东菱精纯克栓酶（DF─521）治疗缺血性脑血管病的疗效观察

东菱精纯克栓酶（ＤＦ─５２１）治疗缺血性脑血管病的疗效观察解放军总医院神经内科匡培根,郎森阳,于生元,王国平,朱克,李永昌缺血性脑血管病为临床常见的疾患,近年来更有发病率上升及发病年龄年轻化的趋势。东菱精纯克栓酶（ＤＦ─５２１）注射剂为新型强力溶血栓...     

蝮蛇抗栓酶对高粘血症患者血液流变与微循环影响的观察

静注蝮蛇抗栓酶并口服青龙胶囊治疗高粘血症１４０例患者。结果显示,蝮蛇抗栓酶能明显降低血液粘度,表现为全血粘度、血浆粘度、全血还原粘度及纤维蛋白原降低,同时降低甲襞微循环形态、流态及管周状态积分。探讨其改善血液粘度机制。     

降纤酶治疗急性脑梗死的临床研究

目的　评估降纤酶对急性脑梗死的疗效及安全性。　方法　采用前瞻性、随机、对照试验 ,以东菱精纯克栓酶 ( DF-52 1 )和低分子右旋糖酐为对照组 ,从 1 996年 1月至 1 998年 1 0月共观察 4 81例 ,其中降纤酶组 2 89例 ,东菱组 92例 ,低右组 1 0 0例 ,共完成试验者 30 1例 ,各组份别为 1 4 9例、 70例和 82例 ,于治疗前及治疗后第 1天 ,第 3天 ,第 7天 ,第 1 4天查血浆纤维蛋白原、凝血酶原时间及血小板计数、肝肾功能等。并于治疗前及治疗后 1 ,7,1 4天评估神经功能恢复情况。　结果　降纤酶对急性脑梗死疗效显著 ,明显优于低分子右旋糖酐 ,在治疗后 1天已表现出明显效果 ,与日本生产的东菱精纯克栓酶比较疗效相似 ,发病 1 4天治疗总有效率分别为 84 .4 5%和 80 .0 0 %。同时降纤酶组与东菱组治疗后纤维蛋白原下降明显 ,于 7～ 1 4天有回升趋势 ;低右组则无明显变化。　结论　降纤酶具有与东菱精纯克栓酶相似的疗效、副作用小 ,价格明显低于东菱精纯克栓酶。认为国产降纤酶可以取代东菱精纯克栓酶 ,其在脑梗死急性期治疗上具有广泛的前景     

蕲蛇酶注射液能有效治疗基底节区的脑出血患者

为了分析蕲蛇酶注射液对基底节区脑出血患者血清髓鞘碱性蛋白及凝血酶的影响,本研究选取2014年5月至2016年5月我院收治的基底节区脑出血患者80例作为研究对象,依据随机数字表法将这些患者分为蕲蛇酶组(n=40)和东菱克栓酶组(n=40)两组,蕲蛇酶组患者接受蕲蛇酶注射液治疗,给予患者静脉滴注0.75 U蕲蛇酶注射液+500 m L生理盐水,每天1次,2周为1个疗程;东菱克栓酶组患者接受东菱克栓酶注射液治疗,给予患者静脉滴注10 BU东菱克栓酶注射液+150 m L生理盐水,至少1 h滴注完,每2天1次,共治疗5次。对两组患者的NIHSS评分、ADL评分及GCS评分、临床疗效、血清MBP、凝血酶水平进行统计分析。结果表明,蕲蛇酶组患者的NIHSS评分显著低于东菱克栓酶组(p0.05),ADL评分及GCS评分均显著高于东菱克栓酶组(p0.05),治疗的总有效率为95.0%(38/40)显著高于东菱克栓酶组80.0%(32/40)(p0.05),血清MBP、凝血酶水平均显著低于东菱克栓酶组(p0.05),两组患者均没有发生严重不良反应。本研究结果表明蕲蛇酶注射液较东菱克栓酶更能促进基底节区脑出血患者的血清髓鞘碱性蛋白及凝血酶的有效降低,并对患者的神经功能缺损情况、日常生活能力及预后进行改善,临床疗效更为显著,值得临床应用推广。     

蕲蛇酶对80例高粘血症的纤维蛋白原浓度作用的研究

目的　通过蕲蛇酶对 80例高粘血症患者的治疗 ,研究其对纤维蛋白原的影响 ,试图寻找防栓抗栓的理想药物。方法　采用蕲蛇酶注射液 0 .75 u静脉滴注 ,每天 1次 ,连用 1 4天 ,观察治疗前后临床症状、甲襞微循环 ( NFM)、血液流变学及脂代谢的变化。结果　该药除具有缓解临床症状 ,改善 NFM,降低血粘度、红细胞压积、血小板吸附率及改变脂代谢紊乱等作用外 ,还能有效地降低血浆纤维蛋白原含量。结论　蕲蛇酶注射液对防治血栓形成具有重要意义。     

清栓酶在治疗慢性粒细胞白血病中的地位：附5例报告

慢性粒细胞白血病慢性期全血粘度,血浆粘度增高伴高粘滞综合症表现.在用马利兰作化疗同时应用清栓酶治疗,结果发现在马利兰未使白细胞下降前,患者全血粘度,血浆粘度明显下降及高粘滞综合症得以缓解,而其它血液流变学指标治疗前后也有明显改变.证明清栓酶能降低慢性粒细胞白血病化疗前血粘度增高,缓解高粘滞综合征临床表现.     

降纤酶与东菱精纯克栓酶治疗急性脑梗死的对比研究

目的 探讨降纤酶治疗急性脑梗死的疗效和安全性。方法 １０６例发病在７２ｈ内的急性脑梗死患者随机分成治疗组和对照组,两组患者年龄、性别、伴发疾病和既往史积分、治疗前神经功能缺损程度评分相似,具有可比性。治疗组给降纤酶１０ｕ静脉滴注,每天１次;对照组给东菱精纯克栓酶（ＤＦ－５２１）１０ＩＵ静脉滴注,隔天１次,７天为１个疗程。动态监测血浆纤维蛋白原浓度,并进行疗效和安全性评价。结果 降纤酶具有纤维蛋白原     

蛇毒酶对帕金森氏病和帕金森综合征的治疗研究

目的研究观察蛇毒酶治疗帕金森氏病（ＰＤ）、帕金森综合征（ＰＳ）的临床效果,方法对８２例ＰＤ和ＰＳ患者进行随机分组,Ａ组应用精制蝮蛇抗栓酶,Ｂ组应用东菱克栓酶,Ｃ组应用力源精纯溶栓酶;对每例病人进行治疗前后Ｗｅｂｓｔｅｒ记分和记录多巴制剂的递减／递增量,同时检测血液流变学和血凝学５项指标,并给予统计比较,结果Ａ组病例不论是临床症状的改善,还是多巴制剂的用量递减、血液流变学和血凝学指标变化均优于Ｂ、Ｃ     

关于部颁降纤酶标准（试行）有关部分的商榷

１　历史回顾　　实践证明,从蛇毒中提取的凝血酶样酶（ｔｈｒｏｍｂｉｎＬｉｋｅｅｎｚｙｍｅ,ＴＬＥ）即降纤酶,是诸多治疗血栓病药物中最为理想的。７０年代初,伦敦Ｔｗｙｆｏｒｄ药厂生产出Ａｎｃｒｏｄ,其后瑞士Ｐａｎｔａｐｈａｒｍ药厂生产的Ｂａｔｒｏｘｏｂｉｎ,有效成分均为ＴＬＥ,近年从日本引进的东菱精纯克栓酶注明为单成分ＴＬＥ。　　我国８０年代由中国科学院昆明动物研究所首先从尖吻蝮蛇毒中获得ＴＬＥ,研制出“去纤酶”,为我国第１个用于治疗血栓病的蛇毒酶产品,１９８３年云南省卫生厅批准生产。经临床应用…     

常用降纤剂疗效比较研究

目的 对常用的３种降纤药物、东菱克栓酶、ＥＷ－速效溶栓清、精制蝮蛇抗栓酶治疗急性缺血笥脑血管病进行比较。方法 对１９９７年６月～１９９８年１２月,发病１周内,急性缺血性脑血管病,按全国第四届脑血管病会议制定的标准,在可比的条件下,用东菱克栓酶治疗;乙组２８例,用ＥＷ－速效溶栓清治疗;丙组２８例,用精制蝮蛇抗栓酶治疗。进行与实验室观察。结果 ３组疗效临床评分有效率各为：９５．６５％、９２．８６％８８     

脉冲电场和磁场对高血粘和高凝血影响的比较研究

比较研究脉冲电场和脉冲磁场对高血粘和高凝血的影响,探寻降低血液粘度,抑制凝血过快、过强的物理方法.每份血样等分9份,1份作对照,对另外8份分别作不同的脉冲电场或磁场处理.结果显示不同上升沿速率的脉冲电场和磁场对高血粘和高凝血的影响程度不同,上升沿速率为2.5 × 105T s-1的脉冲磁场使全血表观粘度η降低(P＜0.01)、复钙凝血时间tr变长(P＜0.01),血块的最大剪切应力τax变小(P＜0.01).脉冲磁场作用能改善高血粘和高凝血状况.     

Hemorheological abnormalities in experimental cerebral ischemia and effects of protein kinase inhibitor on blood fluidity

The aim of this study was to investigate the mechanisms of the pathogenesis of hyperviscosity following cerebral ischemia. Focal ischemia was produced by embolic occlusion of the right middle cerebral artery (MCA) in rats for 1 hour, followed by recirculation. Twenty-four hours after MCA occlusion, fasudil, a protein kinase inhibitor, was administered intraperitoneally. Blood samples were taken from the abdominal aorta, and viscosity was measured using a cone-plate viscometer. The viscosity of whole blood in the ischemic attack group was significantly increased compared with the sham operated group 24 hours after MCA occlusion. Fasudil dose-dependently and significantly decreased the blood viscosity, and reduced to the normal range after administration of 10 mg/kg of fasudil (sham-operated rats, 5.17+/-0.05 cP; pre dose/ischemic rats, 6.05+/-0.08 cP; post dose/ischemic rats, 5.23+/-0.14 cP; 37.5 sec(-1)). Our findings suggest that cerebral ischemia induces a potent, systemic and long-lasting hyperviscosity, and that the inhibition of protein kinases, especially rho kinase, is efficacious in preventing this hyperviscosity.     

D- 二聚体、血流变学指标对结缔组织病患者诊疗价值研究

目的:探讨分析结缔组织病合并多器官损害患者D-二聚体(DD)、血流变学指标(血浆纤维蛋白原/血浆纤维蛋白降解产物FDP、全血黏度、血浆黏度)水平及指标变化对结缔组织病合并多器官损害患者病情活动期的诊疗价值。方法:本研究共纳入120例患者,其中活动组患者60例,病情缓解组患者60例,分别测定二组患者DD、血流变学指标水平,并采用t检验、灵敏度与特异度进行统计学分析与描述。结果:与缓解组比较,活动组DD、纤维蛋白降解产物(FDP)、全血黏度、血浆黏度、γ球蛋白、补体C4、ESR均具有统计学差异(P0.01),补体C3组间差异也具有统计学意义(P0.05)。各指标对于疾病活动性诊断的准确性,其DDFDP补体C3、C4γ-球蛋白血浆黏度全血黏度ESR。结论:结缔组织病合并多器官损害患者,其纤溶水平、微循环状态与疾病活动密切相关。     

不同海拔地区藏族就诊人群血脂、血液黏度、HCY水平与心血管疾病的相关性研究

目的:探讨不同海拔地区藏族就诊人群血脂、血液黏度、HCY水平与心血管疾病的相关性。方法:采用回顾性分析的方法,将328例来自不同海拔地区的藏族就诊患者为三组,高海拔组(纳入99例),中海拔(纳入120例)和低海拔组(纳入109例),比较不同海拔高度组患者血压、血脂、血液黏度、HCY、疾病类型的差异,采用多元Logistic回归模型分析藏族就诊人群心血管疾病发病的影响因素。结果:不同海拔组收缩压、舒张压、血清HCY、TC、TG、HDL-C、LDL-C水平、全血黏度低切、中切、高切、血浆黏度和红细胞压积比较差异均有统计学意义(P0.05),随着海拔升高,收缩压、舒张压、血清HCY、TC、TG以及LDL-C、全血黏度低切、中切、高切、血浆黏度和红细胞压积水平显著升高(P0.05),而血清HDL-C水平显著下降。41.8%(137/328)的就诊者至少患有一种心血管疾病,和非心血管组比较,心血管疾病组年龄明显偏高,居住主要分布在中度及高度海拔地区,合并高血糖、高血脂、高HCY的比例均明显较高,差异均有统计学意义(P0.05)。年龄、海拔、高血糖、高血脂、高HCY均和心血管疾病相关(r=-0.230~0.334,P0.05)。多元Logistic回归分析显示年龄、居住地海拔、HCY水平、全血低切粘度、TG水平、LDL-C等因素是心血管疾病发生的危险因素,HDL-C是保护因素。结论:来自不同海拔地区的就诊人群在血压、血脂、血液黏度、HCY水平以及心血管疾病患者占比不同。年龄、居住地海拔、HCY水平、血液黏度、血脂水平等增加可能使高原藏族人群心血管疾病发生风险增加。     

The clinical significance of whole blood viscosity in (cardio)vascular medicine

Whole blood is a non-Newtonian fluid, which means that its viscosity depends on shear rate. At low shear, blood cells aggregate, which induces a sharp increase in viscosity, whereas at higher shear blood cells disaggregate, deform and align in the direction of flow. Other important determinants of blood viscosity are the haematocrit, the presence of macro-molecules in the medium, temperature and, especially at high shear, the deformability of red blood cells. At the sites of severe atherosclerotic obstructions or at vasospastic locations, when change of vessel diameter is limited, blood viscosity contributes to stenotic resistance thereby jeopardising tissue perfusion. However, blood viscosity plays its most important role in the microcirculation where it contributes significantly to peripheral resistance and may cause sludging in the postcapillary venules. Apart from the direct haemodynamic significance, an increase in blood viscosity at low shear by red blood cell aggregation is also associated with increased thrombotic risk, as has been demonstrated in atrial fibrillation. Furthermore, as increased red blood cell aggregation is a reflection of inflammation, hyperviscosity has been shown to be a marker of inflammatory activity. Thus, because of its potential role in haemodynamics, thrombosis and inflammation, determination of whole blood viscosity could provide useful information for diagnostics and therapy of (cardio)vascular disease.     

The effect of propranolol on blood viscosity changes induced by experimental coronary occlusion

The effect of propranolol treatment was investigated in the myocardial ischemia-induced hyperviscosity state in anesthetized dogs. In untreated control dogs, low shear blood viscosity rose progressively, following an acute occlusion of the left anterior descending coronary artery; this effect was partially but significantly reduced by intravenously administered propranolol (0.2 mg/kg). The effect of the in vitro addition of propranolol was also determined upon viscosity of blood samples obtained at hourly intervals from dogs subjected to similar coronary ligation. The in vitro addition of propranolol did not produce a similar reversal of the hyperviscosity state observed in the blood obtained from dogs after coronary ligation.     

Variability of plasma viscosity in monoclonal IgM gammopathies.

Hyperviscosity syndromes can caused by both plasmatic and cellular factors. We have studied 20 patients affected by IgM gammopathy of different origin and 12 healthy subjects matched for sex and age, in order to evaluate the relation between paraprotein levels and plasma viscosity. We have observed a significant plasma viscosity increase only in 14 patients with monoclonal IgMk gammopathy. In the same patients was also evident an hyperviscosity syndrome. In the other 6 patients, with monoclonal IgM or polyclonal gammopathy and without clinical symptoms, plasma viscosity was only slightly increased. We have also observed a significant correlation between IgM and light chains (kappa, lambda) serum level and increased plasma viscosity. These results suggest that one can't consider all IgM gammopathies as cause of hyperviscosity syndrome.     

Comparison of oxidative stress markers in vaginal deliveries with or without epidural analgesia

Abstract

Background

It has been demonstrated that oxidative stress can induce red blood cell rigidity and haemolysis, which in turn can cause hyperviscosity and hyperbilirubinaemia, respectively. However, haemolysis may be associated with a low level of haemoglobin, which reduces whole blood viscosity (WBV). Bilirubin can behave as antioxidant or oxidant, and one uncharted course for diagnostic pathology is how or whether bilirubinaemia and viscosity are associated. Further, oxidative stress is now being assessed using lipoprotein-a (Lp(a)), among other things but whether it is associated with blood viscosity has not been established.

Aim

This study investigates the association and correlation of haemoglobin level and WBV with serum Lp(a) and bilirubin levels in a general population of patients.

Materials and methods

Sixty-eight cases that were tested for Lp(a), concomitantly with full blood count and liver function, in our archived clinical pathology database were used in this study. WBV levels were determined using a validated formula. Multivariate and univariate analyses as well as correlation were performed.

Results

WBV was found to be significantly associated with bilirubin (P < 0.02), but not with Lp(a). Haemoglobin concentration was inversely correlated with Lp(a) (P < 0.04), but not with bilirubinaemia.

Conclusion

This pilot study suggests that hyperbilirubinaemia and hyperviscosity are associated and positively correlated. Consideration of whether serum bilirubin (as an indirect index of oxidative stress) can be used in combination with WBV (as index of macrovascular effect of oxidative stress) to assess oxidative damage is recommended.     

血脂及血液流变学指标与突发性聋患者听力曲线类型的关系及其临床疗效的影响因素分析

摘要 目的：探究血脂及血液流变学指标与突发性聋（SSHL）患者听力曲线类型的关系,并分析临床疗效的影响因素。方法：选取2020年6月-2022年1月我院收治的103例SSHL患者设为SSHL组,另选取103例体检健康者设为健康组,分析两组血脂水平及血液流变学指标,比较不同听力曲线类型的SSHL患者血脂水平及血液流变学指标,Spearman相关分析血脂水平及血液流变学指标与SSHL患者听力曲线类型的关系,单因素和多因素Logistic回归模型分析SSHL患者临床疗效的影响因素。结果：与健康组比较,SSHL组总胆固醇（TC）、三酰甘油（TG）与全血高切、中切、低切粘度及血浆粘度明显增高（P＜0.05）,高密度脂蛋白-C（HDL-C）、低密度脂蛋白-C（LDL-C）差异比较无统计学意义（P＞0.05）。不同听力曲线类型的SSHL患者各项血脂指标比较差异均无统计学意义（P＞0.05）,不同听力曲线类型的SSHL患者各项血液流变学指标比较差异均有统计学意义（P＜0.05）,其中全聋型患者各项血液流变学指标显著高于低频下降型患者（P＜0.05）。血脂四项与SSHL听力曲线类型无显著相关性（P＞0.05）,而血液流变学指标与SSHL听力曲线类型显著相关（P<0.05）。治疗无效组患者双耳患病比例、听力曲线类型为全聋型比例、全血高切粘度、全血低切粘度、血浆粘度显著高于有效组患者（P＜0.05）,多因素Logistic分析结果显示：双耳患病、听力曲线类型为全聋型、血浆粘度增加为SSHL患者治疗无效的危险因素（P＜0.05）。结论：SSHL患者存在血脂及血液流变学异常,血液流变学与SSHL患者听力曲线类型和临床疗效有一定关系,其中双耳患病、全聋型、血浆粘度增加为SSHL患者治疗无效的危险因素,检测血脂和血液流变学对于SSHL诊治具有一定临床指导意义。     

氟桂利嗪联合血塞通治疗偏头痛患者的临床疗效及对血液流变学的影响

目的:探讨氟桂利嗪联合血塞通治疗偏头痛患者的临床疗效及对血液流变学的影响。方法:选择2012年2月到2014年6月在我院就诊的240例偏头痛患者,随机分为对照组(n=120)和实验组(n=120)。对照组给予氟桂利嗪治疗,实验组在对照组基础上加用血塞通治疗,对比两组治疗效果和治疗前后血液流变学的变化。结果:治疗后两组患者偏头痛发作频率及VAS评分较治疗前均显著降低(P0.05),疼痛持续时间显著缩短(P0.05)且实验组显著优于对照组(P0.05);实验组的有效率(95.8%)明显高于对照组(72.5%),具有显著性差异(P0.05)。治疗后两组患者血浆黏度、全血高、低切黏度、红细胞压积及纤维蛋白原较治疗前均显著降低(P0.05),且实验组患者各指标均显著低于对照组(P0.05)。结论:氟桂利嗪联合血塞通治疗偏头痛临床疗效显著,可显著改善患者血液流变学指标,效果优于单独使用氟桂利嗪。