血栓弹力图评价心力衰竭合并肺部感染患者凝血状态的价值研究

摘要 目的：探讨血栓弹力图（TEG）评价心力衰竭合并肺部感染患者凝血状态的价值。方法：选取来我院就诊的心力衰竭合并肺部感染患者70例作为研究组,同时选取非心力衰竭合并肺部感染并且无凝血相关疾病患者70例作为对照组。检测常规凝血相关指标、血小板指标以及TEG相关参数,分析TEG相关参数与常规凝血检查指标和血小板指标之间的相关性。以超声检查血栓是否发生为判断标准,对常规凝血检查指标、血小板指标和TEG参数分别进行回归分析,得到回归分析方程后绘制ROC曲线,比较TEG、常规凝血检查和血小板指标评价心力衰竭合并肺部感染患者凝血状态的效能。结果：研究组PT、TT和APTT、PLT水平较对照组显著降低,FIB和D-D较对照组显著升高,差异均具有统计学意义（P<0.05）。研究组中R值、K值较对照组显著下调,而α角和MA值较对照组显著上调,差异具有统计学意义（P<0.05）。R值与PT、 TT以及APTT呈正相关（P<0.05）;K值与FIB呈负相关,与APTT、PLT呈正相关（P<0.05）;α角与FIB、D-D呈正相关,与PLT呈负相关（P<0.05）;MA值与PT、 PLT呈负相关,与FIB呈正相关（P<0.05）。ROC曲线显示,APTT、 D-D、PLT诊断血栓的曲线下面积、特异度和灵敏度均小于TEG。结论：相比于传统常规凝血检查和血小板检查,TEG可以更加全面反映心力衰竭合并肺部感染患者的凝血状态,快速准确地判断心力衰竭合并肺部感染患者是否发生血栓。     

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。     

血栓弹力图测定结果的比对研究

目的:探讨裕泽毅血栓弹力图仪与美国血计公司TEG血栓弹力图仪检测结果相关性,可信度与优劣。方法:根据美国NCCLS-EP9-A,从我院随机抽取60例病人,分别取静脉血2ml、枸橼酸抗凝处理充分混匀后进行测定。用裕泽毅血栓弹力图仪与TEG血栓弹力图仪及两家公司生产的试剂进行平行交叉测定,观察其相关性。结果:美国血技公司TEG血栓弹力图仪对于两家公司的试剂检测结果高度相关(r0.8);裕泽毅公司血栓弹力图仪和试剂对于TEG血栓弹力图仪和试剂检测结果高度相关(r0.8)。结论:裕泽毅公司机器和试剂可以替代TEG机器和试剂进行血栓弹力图检测,能为临床医生提供可靠、准确、有价值的诊断指导依据。     

农业生产中四组数据的Logistic模型的参数确定

本文介绍了求非线性回归模型参数的基本理论,选择Logistic回归模型作为模型函数.以牧草再生长的数据集1为例,用Mathematica软件绘制了数据集1的点图.最后给出四组数据的拟合曲线和置信域.     

血栓弹力图预测下肢骨折围手术期深静脉血栓的应用研究

目的:探讨血栓弹力图(TEG)预测下肢骨折围手术期深静脉血栓的临床价值。方法:选择在我院进行体检的健康志愿献血者作为对照组(Ⅰ),同时选择82例在我院进行骨科手术的下肢骨折患者作为实验组(Ⅱ)。分别在骨折后第2天、手术当天、术后第3天、术后第7天和术后第10天进行血栓弹力图检测,比较实验组(Ⅱ)与对照组(Ⅰ)TEG各参数差异,并对所有数据进行相关性分析。结果:实验组(Ⅱ)82例研究对象中有63例(76.83%)于术后一周内出现高凝状态。与对照组(Ⅰ)比较,实验组(Ⅱ)骨折第2天、手术当天、术后第3天、术后第7天和术后第10天R、K缩短,Angle角、MA、CI值均延长。与手术当日比较,实验组(Ⅱ)术后第3天、术后第7天R和K明显缩短,Angle角、MA、CI值均明显延长(P0.05),与术后第3天、术后第7天比较,术后第10天R、K延长,Angle角、MA、CI值有缩短趋势。结论:血栓弹力图能及时准确监测下肢骨折患者凝血状态变化情况,及时预测下肢深静脉血栓(LDVT)发生风险,为抗凝药物的合理使用提供参考依据。     

新型可控性栓塞剂MNPs-tTF的构建

目的:构建新型的具有可控性且能诱发动物血栓的栓塞剂——磁靶向凝血蛋白,从而为动物血栓模型的建立提供新工具。方法:使用化学共沉淀法合成磁流体(magnetic nanoparticles,MNPs),通过透析对其纯化后用超导量子干涉磁强针(SQUID)测定其磁性能;利用基因工程方法表达截短组织因子(truncated tissue factor,tTF)(又称为凝血蛋白)并纯化与鉴定;采用戊二醛交联法构建磁靶向凝血蛋白(MNPs-tTF),体外分析其磁控靶向性及凝血效力。结果:成功构建了磁靶向凝血蛋白MNPs-tTF,体外实验证实其保留有磁流体MNPs的磁控靶向性,以及凝血蛋白tTF的凝血效力。结论:成功构建了磁靶向凝血蛋白MNPs-tTF,为血栓模型动物的建立提供一种新工具。     

几种光合作用光响应典型模型的比较研究

光响应曲线是判定植物光合效率的重要方法,通过曲线可以获得植物光合特性的相关生理参数,但不同模型提取的光响应参数和指标存在差异。本文选择直角双曲线、非直角双曲线和两种指数曲线模型,分别对3个品系常绿杨光响应数据进行拟合,提取了各光响应曲线模型的主要特征参数,对比分析了各模型参数问的差异,并对光饱和点（LSP）的不同计算方法进行了讨论。最后用巨尾桉光响应数据对分析结果作了进一步验证。结果表明,直角和非直角双曲线模型拟合的最大净光合速率（P＇max）、表观量子效率（a）及暗呼吸速率（Rd）值高于指数模型拟合值,且直角双曲线拟合的各参数均比非直角双曲线拟合的各参数的值大,而两指数模型各参数拟合值基本一致;在LSP计算方法中,用光通量200μmol·m^-2·s^-1以下的点拟合的Pn-I直线与其它模型相结合得到光饱和点的方法不可靠,会使计算结果明显偏小,用接近最大总光合速率Pmax一定比例的方法估计LSP也存在较大偏差,而P＇max由于消除了Rd的影响,计算光饱和点时各模型的估计比例相对固定,是一个比较理想的LSP估计方法,初步得出直角、非直角及指数模型用P＇max来估计光饱和点时应选取的比例分别为（78±1）％、（82±1）％及（96±1）％。     

维生素A缺乏对大鼠肺脏发育的影响

目的探讨维生素A缺乏（vitamin A deficiency,VAD）对大鼠肺脏发育的影响及其可能的机制。方法建立VAD大鼠模型,取出生后2周正常及VAD幼鼠肺脏,HE、Weigert染色分别观察其肺脏组织形态变化和弹力纤维变化;Image Pro Plus5．0软件做肺脏形态学定量分析,蛋白质免疫印记检测大鼠肺组织MMP-9及TIMP-1蛋白含量变化。结果①VAD组大鼠肺上皮细胞堆积,出现明显的肺气肿,并发弥散的间质性肺炎,肺组织弹力纤维显著减少;②VAD组大鼠肺MMP-9的蛋白质表达水平明显高于对照组,TIMP-1水平变化不大,MMP-9与TIMP-1的比值升高。结论VAD导致大鼠肺脏正常发育受损,肺脏组织形态异常,可能通过上调MMP-9的表达诱发大鼠肺气肿。     

4种光响应曲线模型对3种十大功劳属植物的实用性

运用4种光合作用光响应模型对3种十大功劳属植物的光响应数据进行拟合,提取了各光响应模型的主要特征参数并对比分析了各模型参数间的差异。结果表明:不同模型对同一种十大功劳的光响应曲线的拟合结果存在着差异;同一模型对不同十大功劳的光响应曲线的拟合效果也不同;但直角双曲线修正模型对3种十大功劳光响应曲线的拟合效果最佳。因此,在研究植物的光响应时,应考虑光响应模型对植物的整体拟合效果,不能以某个参数作为衡量标准来选取最优的光响应模型。     

CRUSADE评分联合血栓弹力图对急性冠脉综合征患者出血风险的评估

目的:运用CRUSADE评分系统联合血栓弹力图对急性冠脉综合征(acute coronary syndrome,ACS)患者抗栓治疗中的出血风险进行评估。方法:回顾性分析2013年1月至2013年12月在上海交通大学医学院附属新华医院住院的ACS患者病历249例,用CRUSADE评分联合血栓弹力图评估ACS患者30天出血事件的发生。结果:随访的249例ACS患者,共有46例(18.5%)患者发生了出血事件;按照CRUSADE评分进行危险分层,极低危组、低危组、中危组、高危组、极高危组的出血率分别为:15%、7.5%、21.2%、32.5%26.7%;各组间出血率的比较:中危组、高危组及极高危组各组的出血率均高于低危组,差异有统计学意义;而高危组出血率高于极低危组,差异有统计学意义,而极低危组与其他各组比较,差异无统计学意义;低危组以上患者出血率高于低危组以下,差异有统计学意义。低危组以上中危组、高危组及极高危组各组间出血率比较,差异无统计学意义;按照血小板抑制率中位数分组,大于中位数组的出血率高于小于中位数组,差异有统计学意义。经多因素Logistic分析:PAg T抑制率(ADP)是ACS患者抗栓治疗中出血事件的独立影响因素。利用ROC曲线分析CRUSADE评分、血栓弹力图以及两者联合对患者出血事件发生的评估,两者联合的曲线下面积大于单独利用CRUSADE评分。结论:随着CRUSADE评分危险分层的增加出血的发生率亦呈增加趋势;危险分层低危以上的患者,不论中危、高危、极高危发生出血事件风险较低危险以下有明显增加;血栓弹力图监测血小板抑制率可作为CRUSADE评分的补充,提高对ACS患者出血风险的预测。     

Measuring the mechanical properties of blood clots formed via the tissue factor pathway of coagulation

Thrombelastography (TEG) is a method that is used to conduct global assays that monitor fibrin formation and fibrinolysis and platelet aggregation in whole blood. The purpose of this study was to use a well-characterized tissue factor (Tf) reagent and contact pathway inhibitor (corn trypsin inhibitor, CTI) to develop a reproducible thrombelastography assay. In this study, blood was collected from 5 male subjects (three times). Clot formation was initiated in whole blood with 5 pM Tf in the presence of CTI, and fibrinolysis was induced by adding tissue plasminogen activator (tPA). Changes in viscoelasticity were then monitored by TEG. In quality control assays, our Tf reagent, when used at 5 pM, induced coagulation in whole blood in 3.93 ± 0.23 min and in plasma in 5.12 ± 0.23 min (n=3). In TEG assays, tPA significantly decreased clot strength (maximum amplitude, MA) in all individuals but had no effect on clot time (R time). The intraassay variability (CVa<10%) for R time, angle, and MA suggests that these parameters reliably describe the dynamics of fibrin formation and degradation in whole blood. Our Tf reagent reproducibly induces coagulation, making it an ideal tool to quantify the processes that contribute to mechanical clot strength in whole blood.     

血栓弹力图指导食管癌患者临床输血的价值及其与常规凝血实验检测指标的相关性分析

目的:探讨血栓弹力图(TEG)指导食管癌患者临床输血的价值及其与常规凝血实验检测指标的相关性。方法:选取2017年1月-2019年3月在我院收治的食管癌手术治疗需输血的99例患者作为研究对象,将99例患者随机分为常规凝血功能检测组和TEG组,常规凝血功能检测组采用常规凝血实验检查结果指导输血,TEG组采用TEG检查结果指导输血,对比两组输血前后的常规凝血实验检测指标以及临床用血量,对比TEG组输血前后的TEG指标,分析TEG指标与常规凝血实验检测指标的相关性。结果:两组患者输血前凝血四项和血小板计数(PLT)差异无统计学意义(P>0.05),输血后两组活化凝血酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)均有不同程度的改善(P<0.05),TEG组PT、TT较常规凝血功能检测组低(P<0.05);输血后,TEG组患者凝血反应时间(R值)、血凝块形成时间(K值)较输血前降低,最大血凝块强度(MA值)、凝血综合指数(CI值)升高,凝血形成速率(Angle角)增大,差异有统计学意义(P<0.05);Pearson相关性分析结果显示,R值与APTT呈正相关(P<0.05),K值与PLT呈负相关,与FIB呈正相关(P<0.05),Angle角、MA值、CI值与FIB、PLT呈正相关(P<0.05);TEG组新鲜冰冻血浆、冷沉淀输注量少于常规凝血功能检测组,差异有统计学意义(P<0.05)。结论:TEG能更好地指导食管癌手术患者各种血液成分的合理输注,有效改善凝血异常情况,减少输血用量,TEG指标与常规凝血实验检测指标存在一定的相关性。     

血栓弹力图检测在卵巢过度刺激综合征中的应用

目的:研究血栓弹力图在卵巢过度刺激综合征(Ovarian Hyperstimulation Syndrome,OHSS)患者血凝块形成评价中的应用及临床意义。方法:将35例接受胚胎移植治疗后发生OHSS患者及21例同期治疗未发生OHSS患者,进行血栓弹力图(Thromboelastography,TEG)检测,同时收集常规凝血参数(凝血酶原时间(Prothrombin time,PT)、活化部分凝血活酶时间(Activated partial thromboplastin time,APTT)、纤维蛋白原(Fibrinogen,FIB)等)。分析OHSS患者与对照患者凝血和TEG各指标的差异,以及OHSS患者治疗前后TEG各指标的差异。结果:(1)OHSS患者PT时间明显高于对照组,FIB水平明显低于对照组,但APTT时间无明显区别(P=0.112);(2)TEG检测OHSS组的血凝综合指数明显高于对照组(3.6±0.7:0.8±0.5);(3)治疗后,OHSS患者血凝综合指数2.8±0.9,较治疗前明显下降(P0.01)。结论:TEG检测可用于OHSS患者凝血功能的评估。     

Effects of Extremely Low Frequency Magnetic Fields on Blood Coagulation in Mice: An Initial Study

OF1 mice were chronically exposed to a 50‐Hz sinusoidal East–West magnetic field 15 µT (rms), in order to evaluate the blood coagulation variations related to the effect of this nonionizing radiation. Mating and pregnancy of ancestors (first generation), and birth, lactation, and development of second‐generation female mice until adulthood took place in the experimental field. A global blood coagulation study of both control and exposed 14‐ to 15‐week‐old and 50‐ to 52‐week‐old, second‐generation females was carried out. Plasma calcium content was determined by atomic absorption spectrophotometry. Different steps of blood coagulation were studied by thromboelastography (TEG) in whole blood (WB), platelet‐rich plasma (PRP), and platelet‐poor plasma (PPP). A significant decrease (approximately 34.5%) of calcium concentration was detected with aging; however, no change was induced by medium‐term or long‐term exposure to extremely low frequency magnetic field (ELF‐MF). Medium‐term exposure could not be related to noticeable changes in global coagulation. However, a great deterioration of fibrin clot formation in mature exposed female mice was detected as a result of the long‐term exposure that was strengthened by aging. These deficiencies seemed to be compensated by the discrete, although statistically not significant, decrease of platelet counts and the significant decrease of blood cells' mean corpuscular volume associated to ELF‐MF exposure of 50‐Hz, 15 µT. Consequently, whole blood TEG values of mature exposed female mice were similar to those from the young control group. In view of the obtained results, further studies on variations associated with ELF‐MF exposure in different coagulation parameters will be necessary.     

Role of thromboelastography in clinical emergency trauma patients

This study aimed to investigate dynamic changes in thromboelastography (TEG) and evaluate its value for emergency trauma patients. TEG values (R, K, Angle, MA and CI) were detected l, 3, and 7 days post trauma. Followup prognosis data were recorded among all patients and correlations between TEG changes and prognosis were assessed. The results revealed that the K and R volumes of the poor prognosis group were obviously higher than those of the good prognosis group at each time point; while the Angle, MA, and CI volumes of the poor prognosis group were relatively lower than those of the good prognosis group, and showed a little rising tendency. This study suggests that variables measured by TEG were closely associated with prognosis evaluation, and highlighted the dangers of coagulation disorder at early stage. TEG is of benefit in evaluating the function of coagulation in clinical emergency trauma patients.     

Mathematical model of antiviral immune response. II. Parameters identification for acute viral hepatitis B

Considering the mathematical model of antiviral immune response, we describe a method of fitting the model to the data characterizing acute viral hepatitis B. The corresponding procedure employs an idea of sequential parameter estimation to make the problem of fitting manageable. The underlying mechanisms responsible for the quantitative manifestations of the four basic phases of acute hepatitis B are used to select the model parameters. The identified model of acute hepatitis B is then tested with regard to the following situations: the effect of HBsAg-specific antibodies on HBV challenge; the vaccination and the resistance to challenge using live hepatitis B virus; the dose of viruses--the incubation time relationships. The sensitivity of the model with respect to parameters variations is then analysed. The developed model allows us to quantitatively simulate the basic features of the antiviral immune response during acute hepatitis B and some closely related phenomena.     

Mathematical modeling of cancer radiovirotherapy

Cancer virotherapy represents a dynamical system that requires mathematical modeling for complete understanding of the outcomes. The combination of virotherapy with radiation (radiovirotherapy) has been recently shown to successfully eliminate tumors when virotherapy alone failed. However, it introduces a new level of complexity. We have developed a mathematical model, based on population dynamics, that captures the essential elements of radiovirotherapy. The existence of corresponding equilibrium points related to complete cure, partial cure, and therapy failure is proved and discussed. The parameters of the model were estimated by fitting to experimental data. By using simulations we analyzed the influence of parameters that describe the interaction between virus and tumor cell on the outcome of the therapy. Furthermore, we evaluated relevant therapeutic scenarios for radiovirotherapy, and offered elements for optimization.     

Toward a mathematical model of the assembly and disassembly of membrane microdomains: comparison with experimental models

We study a model system in which lipid bilayers are created using variable (precisely known) proportions of phosphatidylcholine and cholesterol. The model membranes exhibit cholesterol-enriched microdomains that are analogous to the so-called "lipid rafts" that form in living cells. After briefly presenting some experimental results, we formulate and solve a novel mathematical model based on the Smoluchowski equations for coagulation and fragmentation. We present a comparison between the distribution of lipid-raft areas observed in experimental lipid bilayers, and that distribution predicted by the theoretical model. Excellent agreement between the experiments and theory is obtained, with minimal parameter fitting.     

A mathematical and statistical framework for modelling dispersal

Mechanistic and phenomenological dispersal modelling of organisms has long been an area of intensive research. Recently, there has been an increased interest in intermediate models between the two. Intermediate models include major mechanisms that affect dispersal, in addition to the dispersal curve of a phenomenological model. Here we review and describe the mathematical and statistical framework for phenomenological dispersal modelling. In the mathematical development we describe modelling of dispersal in two dimensions from a point source, and in one dimension from a line or area source. In the statistical development we describe applicable observation distributions, and the procedures of model fitting, comparison, checking, and prediction. The procedures are also demonstrated using data from dispersal experiments. The data are hierarchically structured, and hence, we fit hierarchical models. The Bayesian modelling approach is applied, which allows us to show the uncertainty in the parameter estimates and in predictions. Finally, we show how to account for the effect of wind speed on the estimates of the dispersal parameters. This serves as an example of how to strengthen the coupling in the modelling between the phenomenon observed in an experiment and the underlying process – something that should be striven for in the statistical modelling of dispersal.     

A Mathematical Model of Uterine Dynamics and its Application to Human Parturition

We have developed a simple mathematical model with three physiologically significant states to describe the changes in intrauterine pressure associated with a contraction during human parturition. The myometrium is modelled as a set of smooth muscle cells, each of which is in one of three states (quiescent, contracted, refractory) at a given time. These states are occupied according to a cycle governed by three temporal parameters. The solutions of the equations describing the model show an oscillatory behavior for particular values of these parameters, which is very similar to the time dependant development of intrauterine pressure during labor. Due to its non-linear terms, our model could lead to chaotic oscillations (in the mathematical sense), whose clinical counterpart may occur in cases of dystocia. Despite its simplicity, this model appears to be a useful guide to further investigations of the oscillatory behavior of the myometrium, or other smooth muscles, in normal and pathological situations.