急性颅内大血管闭塞性脑梗死患者血栓病理对机械取栓后出血转化的影响

目的:分析急性颅内大血管闭塞性脑梗死患者血栓病理对机械取栓后出血转化的影响。方法:收集2020年6月~2022年5月太和县人民医院收治的145例急性颅内大血管闭塞性脑梗死患者的临床资料。依据机械取栓后出血转化情况分为出血转化组和非出血转化组,比较两组基线资料及血栓病理,并分析影响急性颅内大血管闭塞性脑梗死患者机械取栓后出血转化的血栓病理因素。结果:145例急性颅内大血管闭塞性脑梗死患者中,30例(20.69%)机械取栓后发生出血转化。出血转化组患者入院时NIHSS评分、多次取栓及血栓病理为红细胞富集占比高于非出血转化组(P<0.05),并与机械取栓后出血转化均呈正相关(P<0.05)。多因素Logistic回归分析显示,入院时NIHSS评分高、多次取栓、血栓病理为红细胞富集均是急性颅内大血管闭塞性脑梗死患者机械取栓后出血转化的危险因素(P<0.05)。结论:急性颅内大血管闭塞性脑梗死患者血栓病理为红细胞富集会增加机械取栓后出血转化风险。

血栓病理与急性缺血性脑卒中血管内治疗预后相关性研究

目的探讨脑动脉血栓病理与急性缺血性脑卒中血管内治疗预后的相关性。方法连续入选血管内治疗的急性缺血性脑卒中获得脑动脉血栓的患者58例,取出的血栓采用苏木精-伊红染色行病理检查;测定红细胞及纤维蛋白/血小板成分的比例,依据红细胞在血栓中的含量分为富含红细胞组(红细胞比例≥70%)、混合组(红细胞比例31%~69%)、富含纤维蛋白/血小板组(红细胞比例≤30%)。认定良好预后为术后90 d mRS评分0~2分、不良预后为mRS评分3~6分。分析血栓病理与血管内治疗预后的相关性。结果58例患者中,富含红细胞组为18.97%、混合组为63.79%、富含纤维蛋白/血小板组为17.24%,其中良好预后为43.10%、不良预后为56.90%。良好预后与不良预后在3组差异均无统计学意义(P>0.05)。应用logistic回归分析,纳入基线资料中相关因子,相对于富含纤维蛋白/血小板组,混合组达到良好预后的OR值为0.60(P=0.592),富含红细胞组达到良好预后的OR值为0.74(P=0.793),年龄与良好预后有显著的负相关(OR=0.91,P=0.013),ASPECTS评分与良好预后有显著的正相关(OR=2.01,P=0.002),阿替普酶桥接治疗与良好预后有边际显著的正相关(OR=4.23,P=0.083)。结论脑动脉血栓红细胞含量与急性缺血性脑卒中血管内治疗预后可能无相关性。血管内治疗良好预后与低龄、入院时高ASPECTS评分、阿替普酶桥接治疗相关。

急性ST段抬高型心肌梗死不同缺血时间冠状动脉内血栓的病理分析

目的探讨不同缺血时间对急性ST段抬高型心肌梗死(STEMI)患者冠状动脉血栓病理类型的影响。方法连续入选2012年9月-2016年4月行急诊PCI及冠状动脉血栓抽吸术的STEMI患者82例,按照缺血时间分为≤4h组(n=36)、4~7h组(n=30)、>7h组(n=16),比较3组间血栓类型(红色血栓、白色血栓、混合血栓)百分率的差异。结果≤4h组白血栓、红血栓、混合血栓的百分率分别为:61.1%(22/36)、8.3%(3/36)、30.6%(11/36),组内比较差异有统计学意义(P=0.019);4~7h组分别为23.3%(7/30)、10.0%(3/30)、66.7%(20/30),组内比较差异有统计学意义(P=0.012);>7h组分别为43.8%(7/16)、12.5%(2/16)、43.8%(7/16),组内比较差异无统计学意义(P=0.913)。白血栓在≤4h、4~7h、>7h组分别占61.1%(22/36)、19.4%(7/36)、19.4%(7/36),差异有统计学意义(P=0.009);混合血栓在≤4h、4~7h、>7h组分别占28.9%(11/38)、52.6%(20/38)、18.4%(7/38),差异有统计学意义(P=0.013);红血栓在≤4h、4~7h、>7h组分别占37.5%(3/8)、37.5%(3/8)、25.0%(2/8),差异无统计学意义(P=0.895)。结论不同缺血时间的STEMI患者其血栓主要构成类型不同,同种血栓在不同缺血时间的分布不同,缺血时间可能成为冠状动脉血栓类型的预测因素。

急性下肢深静脉血栓形成治疗过程中D-二聚体的变化

目的:研究急性下肢深静脉血栓形成治疗过程中血浆D-二聚体的变化规律。方法:用乳胶凝集法(tinaquant法)测定20例急性下肢深静脉血栓形成患者在治疗过程中不同时间(治疗前、治疗后第1～3天、10天、2周)的D-二聚体含量,同时测量患肢与健侧肢体周径差。结果:治疗后D-二聚体水平显著性升高,峰值出现时间平均为2.1d。治疗后10d,D-二聚体下降至溶栓前水平,治疗后2周D-二聚体与溶栓前比较差异有统计学意义。随着治疗后患肢周径的持续下降,D-二聚体呈现先高后低的变化规律。结论:D-二聚体是急性下肢深静脉血栓形成诊断和治疗过程中疗效评价的有效指标。

血栓前状态标志物在糖尿病酮症酸中毒患者中的表达及其意义

【目的】探讨血栓前状态标志物在糖尿病酮症酸中毒（DKA）患者中的表达及其意义。【方法】收集正常对照30例（NC组）、单纯糖尿痛（SDM）组33例、DKA组24例，检测并比较三组血浆n二聚体（D-D）、纤维蛋白原（FIB）及血清超敏C反应蛋白（hs—CRP）、脂蛋白相关磷脂酶Az（Lp—PLAz）水平。【结果IDKA组的D-D、FIB、hs—CRP、Lp—PLA2水平明显高于SDM组及NC组（P％0．01）；SDM组的D-D、FIB、hs—CRP、Lp—PLA：水平显著高于NC组（P〈O．05）。【结论IDKA患者血栓前状态标志物明显增高，血液存在高凝状态，在临床工作中应及时处理，预防缺血性疾病的发生。

深静脉血栓患者抗凝与纤溶功能研究

目的 :通过对深静脉血栓形成 (DVT)患者抗凝和纤溶系统各种指标的检测 ,探讨高凝状态在DVT患者发病机制中的重要作用。方法 :选择 72例经超声和 (或 )静脉造影确诊的DVT患者 ,以 70例健康体检者作为对照组测定抗凝血酶 Ⅲ (AT Ⅲ )活性、蛋白C(PC)活性、总蛋白抗原S(PS)、纤溶酶原 (Plg)活性、纤溶酶原激活剂抑制物 1(PAI 1)、D 二聚体 (D dimer)、尿激酶 (uPA)和尿激酶受体 (uPAR)含量。结果 :DVT患者的AT Ⅲ活性、PC活性和PS含量明显低于对照组 ,患者组中抗凝蛋白AT Ⅲ、PC和PS缺陷的发生率明显高于对照组 ,其中复发组的AT Ⅲ、PC和PS缺陷的发生率明显高于初发组。DVT患者的Plg含量明显低于对照组 ,而PAI 1、D dimer、uPA、uPAR水平明显高于对照组。患者组中D dimer含量 >5 0 0ng/L者占97.2 % ,而对照组仅占 1.4 %。结论 :DVT患者中普遍存在抗凝功能的降低 ,表现为各种抗凝蛋白水平的降低 ,DVT患者中抗凝蛋白缺陷的发生率明显高于对照组 ,复发DVT患者的抗凝蛋白缺陷发生率明显高于初发患者 ,证明抗凝蛋白缺陷是DVT发生和复发的重要因素之一。DVT患者普遍存在纤溶功能的降低 ,表现为Plg含量的降低和PAI 1含量的升高 ,患者组uPA和uPAR含量明显高于对照组 ,主要是由于uPA/uPAR介导的纤溶活性在DVT发生后?

JAK-STAT信号通路在创伤性深静脉血栓形成中作用的实验研究

目的:探讨Jak蛋白酪氨酸激酶-信号转导子和转录激活子信号通路在创伤性深静脉血栓形成中的作用。方法:将150只SD大鼠随机分为正常对照(A组)和模型组。模型组根据造模后的不同生物学状态再分为7组:创伤即刻(B组)、血栓形成前期(C组)、高峰期血栓形成(D组)、高峰期血栓不形成(H组)、血栓消退期(E组)、血栓不消退(F组)和血栓不形成(G组),在相应时相点无创切取股静脉血管组织,随后抽取各组大鼠总RNA,用Genechip Rat Genome430 2.0芯片测定股静脉RNA表达,并分析Jak蛋白酪氨酸激酶-信号转导子和转录激活子信号通路基因表达变化情况。结果:Jak蛋白酪氨酸激酶-信号转导子和转录激活子信号通路中Cytokine R、STAT、PI3K、AKT、SOCS、CycD等关键基因均呈下调,调控着细胞凋亡、细胞周期等。结论:Jak蛋白酪氨酸激酶-信号转导子和转录激活子信号通路可能是调控血栓的生物学状态的重要信号通路之一。

白介素-6及纤维蛋白原在下肢深静脉血栓中的表现及意义

目的:探讨炎症因子白介素-6及纤维蛋白原在急性下肢深静脉血栓中的表现及作用。方法:对20例急性下肢静脉血栓患者(血栓组)及20例健康对照者(对照组)测定血栓组治疗前后及对照组血清白介素-6、纤维蛋白原、白细胞、中性粒细胞、单核细胞及淋巴细胞水平。结果:血栓组患者血清白介素-6、纤维蛋白原和血清白细胞、中性粒细胞及单核细胞计数明显高于对照组(P<0.01),而淋巴细胞血栓组则低于对照组(P<0.05)。治疗后血栓组炎症因子水平则显著低于治疗前(P<0.01);而淋巴细胞较治疗前增高(P<0.05)。治疗后两组白细胞、中性粒细胞、单核细胞及淋巴细胞计数无显著性差异(P>0.05)。结论:白介素-6、纤维蛋白原等炎症因子参与下肢深静脉血栓的形成。

血栓康对大鼠实验性静脉血栓形成的影响

目的观察中药复方血栓康对实验性大鼠下腔静脉血栓形成的抑制作用。方法选用Wistar大鼠40只,随机分为4组。模型对照组、复方丹参片对照组、血栓康小剂量和血栓康大剂量治疗组,采用结扎大鼠下腔静脉法造成静脉血栓模型,缝合腹壁6h后重新打开腹腔。每组随机抽取2只大鼠的下腔静脉按常规制作石蜡切片进行病理组织形态观察,其余的8只大鼠剥离静脉取出血栓,称湿重及干重。结果与模型对照组比较,其余3组下腔静脉血栓湿重、干重均减少,以血栓康大剂量治疗组和小剂量组较为明显(P<0.05),复方丹参片对照组血栓湿重和干重虽有所下降,但无统计学意义。病理形态观察表明,各组血管内皮细胞损伤程度不同,血栓康大剂量组明显减轻。结论血栓康具有预防静脉血栓形成的作用及保护大鼠下腔静脉内皮细胞,预防内皮细胞损害的功能。

抗血小板介导的血栓形成需寻找新的对策

血管损伤后，血小板是该部位止血过程的核心介导因子，同时也引发病理性血栓形成。动脉粥样硬化斑块破裂或内皮细胞损伤后，激活的血小板会刺激血栓形成并导致血栓性疾病。血小板也可与内皮细胞和白细胞相互作用，促进炎性反应的发生，后者进一步促进血栓形成。有多种途径可以激活血小板，目前口服的抗血小板聚集药物阿司匹林和二磷酸腺苷（ADP）受体拮抗剂——P2Y12的作用靶点分别是血栓烷A2和ADP通路。

家族史用于筛查中风儿童血栓形成前基因的效果不佳

Objective: To evaluate family history of early pathological thrombosis as a sc reen for genetic prothrombotic risk factors in children with stroke. Study desig n: A 5-year retrospective review of standardized pediatric stroke clinic evaluations of children with arterial ischemic stroke (AIS) or sinovenous thrombosis (SVT). A family history of early pathological thrombosis was defined as stroke, heart attack, or deep venous thrombosis before 50 years of age or multiple miscarriages in the parents or grandparents of the patient. W e evaluated the association between family history and the presence of the Facto r V Leiden mutation (FVL) and/or Prothrombin G20210A mutation (PTG) in these chi ldren. Results: The study included 68 children. Thirteen (19.1%) had a positive family history of early pathological thrombosis, nine (13.2%)were heterozygous for FVL, and one (1.5%) was heterozygous for PTG. Family history was not assoc iated with the presence of FVL (P= .36) or FVL combined with PTG (p = .40). For FVL, family history had a positive predictive value of 23.1%and a negative pred ictive value of 89.1%. Conclusion: A family history of early thrombosis is not associated with the presence of FVL or PTG in children with stroke. We recommend that all children with stroke receive a prothrombotic workup regardless of fami ly history.

THROMBOENDARTERECTOMY FOR CHRONIC PULMONARY THROMBOEMBOLISM

Objective To evaluate the improving reliability and safety of thromboendarterectomy and perioperative management for chronic pulmonary thromboembolism. Methods The clinical data of 12 cases with chronic pulmonary thromboembolism, who underwent thromboendarterec- tomy assisted by low flow or circulation arrest with deep hypothermia, were reviewed retrospectively. Results Pulmonary artery pressure decreased 20 to 40 mmHg immediately after surgical procedures in 9 cases. The postoperative pulmonary edema at various degrees happened in 12 cases, among them, 1 died of severe lung infection and pulmonary re-embolism at 19 days postoperation. Computed tomography pulmonary angiography and angiography of 11 cases indicated that the original obstruction of pulmonary artery disappeared. During the follow-up period of 2 months to 5 years, the clinical symptoms and activity was improved. Conclusion Thromboendarterectomy is an effective treatment for chronic pulmonary thromboembolism. The outcome of the surgical procedure needs to be further investigated and followed up regularly according to an evaluative system, because it might be influenced by multiple factors.

Portal venous gas and thrombosis in a Chinese patient with fulminant Crohn’s colitis: A case report with literature review

Ever since its earliest reports, portal venous gas (PVG) has been associated with numerous intraabdominal catastrophes and has served as an indication for urgent surgical exploration. It is traditionally regarded to be an ominous finding of impending death, with highest mortality reported in patients with underlying bowel ischemia. Today, computed tomography has demonstrated a wider range of clinical conditions associated with PVG, some of which are ‘benign’ and do not necessarily require surgery, unless when there are signs of intraabdominal catastrophe or systemic toxicity. One of these ‘benign’ conditions is Crohn’s disease. The present report describes a 19-year-old Chinese boy with Crohn’s pancolitis who presented with septic shock associated with PVG and portal vein thrombosis, and was successfully managed surgically. To our knowledge, this is the fi rst report of PVG and portal vein thrombosis associated with Crohn’s disease in a Chinese patient. In addition, we have also reviewed the reports of another 18 Crohn’s patients with PVG previously described in the English literature. Specifi c predisposing factors for PVG were identified in 8 patients, including barium enema, colonoscopy, blunt abdominal trauma, and enterovenous f istula. The patients who developed PVG following barium enema and blunt trauma were all asymptomatic and no specifi c treatment was necessary. Eleven patients (58%) who presented with signs of intraabdominal catastrophe or systemic toxicity required either immediate or eventual surgery. The overall mortality rate among the 19 patients was only 11%. The present literature review has shown that the f inding of PVG associated with Crohn’ s disease does not always mandate surgical intervention. It is the clinical features and the related complications that ultimately determine the treatment approaches. The overall outcome of PVG associated with Crohn’s disease has been favourable.

Management of ischemic proctitis with severe rectal haemorrhage: A case report

Acute ischemic proctitis is a rare pathological condition. We report here a patient presented with massive rectal haemorrhage from a bleeding vessel superimposed on an underlying pathology of ischemic proctitis. This case report illustrates the difficulties in making the clinical distinction between ischemic proctitis and other pathological entities. We also discussed the beneficial role of arteriogram with embolotherapy as an effective therapeutic measure in the management of lower gastrointestinal bleeding. The literature on the subject is reviewed.

Portal thrombosis and steatosis after preoperative chemotherapy with FOLFIRI-bevacizumab for colorectal liver metastases

In order to discuss the role of preoperative chemo- therapy for colorectal liver metastases, which is used frequently before hepatic resection, even in patients with resectable disease at presentation, we herein report the development of two complications, partial portal vein thrombosis and hepatic steatosis with Iobular inflammation, during the course of preoperative chemotherapy with FOLFIRI plus bevacizumab for colorectal liver metastases, which recognition led to timely discontinuation of chemotherapy as well as a change in the surgical strategy to resect the tumors and the damaged liver through advanced techniques. We conclude that duration of treatment and drug doses and combinations may impact the development of chemotherapy-induced liver injury. Surgeons and medical oncologists must work together to devise safe, rational, and oncologically appropriate treatments for patients with multiple colorectal liver metastases, and to improve the understanding of the pathogenesis of chemotherapyinduced liver injury.

LUPUS NEPHRITIS COMPLICATED WITH MALIGNANT HYPERTENSION:FROM RENAL VASCULAR PATHOLOGY TO CLINICAL RELEVANCE

Objective To investigate the clinical and pathological characteristics of lupus nephritis patients complicated with malignant hypertension.Methods We retrospectively studied 19 patients with lupus nephritis complicated with malignant hypertension who underwent renal biopsy between January 2002 and December 2006.Results Of 19 patients,3 were men and 16 were women,with a mean age of 24.4±7.7 years old.All had positive antinuclear antibodies and low serum complement was found in 13 patients.All were anemic and 12 of them were thrombocytopenic.Impaired renal function was found in 17 patients with an average serum creatinine of 184.5±88.9 μmol/L.Severe intrarenal arteriolar lesion was found in all patients.Six patients had lupus vasculopathy,11 patients had renal thrombotic microangiopathy lesion,2 had severe arteriosclerosis.All patients received steroids and immunosuppressive drugs,15 received angiotensin-converting enzyme inhibitor(ACEI)/angiotensin receptor blocker(ARB)with resultant well-controlled blood pressure.Thrombocytopenia and hemolytic anemia resolved remarkably.The renal function improved or recovered in 14 of 17 patients,and 3 developed end-stage renal disease on maintenance dialysis.Conclusions Severe intrarenal vascular lesion complicated with renal nephritis parallels clinical manifestation of malignant hypertension.Renal pathology is the key of treatment strategy emphasizing on the significance of renal vascular involvement and type.On the basis of immunosuppressive drugs and steroids to control systemic lupus activity,timely initiation of ACEI/ARB could be of benefit to blood pressure control and long term renal survival.