对比分析多种介入途径治疗门静脉系统血栓的临床疗效

目的:对比分析多种介入途径治疗门静脉系统血栓的临床疗效。方法:收集从2001年1月至2009年3月经我科治疗的37例门静脉系统(包括门静脉、肠系膜上、下静脉及脾静脉)血栓形成患者,根据介入治疗途径的不同分为三组:A组(13例)行经TIPS途径门静脉行碎栓溶栓及置管溶栓术;B组(19例)行直接经皮穿肝门静脉碎栓和或置管溶栓术;C组(5例)行经肠系膜上动脉置管溶栓治疗。所有的患者术后定期随访1-12个月,复查CT或彩超了解门静脉系统的血流变化及临床症状恢复情况。结果:A组:经治疗出院时11例(85%)患者门静脉完全再通,;1例(8%)门静脉血流部分再通,1例(8%)术后第二天因出血死亡。术后随访1、3、6、12月门静脉通畅率分别为:85%,77%,77%,62%;所有患者的临床症状均明显缓解。B组:经治疗出院时7例(37%)门静脉完全再通,9例(47%)部分再通,3例(16%)因出血中止溶栓;随访1、3、6月、12月门静脉通畅率分别为:32%,26%,16%,16%。C组:经治疗出院时5例(100%)患者门静脉均未再通,通畅率为0%,术后随访1-3个月内4例患者临床症状得到部分缓解。结论:经TIPS途径治疗后门静脉的再通率及临床症状改善均好于直接经皮穿肝及经肠系膜上动脉途径。经肠系膜上动脉置管溶栓法无法使已有侧支形成的门静脉主干复通,仅能一定程度缓解患者的临床症状。     

Mouse Complete Stasis Model of Inferior Vena Cava Thrombosis

Venous thromboembolism (VTE) includes both deep vein thrombosis (DVT) and pulmonary embolism (PE). In the United States (U.S.), the high morbidity and mortality rates make VTE a serious health concern ^1-2. After heart disease and stroke, VTE is the third most common vascular disease ³. In the U.S. alone, there is an estimated 900,000 people affected each year, with 300,000 deaths occurring annually ³. A reliable in vivo animal model to study the mechanisms of this disease is necessary.The advantages of using the mouse complete stasis model of inferior vena cava thrombosis are several. The mouse model allows for the administration of very small volumes of limited availability test agents, reducing costs dramatically. Most promising is the potential for mice with gene knockouts that allow specific inflammatory and coagulation factor functions to be delineated. Current molecular assays allow for the quantitation of vein wall, thrombus, whole blood, and plasma for assays. However, a major concern involving this model is the operative size constraints and the friability of the vessels. Also, due to the small IVC sample weight (mean 0.005 grams) it is necessary to increase animal numbers for accurate statistical analysis for tissue, thrombus, and blood assays such as real-time polymerase chain reaction (RT-PCR), western blot, enzyme-linked immunosorbent (ELISA), zymography, vein wall and thrombus cellular analysis, and whole blood and plasma assays ^4-8.The major disadvantage with the stasis model is that the lack of blood flow inhibits the maximal effect of administered systemic therapeutic agents on the thrombus and vein wall.     

Novel factor Xa inhibitor,maslinic acid,with antiplatelet aggregation activity

As antithrombotic effects of maslinic acid (MA) have not yet been studied, MA-mediated downregulation of coagulation factor Xa (FXa) and platelet aggregation was studied. We show that MA inhibited the enzymatic activity of FXa and platelet aggregation, induced by adenosine diphosphate (ADP) and a thromboxane A₂ (TXA₂) analog, U46619 with a similar antithrombotic efficacy to rivaroxaban, a direct FXa inhibitor used as a positive control. Mechanistically, MA suppressed U46619- or ADP-induced phosphorylation of myristoylated alanine-rich C kinase substrate, and the expression of P-selectin, and activated PAC-1 in platelets. MA increased generation of nitric oxide, but downregulated excessive secretion of endothelin-1 in ADP- or U46619-treated human umbilical vein endothelial cells. In arterial and pulmonary thrombosis mouse model, MA showed prominent anticoagulant and antithrombotic effects. Our data suggest MA as a candidate molecule for a new class of drugs targeting anti-FXa and antiplatelet.     

The FXIIIVal34Leu, common and risk factors of venous thrombosis in early middle-age Costa Rican patients

In this study, eight common polymorphisms associated with venous thrombosis (VT) and thrombophilia factors were analyzed in a Costa Rican case-control study. With the use of polymerase chain reaction (PCR) methods the polymorphisms were detected in 120 patients and 133 controls (mean age <40 years old). It was concluded that a high level of fibrinogen, antiphospholipid antibodies, family history, and the genotype 34LeuLeu of FXIII OR 0.42 (0.20-0.89) showed a significant effect on the risk of VT.Associations between the risk of VT and genetic polymorphisms have been established. Some of these polymorphisms are highly prevalent in Caucasians, but there is a significant geographic variation in their prevalence among different populations. The results of this study support the protective effect of FXIII Val34Leu polymorphism in VT. These findings are consistent with previous reports that included other populations.     

Gα13 Switch Region 2 Binds to the Talin Head Domain and Activates αIIbβ3 Integrin in Human Platelets

Even though GPCR signaling in human platelets is directly involved in hemostasis and thrombus formation, the sequence of events by which G protein activation leads to αIIbβ3 integrin activation (inside-out signaling) is not clearly defined. We previously demonstrated that a conformationally sensitive domain of one G protein, i.e. Gα₁₃ switch region 1 (Gα₁₃SR1), can directly participate in the platelet inside-out signaling process. Interestingly however, the dependence on Gα₁₃SR1 signaling was limited to PAR1 receptors, and did not involve signaling through other important platelet GPCRs. Based on the limited scope of this involvement, and the known importance of G₁₃ in hemostasis and thrombosis, the present study examined whether signaling through another switch region of G₁₃, i.e. Gα₁₃ switch region 2 (Gα₁₃SR2) may represent a more global mechanism of platelet activation. Using multiple experimental approaches, our results demonstrate that Gα₁₃SR2 forms a bi-molecular complex with the head domain of talin and thereby promotes β3 integrin activation. Moreover, additional studies provided evidence that Gα₁₃SR2 is not constitutively associated with talin in unactivated platelets, but becomes bound to talin in response to elevated intraplatelet calcium levels. Collectively, these findings provide evidence for a novel paradigm of inside-out signaling in platelets, whereby β3 integrin activation involves the direct binding of the talin head domain to the switch region 2 sequence of the Gα₁₃ subunit.     

Quercetin-3-rutinoside Inhibits Protein Disulfide Isomerase by Binding to Its b′x Domain

Quercetin-3-rutinoside inhibits thrombus formation in a mouse model by inhibiting extracellular protein disulfide isomerase (PDI), an enzyme required for platelet thrombus formation and fibrin generation. Prior studies have identified PDI as a potential target for novel antithrombotic agents. Using a fluorescence enhancement-based assay and isothermal calorimetry, we show that quercetin-3-rutinoside directly binds to the b′ domain of PDI with a 1:1 stoichiometry. The binding of quercetin-3-rutinoside to PDI induces a more compact conformation and restricts the conformational flexibility of PDI, as revealed by small angle x-ray scattering. The binding sites of quercetin-3-rutinoside to PDI were determined by studying its interaction with isolated fragments of PDI. Quercetin-3-rutinoside binds to the b′x domain of PDI. The infusion of the b′x fragment of PDI rescued thrombus formation that was inhibited by quercetin-3-rutinoside in a mouse thrombosis model. This b′x fragment does not possess reductase activity and, in the absence of quercetin-3-rutinoside, does not affect thrombus formation in vivo. The isolated b′ domain of PDI has potential as an antidote to reverse the antithrombotic effect of quercetin-3-rutinoside by binding and neutralizing quercetin-3-rutinoside.     

Expression of cholera toxin B subunit–lumbrokinase in edible sunflower seeds–the use of transmucosal carrier to enhance its fusion protein's effect on protection of rats and mice against thrombosis

Lumbrokinase (LK) is a group of serine proteases with strong fibrinolytic and thrombolytic activities and is useful for treating diseases caused by thrombus. Cholera toxin B subunit (CTB) has been widely used to facilitate antigen delivery by serving as an effective mucosal carrier molecule for the induction of oral tolerance. We investigate here the application of CTB as a transmucosal carrier in enhancing its fusion protein‐LKs effect to protect rats against thrombosis. Thus, in this study, CTB‐LK fusion gene separated by a furin cleavage site was expressed in seeds of Helianthus annuus L. The activity of recombinant protein in seeds of transgenic sunflower was confirmed by Western blot analysis, fibrin plate assays and G_M1‐ganglioside ELISA. The thrombosis model of rats and mice revealed that the oral administration of peeled seeds of sunflower expressing CTB‐LK had a more significant anti‐thrombotic effect on animals compared with that administration of peeled seeds of sunflower expressing LK. It is possible to conclude that CTB can successfully enhance its fusion protein to be absorbed in rats or mice thrombosis model. The use of CTB as a transmucosal carrier in the delivery of transgenic plant‐derived oral therapeutic proteins was supported. In addition, for the purpose of that recombinant CTB‐LK was designed for oral administration, thus the expression of CTB‐LK in edible sunflower seeds eliminated the need for downstream processing of proteins. © 2014 American Institute of Chemical Engineers Biotechnol. Prog., 30:1029–1039, 2014     

血栓弹力图指导支架内血栓后不稳定心绞痛治疗1 例及文献复习

目的:探讨在血栓弹力图监测血小板抑制率的情况下,调整氯吡格雷及阿司匹林用量,治疗冠心病、PCI术后支架内再发血栓患者的临床意义。方法:报告中国人民解放军总医院1例支架内亚急性血栓患者的临床资料并复习相关文献,对其临床表现、诊断、在血栓弹力图指导下的治疗进行分析。结果:1例支架内亚急性血栓患者经治疗病情好转出院,出院后继续调整氯吡格雷及阿司匹林用量,达到满意血小板抑制率,患者症状消失。结论:冠状动脉介入治疗后发生支架内血栓的患者,应用血栓弹力图指导氯吡格雷及阿司匹林用量,可达到令人满意的血小板抑制率,并防止出血情况发生。     

滇丹参、甘西鼠尾、褐毛甘西鼠尾水提取液对鼠血栓形成及微循环的影响

目的：观察云南产甘西鼠尾属药物滇丹参、甘西鼠尾、褐毛甘西鼠尾的水提取物对鼠血栓形成及微循环的影响。方法：用电刺激法造成大鼠颈动脉血栓形成,观察血流阻塞时间(OT值);小鼠尾静脉注射血栓形成诱导剂,观察滇丹参、甘西鼠尾、褐毛甘西鼠尾对抗肺血栓形成的作用;采用活体微循环观察方法,研究滇丹参、甘西鼠尾、褐毛甘西鼠尾对去甲肾上腺素和高分子右旋糖苷所致小鼠、大鼠肠系膜微循环障碍的影响。结果：滇丹参、甘西鼠尾、褐毛甘西鼠尾2、4g/kg时,能明显延长闭塞性血栓形成时间(OT值)(P＜0．01)。20、40g/kg时,能有效抑制胶原和肾上腺素复合液所致小鼠肺血栓形成(P＜0．0l,P＜0．05)。能显著改善微动脉、微静脉痉挛和血液流态,增加毛细血管开放数,加快血流速度(P＜0．0l,P＜0．05)。结论：滇丹参、甘西鼠尾、褐毛甘西鼠尾均能防止血栓形成、改善微循环障碍。     

高压氧与降纤酶综合治疗脑血栓形成42例分析

目的：探讨高压氧与降纤酶结合治疗脑血栓形成的疗效。方法：把124例脑血栓形成患者随机分为A组、B组、C组,A组42例采用高压氧加降纤酶治疗;B组38例采用降纤酶治疗;C组44例采用常见规治疗。并分析和比较3组患者的治疗效果。结果A组治愈率80．36％,同时治疗前后血液流变学检查血浆比粘度、红细胞压积、低切变等差异有非常显著性意义（P＜0．01）;B组治愈率61．3％;C组治愈率52．3％。三组患者治愈率差异有显著意义（P＜0．01）。结论高压氧与降纤酶联合治疗脑血栓形成的效果优于常规组和单纯降纤酶治疗组的治疗效果,并能改善血液粘调度,是治疗脑血栓形成的好方法。