA动脉溶栓治疗,联合组在溶栓组的基础上联合依达拉奉右莰醇治疗。比较2组患者的治疗效果、神经功能情况、氧化应激反应、炎性反应、日常生活功能以及不良事件发生情况。结果2组治疗总有效率比较,差异无统计学意义(P>0.05)。2组治疗14 d后血清神经元特异性烯醇化酶、基质金属蛋白酶9、中枢神经特异性蛋白β、丙二醛、白细胞介素6、C反应蛋白水平、改良的Rankin量表评分、美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分均低于治疗前(P<0.05),且联合组治疗14 d后神经元特异性烯醇化酶、基质金属蛋白酶9、中枢神经特异性蛋白β、丙二醛、白细胞介素6、C反应蛋白水平、改良的Rankin量表评分、NIHSS评分均低于溶栓组(P<0.05,P<0.01);联合组治疗90 d后NIHSS评分低于溶栓组[(6.15±0.92)分vs(7.48±0.83)分,P<0.01]。2组治疗14 d后超氧化物歧化酶水平、Barthel指数量表评分均高于治疗前(P<0.05),且联合组治疗14 d后超氧化物歧化酶水平、Barthel指数量表评分高于溶栓组(P<0.01)。2组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论老年后循环穿支动脉型脑梗死患者在接受rt-PA动脉溶栓治疗的同时联合使用依达拉奉右莰醇的临床疗效较好,可以降低氧化应激和炎性反应,改善患者的脑组织损伤情况及神经功能状况,同时提高日常生活能力且安全性较好。

N末端B型钠尿肽前体和脂蛋白(a)水平及凝血功能预测慢性心力衰竭并发深静脉血栓作用

目的探讨N末端B型钠尿肽前体(NT-proBNP)、脂蛋白(a)[Lp(a)]及凝血功能指标在老年慢性心力衰竭(CHF)并发下肢深静脉血栓(DVT)患者中的表达以及预测价值。方法选取2022年1月25日至12月25日于衡水市人民医院住院治疗的CHF患者230例,根据是否合并DVT分为DVT组76例和非DVT组154例,选取同期健康体检者100例为对照组。收集各组患者一般临床资料、临床指标、凝血功能指标,采用酶联免疫吸附法检测血清NT-proBNP、Lp(a)水平,采用logistic回归分析独立风险因素,采用ROC曲线分析单项和联合检测的预测价值。结果DVT组合并下肢动脉硬化发生率显著高于非DVT组(P<0.05),其他一般资料比较,差异无统计学意义(P>0.05)。DVT组血小板计数、低密度脂蛋白胆固醇高于非DVT组,高密度脂蛋白胆固醇低于非DVT组(P<0.05)。DVT组活化部分凝血活酶时间(aPTT)、凝血酶原时间、凝血酶时间显著低于非DVT组,纤维蛋白原(FIB)、D-二聚体、NT-proBNP、Lp(a)水平显著高于非DVT组,与对照组比较差异有统计学意义(P<0.05)。Logistic回归分析显示,高密度脂蛋白胆固醇、aPTT、FIB、D-二聚体、NT-proBNP、Lp(a)是老年CHF患者并发DVT的独立风险因素(P<0.05,P<0.01),获得logistic回归模型为:logit(P)=0.933X3+0.744X8+0.812X11+0.681X12+0.774X13+0.684X14。Logistic回归模型联合检测ROC曲线下面积为0.948(95%CI:0.918~0.977),敏感性为89.47%,特异性为89.61%。结论NT-proBNP、Lp(a)及凝血功能指标是老年CHF患者并发DVT的独立风险因素,联合检测具有较高的预测价值。