不同质子泵抑制剂对冠脉支架植入术后氯吡格雷联合阿司匹林抗血小板作用的研究

目的:通过比较奥美拉唑和泮托拉唑对冠状动脉支架术(PCI)后患者血小板功能指标和主要不良心血管事件与出血并发症发生情况,探讨不同质子泵抑制剂对PCI后氯吡格雷联合阿司匹林抗血小板作用的影响。方法:60例实施PCI后常规联合抗血小板治疗(氯吡格雷75mg/d+阿司匹林100mg/d)患者随机分为奥美拉唑组(40mg/d,20例),泮托拉唑组(40mg/d,20例)和对照组(20例),连续用药30d。分别在服药前1d及服药15d,30d用血栓弹力图检测ADP途径诱导的血小板抑制率值和比浊法检测ADP途径诱导的血小板最大聚集率(MPAR)。并观察30d各组主要不良心血管事件和出血并发症的发生情况。结果:①奥美拉唑组和泮托拉唑组与对照组相比,服药前1d及服药15d,30d用血栓弹力图检测的血小板抑制率和比浊法检测的血小板最大聚集率(MPAR)均无明显变化;奥美拉唑与泮托拉唑组间比较,差异也无统计学意义。服药15d,30d与服药前1d相比,每组血小板抑制率明显升高,血小板最大聚集率明显下降,差异有统计学意义(P0.05);但15d和30d相比较,差异无统计学意义。②三组比较心血管事件发生率相近,差异无统计学意义(P0.05);奥美拉唑组和泮托拉唑组比较,心血管事件发生率也无统计学差异(P0.05)。③与对照组比较,奥美拉唑组和泮托拉唑组胃肠道出血发生率均明显减少,有统计学意义(P0.05),但两服药组间比较,出血发生率无明显区别,差异无统计学意义(P0.05)。结论:氯吡格雷联合阿司匹林具有增强血小板抑制,降低血小板凝聚的作用,而不同机制质子泵抑制剂奥美拉唑与泮托拉唑对PCI术后氯吡格雷联合阿司匹林抗血小板治疗患者的血小板功能无明显影响,不降低对心血管事件的预防效果,同时明显降低患者胃肠出血事件的发生率。     

阿托伐他汀强化治疗对冠脉介入冠心病患者的保护作用研究

目的:探讨阿托伐他汀强化治疗对冠脉介入冠心病患者的保护作用。方法:将86例择期行经皮冠脉介入(PCI)治疗的冠心病患者随机分为对照组和观察组,每组各43例。两组均行常规治疗,对照组在PCI术后服用阿托伐他汀20 mg/d,观察组在PCI术前服用阿托伐他汀80 mg,术后服用阿托伐他汀20 mg/d,术后两组均维持服用4周。比较PCI术前、术后患者血小板活化、内皮功能及血清肌酸激酶同工酶(CK-MB)、肌钙蛋白I(c TNI)、超敏C反应蛋白(hs-CRP)水平的变化。结果:术前及术后24 h,两组间血小板活化指标P-选择素(CD62P)和血小板膜糖蛋白Ⅱb/Ⅲa(GPⅡb/Ⅲa)水平比较差异无统计学意义(P0.05),术后4周,两组患者CD62P和GPⅡb/Ⅲa水平均较术前及术后24 h显著降低,且观察组降低更显著(P0.05);术前及术后24 h,两组间内皮功能指标内皮素1(ET-1)、一氧化氮(NO)水平比较差异无统计学意义(P0.05);术后4周,两组患者ET-1水平均较术前及术后24 h显著降低,NO水平均显著升高,且观察组改变更显著(P0.05);术后24 h,两组患者的血清CK-MB、TNI和hs-CRP水平均较术前显著升高(P0.05),但观察组升高幅度明显低于对照组(P0.05)。结论:阿托伐他汀强化治疗可抑制PCI术后血小板活化,改善血管内皮功能,抑制炎症反应,减少心肌损伤。     

银杏叶提取物抗实验性血栓模型大鼠的作用及机制

目的:研究银杏叶提取物对血栓模型大鼠血栓形成,血小板聚集及血浆中一氧化氮(NO),环磷酸鸟苷(cGMP)和前列环素(PGI2)的影响.方法:100只SD雄性大鼠随机分为5组,分别ig给予5gL-1的CMC-Na,100mg.Kg-1阿司匹林(Asp),42,21,10.5mg.Kg-1银杏叶提取物连续4w.建立大鼠动静脉旁路血栓模型,观察药物时血栓形成的影响,比浊法观察对ADP诱导的血小板聚集的作用,按试剂盒方法检测药物对血浆中NO,cGMP,PGI2的影响.结果:银杏叶提取物可显著抑制血栓形成和血小板聚集率,升高血浆中NO,cGMP,PGI2浓度,高剂量组效果优于阿司匹林组.结论:银杏叶提取物具有抗血栓作用.     

单环刺螠糖胺聚糖抗大鼠血小板聚集效应研究

本文研究了单环刺螠糖胺聚糖影响大鼠血小板聚集的效应与机制。采用比浊法测定大鼠血小板最大聚集百分率,双波长Fura-2荧光法测定大鼠血小板内钙离子浓度,激光扫描共聚焦显微镜检测了大鼠血小板中的钙离子水平;酶联免疫吸附法测定大鼠血小板内环磷酸腺苷(c AMP)、血浆血栓素B2(TXB2)和6酮前列腺素F1α及血小板膜糖蛋白GPⅡb/Ⅲa的浓度。结果表明:单环刺螠糖胺聚糖能够显著降低大鼠血小板的最大聚集率(P 0. 01),显著降低血小板内的钙离子浓度(P 0. 01),显著升高大鼠血小板c AMP浓度(P 0. 01),显著降低血浆中的TXB2浓度(P 0. 05),显著升高大鼠血浆中的6酮前列腺素F1α浓度(P 0. 01),显著降低血小板膜糖蛋白的浓度(P 0. 05)。该研究初步揭示了单环刺螠糖胺聚糖抗大鼠血小板聚集的机制,为该糖胺聚糖的进一步利用奠定科学基础。     

CYP2C19基因型检测指导P2Y12受体阻滞剂应用的研究进展

急性冠脉综合征(Acute coronary syndrome,ACS)是全球范围内引发猝死的主要原因,其发生是由于血小板聚集引起冠脉急性闭塞所致。阿司匹林和氯吡格雷已经成为ACS及经皮冠状动脉介入治疗(Percutaneous coronary intervention,PCI)术后患者抗栓治疗的基石,防止PCI术后发生主要不良心血管事件(Major adverse cardiovascular events,MACE)。然而,尽管接受阿司匹林及氯吡格雷双联抗血小板治疗,部分患者仍可再发缺血性心血管事件,考虑存在抗血小板药物抵抗。研究表明,亚洲人群中氯吡格雷抵抗(Clopidogrel resistance,CR)发生率较高,且受多种因素影响,其中基因多态性起着至关重要作用。全面了解不同基因型对氯吡格雷反应的差异,结合血小板聚集率检测,合理选择P2Y12受体阻滞剂,可以显著改善ACS患者预后。     

血小板膜糖蛋白(GP)Ⅲa PLA、Ⅰa807C/T 基因多态性与阿司匹林 抵抗的相关性研究

目的:探讨青岛地区汉族人群阿司匹林抵抗与血小板膜糖蛋白GPⅢaPLA、Ⅰ a807C/T基因多态性之间的关系.方法:筛选150例动脉粥样硬化患者服用阿司匹林(100mg/d)至少14d以上,根据血小板聚集功能测定将其分为阿司匹林抵抗(AR)组、阿司匹林半抵抗(ASR)组,阿司匹林敏感(AS)组.用PCR-RFLP法确定各组GPⅢaPLA、GP Ⅰa 807C/T基因型.结果:仅于ASR组检出1例PLA1/A2基因型,其余均为PLA1/A1基因型,未发现PLA2/A2基因型,差异无统计学意义(P＞0.005);GP Ⅰ a807C/T基因位点AR组、ASR组的T等位基因频率均显著高于AS组,有统计学意义(P＜0.005).结论:GPⅢaPLA2基因可能不是阿司匹林抵抗的遗传危险因素.而GP Ⅰ a 807C/T基因位点的T等位基因与阿司匹林抵抗的发生相关联,可能是阿司匹林抵抗遗传易感因素.     

冠心病患者阿司匹林抵抗发生率与正常人的比较

目的:观察冠心病患者阿司匹林抵抗的发生率是否与正常人群有差异。方法:心内科住院的冠心病病人50例和正常对照组30例每天服用阿司匹林100mg,7天后用二磷酸腺苷(ADP)、花生四烯酸(AA)作为血小板聚集诱导剂检测定血小板聚集率。结果:在50例冠心病患者中,阿司匹林完全抵抗发生率为12%(6/50);阿司匹林半抵抗发生率为26(13/50),阿司匹林敏感率为62%(31/50)。在30例正常对照组中,阿司匹林完全抵抗发生率为13.3%(4/30);阿司匹林半抵抗发生率为26.6%(8/30),阿司匹林敏感率为60.1%(18/30)。结论:冠心病患者阿司匹林抵抗的发生率是与正常人群没有差异。     

不稳定型心绞痛和急性心肌梗死患者血小板指标及超敏C 反应蛋白变化

目的:探讨不稳定型心绞痛(unstable angina pectoris,UAP)、急性心肌梗死(acute myocardial infarction,AMI)患者血小板指标、超敏C反应蛋白(C-reactive protein,hs-CRP)水平变化及意义。方法:选取于我院进行治疗的急性冠脉综合征患者300例中UAP患者121例(UAP组),AMI患者179例(AMI组)。另选100例健康体检者作为对照组。300例急性冠脉综合征患者均口服阿司匹林进行治疗。服用阿司匹林7 d后比较各组血小板指标血小板聚集率、血小板膜糖蛋白CD62p、尿11-脱氢-血栓素B2(11-dehydro-Thromboxane,11-DH-TXB2)及hs-CRP水平变化,同时记录随访1年急性冠脉综合征患者心血管事件发生情况。结果:治疗后UAP组、AMI组二磷酸腺苷(adenosine diphosphate,ADP)及花生四烯酸(arochidonic acid,AA)诱导的血小板聚集率、11-DH-TXB2与对照组差异显著(P0.05),AMI组CD62p、hs-CRP水平均显著高于对照组(P0.05);随访1年,11-DH-TXB2水平≥1500 ng/g者心血管事件发生率为51.02%,11-DH-TXB2水平1500 ng/g者心血管事件发生率为22.28%,二者发生率差异显著(P0.05)。结论:血小板指标、hs-CRP检测对UAP、AMI具有临床意义。     

替格瑞洛与氯吡格雷对急性冠脉综合征患者经皮冠脉动脉介入术后血小板抑制效果的比较

目的:比较替格瑞洛与氯吡格雷对急性冠脉综合征(ACS)患者经皮冠脉动脉介入术(PCI)后血小板的抑制效果。方法:选择2014年3月至8月在我院经替格瑞洛联合阿司匹林治疗的ACS患者85例(替格瑞洛组),按性别、年龄2:1匹配原则随机抽取同一时间服用氯吡格雷联合阿司匹林治疗患者170例(氯吡格雷组)为研究对象,两组患者均行PCI治疗,并于服用抗血小板药物负荷剂量2天(PCI术后)进行血栓弹力图(TEG)检测,观察和比较两组患者经ADP途径及经AA途径的血小板抑制率。结果:氯吡格雷组和替格瑞洛组经ADP途径的血小板抑制率分别为(66.60±25.57)%、(82.10±18.87)%,两组比较差异有统计学意义(P0.05)。氯吡格雷组ADP抑制率50%患者占总人数的29.4%,替格瑞洛组ADP抑制率50%的患者占总人数的10.6%,两组差异有统计学意义(P0.05),氯吡格雷组ADP抑制率75%者占总人数的41.8%;而替格瑞洛组ADP抑制率75%的患者占总人数的69.4%,两组抑制率差异也存在统计学意义(P0.05)。氯吡格雷组和替格瑞洛组经AA途径的血小板抑制率分别为(88.70±23.89)%、(90.32±18.09)%,两组比较差异无统计学意义(P0.05)。结论:替格瑞洛对ACS患者PCI术后血小板的抑制作用优于氯吡格雷。     

瑞舒伐他汀和阿托伐他汀在急性冠脉综合症中对氯吡格雷抗血 小板活性的对比研究

目的：在急性冠脉综合征( acute coronary syndromes, ACS )的治疗中,抗血小板治疗及调脂治疗是最基础的治疗方案。近来 有学者提出,氯吡格雷和他汀类药物都经过细胞色素CYP 3A4 途径代谢,二者因存在竞争性抑制,有可能降低氯吡格雷抗血小板 的活性。本试验将针对阿托伐他汀及瑞舒伐他汀进行研究。方法：选择急性冠脉综合症的患者42 例,所有患者均接受氯吡格雷治 疗（负荷剂量300 mg,维持剂量75 mg/d）。随机分配为A、B 两组,A 组（n=20）服用阿托伐他汀治疗（20 mg/d）,B 组（n=22 服用瑞 舒伐他汀治疗（10 mg/d）。分别于氯吡格雷服用前、服药治疗后3 天、服药治疗后7 天后采静脉血送检,测定ADP（10 滋mol/L）诱导 的血小板聚集率。结果：阿托伐他汀组（A 组）及瑞舒伐他汀组（B 组）相比,服用氯吡格雷前ADP 诱导的血小板聚集率基线值无 统计学差异。服用氯吡格雷3 日及7 日后,ADP诱导的血小板聚集率明显降低,(3.85± 2.58)vs(3.09± 2.27),(0.65± 0.88)vs(1.05± 0.95),P>0.05,无明显统计学差异。结论：氯吡格雷的确可以降低血小板的活性。同时,短期之内氯吡格雷的抗血小板活性未受到 他汀类的影响,包括经过CPY3A4途径的他汀,如阿托伐他汀。     

Characteristics of the membranes of the pellicle of the ciliatePseudomicrothorax dubius

Summary The membranes of the pellicle of the ciliatePseudomicrothorax dubius are investigated using thin section electron microscopy and freeze-fracture replicas. The plasma membrane is covered by a surface coat and is connected to the outer alveolar membrane by short, sometimes branched, bridges. The inner alveolar membrane is coated on both sides. The epiplasm lies in intimate contact with the cytoplasmic surface of this membrane, and there is a corresponding deposit on the other surface. This deposit is regularly striated.The epiplasmic layer and the alveoli are interrupted at sites of cytotic activity,e.g., the attachment sites of trichocysts, the cytoproct, and the parasomal sacs. The striated deposit ends where the epiplasm ends, indicating a direct relationship between these two epimembranous layers.There is a deposit along the sides of the first part of the tip of the trichocysts, and in this region the trichocyst membrane is free of intramembranous particles.The membrane of the parasomal sacs has a coat on both surfaces. That on the extraplasmic surface is similar to the surface coat of the plasma membrane. The origin of the cytoplasmic coat is unknown. The cytotic activity of these sacs is indicated by their highly irregular profiles.     

The early development of the tail and the transformation of the shape of the nucleus of the spermatid of the domestic fowl,Gallus gallus

Summary The differentiation of the spermatid, especially in reference to the formation of the flagellum, and transformation of the shape of the nucleus was investigated in the domestic fowl.In the early stage of the spermatid, a prominent Golgi apparatus appears around the centrioles. The Golgi vesicles then surround the axial-filament complex which develops from the distal centriole. These vesicles fuse to form continuous membrane at the earliest stage of flagellar formation, and in the succeeding stage Golgi lamellae are attached to the plasma membrane of the developing flagellum. From these observations, it is assumed that Golgi apparatus may be a source of the membrane system of the flagellum.The microtubules distributed around the nucleus form the circular manchette. The anterior region of the nucleus with the manchette is cylindrical in shape and the posterior region without it remains irregular in shape. When the circular manchette has been completed, the whole nucleus acquires a slender cylindrical shape. The circular manchette then changes into the longitudinal manchette. The nuclei of spermatids without a longitudinal manchette are abnormal in shape. In view of these observations it is assumed that the nuclear shaping of the spermatid may be accomplished by circular manchette and the maintenance of shape of the elongated nucleus by longitudinal manchette.The authors wish to thank Mr. Takayuki Mori for his helpful suggestions and technical advices     

Characterization of the composition of the aqueous humor and the vitreous body of the eye of the frog Rana temporaria L

This study aimed to analyze the aqueous humor (AH) and the vitreous body (VB) of the eye of the adult frog Rana temporaria L. as a representative species of amphibians, which lead a semi-terrestrial life. The presence of collagen, albumin, uric acid and electron donors was shown in both media; however, there are slight differences in their concentrations. To determine collagen, a spectral-fluorescent probe, cyanine dye, was used. The presence of collagen in AH of the frog was found at the first time. The total content of electron donors (ascorbic and uric acids, tryptophan, and tyrosine) in VB and HA was roughly estimated at ~ 1.5 × 10^− 4 mol/L. Both VB and AH absorb light in similar UV regions. The total protein and albumin contents in AH were found to be somewhat higher than those in VB. The uric acid content was at an equally low level in both intraocular media. It is supposed that the similarity of VB and AH compositions shown in this work is due to some exchange between VB and AH contents in the course of accommodation. The role of intraocular fluids in physiological functions of the eye and in protecting the retina against UV light is discussed.     

Observations on the permeability of the choriocapillaris of the eye

Summary The choriocapillaris is a fenestrated capillary bed located posterior to the retinal pigment epithelium. It serves as the main source of supply to the photoreceptors, retinal pigment epithelium, and other cells of the outer retina. The permeability of these capillaries to intravenously injected ferritin (MW — approx. 480,000; mol. diam. 11 nm) was examined in the mouse, rabbit, and guinea pig, each of which is characterized by a different type of retinal vascularization. In all three species, the bulk of the ferritin remained in the capillary lumina, where it appeared to be blocked at the level of the diaphragmed fenestrae. Some ferritin was present in endothelial cell vacuoles. The results confirm previous work on the rat choriocapillaris and indicate that the barrier function of the choriocapillary endothelium is present even among species in which the retinal circulation differs significantly.Supported by NIH grant EY03418