Thrombin Activatable Fibrinolysis Inhibitor in Preeclmapsia and Gestational Hypertension throughout the Gestation

To clarify the role of TAFI in hypertensive disorders in pregnancy, 22 subjects, including 10 with pre-eclampsia （PE） and 12 with gestational hypertension were examined for the levels of TAFI and thrombin-antithrombin （TAT） complex. Thirty normal pregnant women served as controls. ELISA was employed for the detection. The results showed that the TAFI antigen levels in normal pregnancy group, gestational hypertension group and PE group were （85.35±24.69）%, （99.65±18.27）%, （110.12±23.36）%; （97.06±21.40）%, （114.08±27.76）%, （125.49±24.70）%; （106.6±19.21）%, （129.2±25.07）%, （139.1±30.12）%, in the 1st, 2nd and 3rd trimester respectively. No significant differences were found between the normal pregnancy group and gestational hypertension group but significant difference existed between normal pregnancy group and PE group in each trimester （P〈0.05）. TAT complexes were significantly higher in patients with PE than that in controls （P〈0.05）, but no correlation was found between TAT and TAFI. It is concluded that TAFI may contributed to the impairment of fibrinolysis in the patients with PE and may serves as a sensitive indicator for PE, but it may not help in the diagnosis of the gestational hypertension.

Study on Localization Factors of Coagulation and Fibrinolysis in Glomerulonephritis

The intraglomerular distribution of alpha 2-plasmin inhi-bitor (α2-PI), plasminogen (PLG), fibronectin (FN) andfibrinogen related antigen (FRA), were examined in 118 ca-ses of primary or secondary glomerular disease by immuno-fluorescence method. The plasma concentrations of α2-PI,PLGand FRA were also measured simultaneously. The results ofthis study indicated that there was significant correlationbetween the deposition of α2-PI, PLG, FN, FRA and thedegree of histopathological changes in patients with severeglomerulonephritis. There was no significant correlation be-tween the intensity of α2-PI, PLG, FN and FRA depositionin glomeruli and the serum levels of α2-PI, PLG and FRA.

Correlation Study of Color Doppler Examination of Deep Veins of Both Lower Extremities Combined with Fibrinolysis System in Hypertension during Pregnancy

Objective: To investigate the correlation between deep static color Doppler ultrasound of both lower extremities combined with fibrinolytic system detection in pregnancy-induced hypertension. Methods: A total of 70 normal pregnant women, 70 pregnant women with hypertension during pregnancy, and 50 healthy non-pregnant women in the same period were selected as the research objects. The deep veins of both lower limbs were examined by Rili Erlangshen’s color Doppler ultrasound diagnostic instrument (CDU), and the fibrinolysis system was tested by enzyme-linked immunosorbent assay (ELISA) method and automatic hemagglutination analyzer. Results: Compared with the non-pregnant group, the inner diameters of the left/right femoral vein (CFV) and popliteal vein (POV) in the normal pregnancy group and the pregnancy-induced hypertension group were significantly widened, and the peak blood flow spectrum was significantly reduced. The difference was statistically significant (P < 0.01);FIB, PLG, t-PA, PAI, D-Dimer were significantly increased, the difference was statistically significant (P < 0.01);Compared with the normal pregnancy group, the inner diameter of the left/right femoral vein (CFV) in the hypertensive pregnancy group was significantly wider than that in the normal pregnancy group, and the peak value of the left/right POV blood flow spectrum was significantly lower than that in the normal pregnancy group, the difference was statistically significant (P < 0.01), while the left/right popliteal vein (POV) inner diameter, left/right CFV blood flow peak value did not change significantly from the normal pregnancy group, and the difference was not statistically significant (P > 0.05);FIB, PLG, PAI, D-Dimer of the hypertensive disease group during pregnancy significantly increased, the difference was statistically significant (P < 0.01), while t-PA was not statistically significant (P > 0.05). Conclusion: Normal pregnant women have a hypercoagulable state compared with healthy non-pregnant women, and pregnant women with hypertension during pregnancy are more likely to be in a pre-thrombotic state than pregnant women with normal pregnancy. Deep vein CDU examination of both lower extremities combined with blood fibrinolysis monitoring is of great value in the prevention and treatment of hypertension during pregnancy.

Effects of Acute Normovolemic Hemodilution on Perioperative Coagulation and Fibrinolysis in Elderly Patients Undergoing Hepatic Carcinectomy

Objective To observe the effects of acute normovolemic hemodilution(ANH) on coagulation function and fibrinolysis in elderly patients undergoing hepatic carcinectomy.Methods Thirty elderly patients(aged 60-70 years) with liver cancer(American Society of Anesthesiologists physical status I-II) scheduled for hepatic carcinectomy from February 2007 to February 2008 were randomly divided into ANH group(n=15) and control group(n=15).After tracheal intubation,patients in ANH group and control group were infused with 6% hydroxyethyl starch(HES)(130/0.4),and basic liquid containing 6% HES and routine Ringer's solution,respectively.In all the studied patients,blood samples were drawn at five different time points:before anesthesia induction(T1),30 minutes after ANH(T2),1 hour after start of operation(T3),immediately after operation(T4),and 24 hours after operation(T5).Then coagulation function,soluble fibrin monomer complex(SFMC),prothrombin fragment(F1+2),and platelet membrane glycoprotein(activated GPIIb/GPIIIa and P-selectin) were measured.Results The perioperative blood loss was not significantly different between the two groups(P> 0.05).The volume of allogeneic blood transfusion in ANH group was significantly smaller than that in control group(350.5±70.7 mL vs.457.8±181.3 mL,P<0.01).Compared with the data of T1,prothrombin time(PT) and activated partial thromboplastin time in both groups prolonged significantly after T3(P<0.05),but still within normal range.There were no significant changes in thrombin time and D-dimer between the two groups and between different time points in each group(all P>0.05).SFMC and F1+2 increased in both groups,but without statistical significance.P-selectin expression on the platelet surface of ANH group was significantly lowered at T2 and T3 compared with the level at T1(P< 0.05).Compared with control group,P-selectin was sig-nificantly lower in ANH group at T2-T5(all P<0.05).Conclusions In elderly patients undergoing resection of liver cancer,ANH may not hamper fibrinolysis and coagulation function.It could therefore be safe to largely reduce allogeneic blood transfusion.

Concurrent implantation of intra-aortic balloon pumping with extracorporeal membrane oxygenation improved survival of patients with postcardiotomy cardiogenic shock

Background Extra-corporeal membranous oxygenation (ECMO)and intra-aortic balloon pumping (IABP) are widely used in patients with severe circulatory failure. The decision to initiate ECMO and IABP on optimal occasion in postcardiotomy cardiogenic shock (PCS) remains controversial in the absence of guidelines.

PREVENTION OF PERICARDIAL CONSTRICTION BY TRANSCATHETER INTRAPERICARDIAL FIBRINOLYSIS WITH UROKINASE

Objective To investigate whether intrapericardial urokinase irrigation along with pericardiocentesis could prevent peri-cardial constriction in patients with infectious exudative pericarditis. Methods A total of 94 patients diagnosed as infectious exudative pericarditis (34 patients with purulent pericarditis and 60 with tuberculous pericarditis, the disease courses of all patients were less than 1 month), 44 males and 50 females, aged from 9 to 66 years (mean 45.4 ± 14.7 years), were consecutively recruited from 1993 to 2002. All individuals were randomly given either intrapericardial urokinase along with conventional treatment in study group, or conventional treatment alone (including pericardiocentesis and drainage) in control group. The dosage of urokinase ranged from 200 000 to 600 000 U (mean 320 000 ± 70 000 U). The immediate effects were detected by pericardiography with sterilized air and diatrizoate meglumine as contrast media. The long-term investigation depended on the telephonic survey and echocardiographic examination. The duration of following-up ranged from 8 to 120 months (mean 56.8 ± 29.0 months). Results Percutaneous intrapericardial urokinase irrigation promoted complete drainage of pericardial effusion, signifi-cantly reduced the thickness of pericardium (from 3.1 ± 1.6 mm to 1.6 ± 1.0 mm in study group, P < 0.001; from 3.4 ± 1.6 mm to 3.2 ± 1.8 mm in control group, P > 0.05, respectively), and alleviated the adhesion. Intrapericardial bleeding related to fibrinolysis was found in 6 of 47 patients with non-blood pericardial effusion and no systemic bleeding and severe puncture-related complication was observed. In follow-up, there was no cardiac death, and pericardial constriction events were observed in 9 (19.1%) of study group and 27 (57.4%) of control group. Cox analysis illustrated that urokinase could significantly reduce the occurrence of pericardial constriction (relative hazard coefficient = 0.185, P < 0.0001). Conclusion The early employment of intrapericardial fibrinolysis with urokinase and pericardiocentesis appears to be safe and effective in preventing the development of pericardial constriction in patients with infectious exudative pericarditis.

Single Wall Carbon Nanotube Induced Inflammation in Cruor-Fibrinolysis System

Objective To study single wall carbon nanotubes （SWCNT） and its role in inducing inflammatory cytokines in the cruor-fibrinolysis system of rat. Methods Twenty one Wistar rats were divided into four groups： 1） control; 2） low-dose SWCNT （0.15 mg/kg BW）; 3） medium-dose SWCNT （0.75 mg/kg BW）; 4） high-dose SWCNT （1.5 mg/kg BW）. Intratracheal instillation of SWCNT suspensions was administered to rats once per day for 21 days. In order to assess the exposure effect of SWCNT to the rats, activity of Inflammatory cytokine was measured and markers of cruor-fibrinolysis system were studied via ELSIA. Also, change in clotting time was recorded and histopathology was studied. Results IL-6 and IL-8 concentrations of rats exposed to SWCNT were significantly higher than those in controls （P〈0.05）. The activity of inflammatory cytokines and histopathological change indicated that oxidative damage occurred. Change in clotting time in rats exposed to SWCNT decreased compared with controls. Meanwhile, t-PA （tissue-tupe plassminogen activator） and AT-Ⅲ （antithrombin-Ⅲ） levels in rats exposed to particulates increased or decreased significantly compared with controls （P〈0.05）. A similar trend was observed for D-dimer （D2D） levels, indicating that SWCNT can impact the cruor-fibrinolysis system ofrat. Conclusion The results from our study suggest that an increased procoagulant activity and reduced fibrinolytic activity in rats exposed to SWCNT can cause pulmonary oxidative stress and inflammation, due to the release of pro-thrombotic and inflammatory cytokines into the blood circulation of rat.

The Role of Fibrinolysis in Adhesive Otitis Media(AOM)

Objective To study the effects of Batroxobin on otitis media with effusion(OME), an early stage of Adhesive Otitis Media(AOM), for the purpose of expanding our understanding of the role of fibrinolysis in the pathogenesis of AOM. Method Forty cases of OME(45 ears) were randomly selected to receive intratympanic administration of Dexamethasone at 5 mg/ml(Group 1 or G1), Batroxobin at 1 BU/ml(Group 2 or G2) or Batroxobin at 2 BU/ml (Group 3 or G3). Pre-and post-treatment changes in clinical symptoms, the Air conduction Hearing Threshold (AHT) in pure tone audiometry and average AHT over 0.25 to 2 kHz were compared. Results Data from 31 cases(33 ears) were available for analysis. AHTs among three groups were similar prior to treatment(P > 0.05). The rate of normal hearing following treatment in G3 was 70% or 7 / 10, higher than in G1(41.7% or 5 / 12) and G2 (54.5% or 6 / 11)(P < 0.05). The rate of improvement following treatment was 81.8% or 9/11 and 80.0% or 8 / 10 in G2 and G3, respectively, higher than that in G1(50.0% or 6 / 12)(P < 0.05). Conclusions Therapeutic effects of intratympanic injection of Batroxobin on OME is superior to traditionally used Dexamethasone. In addition, higher concentration of Batroxobin appears to be superior to lower concentrations. These findings confirm that fibrinolysis plays a pivotal role in the pathogenesis of middle ear adhesion and that fibrinolytic medicine can prevent or reduce adhesion development in the middle ear.

THE IMPAIRMENT OF PLATELET FUNCTION IN FIBRINOLYSIS AND PRESERVING EFFECT OF APROTININ

Platelet adhesion depends on the platelet membrane glycoprotein Ib (GPIb) and plasma von Willebrand Factor (vWF), which can be reflected by ristocetin-induced aggregation. Here we report damage effect of fibrinolysis and preserving effect of aprotinin on platelet function. Addition of 40 U/ml urokinase and 0.3 U/ml plasmin to PRP or washed platelets made the ristocetin-induced aggregation decline to 31.6% and 38.5% of control value respectively. The extent of declining was positively correlated with the concentration of urokinase and plasmin. Meanwhile, the platelet GPIb decreased to 76.4% of control value. The results showed that the fibrinolysis impaired the platelet function and this effect may be associated with the hydrolysis of GPIb. Further research found that by adding the same dose of urokinase or plasmin to aprotinin-pretreated PRP or washed platelets, the aggregation did not change statistically and decrement of GPIb is much less marked. We concluded that the aprotinin could relieve the platelet dsfunction effectively by its inhibitory effect on fibrinolytic activity.

Effects of Xuezhikang Capsule(血脂康胶囊) on Blood Lipids,Platelet Activation and Coagulation-Fibrinolysis Activity in Patients with Hyperlipidemia

Objective: To investigate the effects of Xuezhikang capsule (XZK,血脂康胶囊) on blood lipids level, platelet activation and coagulation-fibrinolysis activity in patients with hyerlipidemia. Methods: Seventy-six patients of hyperlipidemia were randomly divided into two groups, the XZK group (n=38) treated with XZK 600mg, taken two times per day and the Simvastatin (SIM) group (n = 38) treated with SIM 20mg per day, with the treatment lasting 8 weeks for both groups. Levels of fasting serum lipids, including total cholesterol (TC), triglyceride (TG), high and low density lipoprotein cholesterol (HDL-C and LDL-C), plasma GMP-140, fibrinogen (FIB), tissue plasminogen activator (t-PA), plasminogen activator inhibitor type-1 (PAI-) and prothrombin time (PT) were all measured before and 8 weeks after treatment. Data were compared before and after treatment and also compared with those measured in 20 healthy subjects of control. Results: Before treantment the levels of TC, TG and LDL-C were obviously higher and HDL-C level was significantly lower in hyperlipidemia patients than those in healthy subjects (P<0.05 or P<0.01). After 4-8 weeks of XZK treatment, the levels of TC, TG, LDL-C and FIB and activities of GMP-140 and PAI-1 were obviously lowered (P<0. 05 or P<0. 01). But in the SIM group there was no obvious change in FIB (P>0.05), instead it showed obvious increase of HDL-C and decrease of TC and LDL-C after treatment (P<0.05 or P<0.01). Conclusion: XZK could inhibit platelet activity and improve coagulation-fibrinolysis function, besides its lipids lowering effect.

A Comparison Study of the Effects Injectable Contraceptive Cyclofem on Blood Coagulation and Fibrinolysis

Forty-six healthy women received Cyclofem (25mg medroxyprogesterone acetate with sing estradiol cypionate) and other /orly--five women, as control,received oral contraceptive pill (Ortho--Novum 1/35, containing norethisterone enantate ling and estradiol valerate 35fig) for nine months. Blood samples were taken during the follicular and luteal phases o/preu treatment, and for Cyclofem group, immediately prior to the 3rd and gth injections and 1 and 3 weeks a/ter the 3rd and gth injections, for Ortho Novum group, blood samples were taken on the irst day o[.the 3rd and gth pill cycles and 1 and 3 weeks later in both cycles. For both groups after at least 3 months nonhormonal method of contraception, blood sampling was repeated at follicular and luteal phases of a normal mentrual cycle.Coagulation and librinolysis parameter were detected including hemoglobin,platelet count, prothrombin time, APTT, fibrinogen, factor Vll, [actor X,plasminogen, in PAl, AT Ill (functional and immunological assays) and protein C.In the Cyclolem group, hemoglobin, platelet count, fibrinogen and /Octor X were not changed. Factor Vll significantly reduced. Prothrombin time and APTT showed minor changes. Plasminogen and protein C decreased while t-- PAl and AT 11.1 increased. These changes showed a dynamic balance between coagulatioll and fibrinolysis. In Ortho---Novum 1/35 group, platelet count, jactor X and [ibrinogen increased and prothrombin time and APTT accelerated. In fibrinolysis and anticoagulation system, plasminogen increased as well as protein C, but AT Ill declined. Those changes showed a tendency o[ hyper-coagulabllity state, fibrinolysis and anticoagulation were enhanced to a certain extent.The result of our study is that there are slight 'changes on coagulation and [ibrinolyls is in Cyclofem injectable contraceptive users.

Role of Intra-Aortic Balloon Pump in Off-Pump Coronary Artery Bypass —A Vettath Modification

Objective: Hemodynamic deterioration during positioning of the heart has been the most critical complication of off-pump coronary artery bypass surgery. Pre-operative use of intra-aortic balloon pump has been shown to prevent this complication in high risk patients. The role of balloon pump in high risk patients has been questioned by our group. We modified the role of balloon pump in our patients, thus avoiding the conversion to cardiopulmonary bypass. Methods: 4063 off-pump coronary bypass surgeries were performed by a single surgeon in our center, over thirteen years. 130 intra-aortic balloons used between July 2002 and December 2015 were removed from the the-ater, once the distal anastomosis was performed. We studied this group of patients for—time and need for insertion, duration of balloon used, local insertion problems and survival. Results: Initially, we inserted intra-aortic balloons in high risk patients. We observed that, patients with low ejection fraction and patients with critical left main coronary artery disease were not the ones who actually needed balloon pump support. It was the patients who had ongoing ischemia, with preserved left ventricular function, and ST depression intra-operatively, who needed balloon pump support to perform complete anatomical revascularization. Conclusions: Intra-aortic balloon pump has helped us to position the heart without hemodynamic instability, thereby avoiding conversion to cardio-pulmonary bypass. This enabled us to perform off-pump surgery in virtually all areas of the heart, thus maintaining perfect hemodynamics.

Thrombin Activable Fibrinolysis Inhibitor

The zymogen thrombin activable fibrinolysis inhibitor(TAFI),also known as procarboxypeptidase U(proCPU),was first described by Hendriks and coworkers in 1989.TAFI can be activated by the thrombin-thrombomodulin complex(T-TM) into its active form(TAFIa).In the activating process,Thrombin cleavesTAFI after Arg 92 resulting in the release of an amino-

Change and significance of fibrinolysis in coronary heart disease patients with angina pactoris

Objectives To study change and the clinical significance of fibrinolysis in coronary heart disease(CHD) patients with angina pactoris(AP).Methods Levels of plas-min plasminogen activator inhibitor-1(PAI-1),tissue-type plasminogen activator(t-PA),fibrinogen(FIB) in 110 CHD patients with AP and 20 normal cases as control group were analyzed in the same ways.Results Levels of PAI-1,FIB in CHD patients with AP were significantly higher than those in control cases,and those of t-PA were significantly lower than control cases;Levels of PAI-1,FIB in UA patients with UA heart events were significantly higher than those in patients with SA,and those of t-PA were significantly lower than patients with SA;Levels of PAI-1,FIB in patients with AP events were significantly higher than those in patients without AP events,and those of t-PA were significantly lower than patients without AP events.Conclusions There was abnormal of fibrinolysis function in CHD patients with AP, specially in patients with UA or with AP events,the abnormal of fibrinolysis might be play an important rule in coronary heart disease(CHD) patients with angina pactoris.

Preoperative Intra-Aortic Balloon Counterpulsation in Coronary Artery Bypass Graft Patients with Severe Left Ventricular Dysfunction

Background: The intra-aortic balloon pumping (IABP) is the most used ventricular mechanical assist device. In recent years, the preoperative use in patients with severe ventricular dysfunction presents itself as a great benefic strategy to the postoperative recovery. This paper aim is to evaluate the IABP post-operative benefit in patients with severe ventricular dysfunction. Methods: From January 2011 to March 2016, 125 patients underwent a coronary artery bypass graft (CABG) with cardiopulmonary bypass and preoperative IABP in Teaching Hospital of the ABC Medical School and Hospital Estadual Mario Covas. The inclusion criteria were the presence of severe ischemic cardiomyopathy with left ventricular ejection fraction (LVEF) less than or equal to 40%, estimated by Doppler echocardiography using the Simpson method. The preoperative LVEF was 30.25% ± 8.53% and the diastolic diameter of the left ventricle (LVDD) 67.75 ± 16.37 mm. IABP was installed approximately 15 hours before the surgery. Results: The patients required the IABP for 2.4 ± 1.58 days, and vasoactive drugs, 4.8 ± 2.12 days. We performed 3.2 ± 1.9 grafts per patient and the total length of stay was 07 ± 5.52 days. Cardiopulmonary bypass time was 67 ± 10.95 minutes and anoxia time, 46.4 ± 10.06 minutes. Twelve patients (9.6%) had pneumonia and four (3.2%), atrial fibrillation. We observed a LVDD reduction to 63 ± 16.26 (p = 0.068) and LVEF enhancement to 36.50 ± 16.86 (p = 0.144). The data were analyzed statistically according to the Wilcoxon test. There were no deaths. Conclusion: The initial experience of the authors with the preoperative IABP in patients with severe left ventricular dysfunction suggests great benefit in post-operative recovery with im-provement of LVEF and reduction of LVDD.

Effects on the renal artery blood flow during the intra-aortic balloonpumping was used

The effects of intra-aortic balloon pumping(IABP) on hemodynamic parameters inthe kidney were studied. The pulse produced by pumping activated the renal nervoussystem and reduced the renal vascular resistance. Therefore, the reduction of the renalvascular resistance is an important reason for the increase the renal blood flow duringintra-aortic balloon pumping.

补肾通脉方对急性ST段抬高型心肌梗死PCI术后凝血-纤溶系统及血脂的影响

目的:观察补肾通脉方对急性ST段抬高型心肌梗死经皮冠状动脉介入术(PCI)术后凝血-纤溶系统及血脂的影响。方法:选取2017年3月—2020年3月南京中医药大学附属徐州中医院收治的92例急性ST段抬高型心肌梗死患者,按照随机分组的方法,将其分为对照组和治疗组,各46例。入组患者均给予标准化内科治疗,治疗组在标准治疗的基础上加用补肾通脉方。观察两组治疗前后纤维蛋白原(FIB)、抗凝血酶Ⅲ(AT-Ⅲ)、组织型纤溶酶原激活物(t-PA)、纤溶酶原活化物抑制剂1(PAI-1)、可溶性白细胞分化抗原40配体(sCD40L)、可溶性细胞间黏附因子-1(sICAM-1)及血脂的变化。结果:治疗前,两组FIB、AT-Ⅲ、t-PA、PAI-1水平比较,差异无统计学意义(P>0.05);治疗后,两组FIB、PAI-1水平下降,AT-Ⅲ、t-PA水平升高,治疗组FIB、PAI-1水平低于对照组,AT-Ⅲ、t-PA水平高于对照组,差异有统计学意义(P<0.05)。治疗前,两组sCD40L、sICAM-1水平比较,差异无统计学意义(P>0.05);治疗后,两组sCD40L、sICAM-1水平均显著下降,治疗组sCD40L、sICAM-1水平低于对照组,差异有统计学意义(P<0.05)。治疗前,两组总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平比较,差异无统计学意义(P>0.05);治疗后,两组TC、TG、LDL-C水平均显著下降,HDL-C升高,治疗组TC、TG、LDL-C水平低于对照组,HDL-C水平高于对照组,差异有统计学意义(P<0.05)。结论:在标准化内科治疗基础上加用补肾通脉方能够改善急性ST段抬高型心肌梗死患者PCI术后高凝状态,调节患者体内凝血-纤溶系统平衡,控制炎症反应,降低血脂水平。

血清TAFI和GDF-15在上消化道出血患者诊断及预后评估中的价值

目的 探讨上消化道出血患者的血清纤溶抑制物(TAFI)、生长分化因子-15(GDF-15)表达水平及其在诊断及预后评估中的价值。方法 选择2020年5月至2023年6月保定市第二中心医院收治的94例上消化道出血患者设为研究组,根据AIMS65评分系统对患者预后的评估结果,将患者分为预后良好组(n=65)和预后不良组(n=29),另选择80名同期健康体检者设为对照组。收集入组患者的一般资料,采用ELISA法检测各组的血清TAFI、GDF-15水平,采用Spearman等级相关分析探讨上消化道出血患者的血清TAFI、GDF-15水平与AIMS65评分的相关性,采用ROC曲线分析血清TAFI、GDF-15对上消化道出血患者诊断和预后评估的价值。结果 研究组与对照组中有消化道出血史的患者占比差异有统计学意义(P<0.05);研究组的血清TAFI水平显著低于对照组,而血清GDF-15水平显著高于对照组(P均<0.05)。预后不良组的血清TAFI水平显著低于预后良好组,而血清GDF-15水平显著高于预后良好组(P均<0.05)。Spearman等级相关分析结果显示,上消化道出血患者的血清TAFI水平与AIMS65评分呈显著负相关,而血清GDF-15水平与AIMS65评分呈显著正相关(r=-0.493,r=0.537,P均<0.001)。ROC曲线分析结果显示,血清TAFI、GDF-15诊断上消化道出血的曲线下面积(AUC)分别为0.734和0.776,两者联合诊断的AUC为0.842,两者联合诊断上消化道出血的效能优于单独诊断(P均<0.05)。血清TAFI、GDF-15水平预测上消化道出血患者预后不良的AUC分别为0.658和0.712,两者联合预测上消化道出血患者预后不良的AUC为0.820,两者联合预测预后的效能优于单独预测(P均<0.05)。结论 TAFI在上消化道出血患者血清中呈低表达,而GDF-15呈高表达,两者与AIMS65评分均有相关性,两者联合检测对上消化道出血患者具有一定的诊断和预后预测价值。

益气温阳活血利水法在膜性肾病中的疗效及对相关抗体、凝血纤溶系统的影响

目的:探究益气温阳活血利水法在膜性肾病(MN)中的疗效及对相关抗体、凝血纤溶系统的影响。方法:选择2020年6月-2022年6月北京市昌平区中医医院收治的83例MN患者,根据随机数表法分为对照组(n=41)和观察组(n=42)。对照组进行常规MN治疗,观察组则在对照组的基础上加用益气温阳活血利水法进行治疗。比较两组的MN治疗总有效率、治疗前后的症状体征积分(颜面肢体水肿、神疲乏力及畏寒肢冷)、相关抗体指标[血清抗磷脂酶A2受体抗体(PLA2R-Ab)及磷脂酶A2-ⅠB(PLA2-ⅠB)]及凝血纤溶指标[组织纤维溶酶原激活物(t-PA)、纤溶酶原激活抑制剂(PAI-Ⅰ)及活化部分凝血活酶时间(APTT)、凝血酶时间(TT)]。结果:观察组治疗总有效率显著高于对照组,差异有统计学意义(P<0.05)。治疗前,两组症状体征积分、相关抗体指标及凝血纤溶指标比较,差异无统计学意义(P>0.05);治疗1个疗程及2个疗程后,观察组各项症状体征积分均低于对照组,差异有统计学意义(P<0.05)。治疗1个疗程及2个疗程后,观察组PLA2R-Ab、PLA2-ⅠB及PAI-Ⅰ显著低于对照组,t-PA高于对照组,APTT、TT长于对照组,差异有统计学意义(P<0.05)。结论:益气温阳活血利水法应用于MN中的疗效较好,且可有效改善患者相关抗体及凝血纤溶状态。