半乳糖凝集素(Gal)-3是β-半乳糖苷结合蛋白家族中的一种,由活化的心脏巨噬细胞释放,反映了心力衰竭病理生理过程中关键的纤维化和心肌重构,并且与结局有明显的相关性[1].Gal-3作为强致炎因子在动脉粥样硬化过程中起着重要作用,可能参与腔内介入治疗后血管再狭窄的病理生理过程.盐皮质激素受体拮抗剂(MRA)的治疗可抑制Gal-3、转化生长因子(TGF)-β、信号转导蛋白(SMAD)-3上调.现结合近年Gal-3与心肌纤维化、心肌重构、血栓性疾病及相关药物的研究进展进行综述.

目的 评价国产Precil C3510全自动血凝分析仪(简称Precil C3510)检测常规凝血项目[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)、D-二聚体(DD)]临床性能及在华法林和普通肝素抗凝治疗效果监测中的应用.方法 依据美国临床实验室标准化协会(CLSI)相关指南对Precil C3510检测PT、APTT、Fib、DD不精密度、抗干扰能力、线性、参考区间进行验证.同时,以STA-Compact全自动血凝分析仪(简称STA-Compact)为参考,应用Spearman相关分析、Passing-Bablok回归分析及Bland-Altman图对Precil C3510进行一致性评价.评价Precil C3510检测口服华法林患者国际标准化比值(INR)与STA-Compact检测结果的一致性.以STA-R Evolution全自动血凝分析仪(简称STA-R Evolution)检测的抗Xa活性(0.3～0.7 IU/mL)为标准,探讨Precil C3510监测普通肝素治疗的APTT参考区间.结果 Precil C3510不精密度、线性、参考区间均符合相应标准.3.2 mg/mL及更高浓度的三酰甘油对DD测定值有负干扰.2台仪器PT、Fib测定值具有较好的一致性(无系统差异、比例差异、随机差异,且偏移在临床接受区间内);APTT测定值存在系统差异[回归方程截距为-18.1216,95％可信区间(CI)为-26.0039～-12.5221]、比例差异(斜率为1.2618,95％CI为1.1234～1.4356)、随机差异(92.31％的偏移位于±1.96 s区间内)、平均偏移(-18.9％,95％CI为-22.9％～-14.9％)不在临床接受区间内(-7.5％～7.5％).2台仪器基于各自参考区间对APTT结果的判定具有较好的一致性(Kappa=0.87,95％CI为0.74～0.99).Precil C3510检测普通肝素抗凝治疗的APTT参考范围为62～108.1 s.2台仪器的口服华法林患者INR具有较好的一致性[35例(87.5％)患者INR差异<0.5].结论 Precil C3510在常规凝血项目检测中具有良好的分析性能,可用于华法林和普通肝素抗凝治疗的临床监测.

目的 探讨机体≥5次献血对铁调素(Hepcidin,HEPC)的影响及其临床意义.方法 收集天津地区自愿献血者血液样本70例,统计18个月内累计献血次数,献血次数大于等于5次为研究组(n=30),献血2～4次为对照组(n=40).ELISA法测定血清HEPC,迈瑞BS800全自动生化分析仪测定血脂及铁蛋白(Ferritin,FER).结果 研究组与对照组比较FER、HEPC明显降低,差异有统计学意义(P<0.05),Lo-gistic回归分析表明HEPC浓度下降为机体≥5次献血后的保护因素.结论 HEPC水平降低与献血关系密切,HEPC下降是大于等于5次献血后机体的保护因素.献血使HEPC水平下降,与降低心血管疾病发病风险可能存在潜在联系.

目的 探讨单核细胞CX3C趋化因子受体1(CX3CR1)表达联合血小板计数(PLT)对经皮冠状动脉介入治疗(PCI)后支架内再狭窄(ISR)的应用价值.方法 2015年11月至2017年3月在天津泰达国际心血管病医院就诊的经冠状动脉造影(CAG)确认的74例ISR患者和40例不明显病变患者纳入试验研究,对照组为125例无冠状动脉疾病的志愿者,并同期随访首次经PCI治疗的69例患者.用流式细胞术分析单核细胞CX3CR1膜蛋白表达,血液分析仪检测外周血PLT;利用Spearman相关、ROC曲线分析CX3CR1表达及CX3CR1表达联合PLT与ISR的关系;应用Kaplan-Meier模型评估CX3CR1表达及CX3CR1表达联合PLT对ISR的预测价值.结果 ISR组、不明显病变组、对照组CX3CR1表达分别为12.0％(7.5％,17.6％)、9.1％(4.9％,12.5％)、7.2％(5.6％,9.8％),Hc=26.50,P<0.001.ISR组CX3CR1表达高于对照组(Z=5.15,P<0.001)和不明显病变组(Z=2.65,P=0.008).ISR组、不明显病变组、对照组PLT分别为(211.65±46.40)×109/L、(182.82±39.80)×109/L、(241.44±52.33)×109/L,F=21.97,P<0.001.ISR组PLT高于不明显病变组(t=3.24,P=0.002),低于对照组(t=-3.88,P<0.001).不同Gensini积分间CX3CR1表达(Hc=3.54,P=0.351)及PLT(Hc=2.02,P=0.121)差异均无统计学意义.CX3CR1表达与吸烟(r=0.257,P=0.027)及PLT(r=0.246,P=0.036)呈正相关.CX3CR1表达联合PLT诊断ISR的ROC曲线下面积(AUCROC)为0.816,敏感性为63.0％,特异性为86.2％.Kaplan-Meier分析显示,CX3CR1表达联合PLT预测远期ISR Log-rankχ2=8.982,P=0.003,阳性预测值(PPV)为21.7％,阴性预测值(NPV)为97.8％,敏感性为83.3％,特异性为71.4％.结论 单核细胞CX3CR1及PLT可能是潜在的ISR的辅助诊断指标和远期排除ISR的阴性预测指标.

In-stent restenosis (ISR) is the most common complication associated with percutaneous coronary intervention (PCI). Although some studies have reported an association between lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) and ISR, not enough clinical validation data are available to support this link. Here, we report our cross-sectional study aimed at exploring the feasibility of LOX-1 as a biomarker for the prognostic diagnosis of patients undergoing PCI.Three groups were included: ISR group, including 99 patients with ISR diagnosed with coronary arteriography (CAG) after PCI; lesion group, comprising 87 patients with coronary artery stenosis (<50%) diagnosed with CAG after PCI; and control group, consisting of 96 volunteers with no coronary artery disease. The levels of LOX-1 were measured in each patient by using an enzyme-linked immunosorbent assay, and their general information as well as laboratory parameters were recorded and followed up during a period of 2 years.LOX-1 levels gradually increased after PCI along with the progression of the lesion in the 3 groups. The levels of LOX-1 were significantly higher in the ISR group than in the other 2 groups (P < .001). LOX-1 levels were correlated with the levels of uric acid (UA) (r = 0.289, P = .007), creatinine (CREA) (r = .316, P = .003), and high-density lipoprotein cholesterol (HDL-C) (r = -0.271, P = .012), whereas no statistically significant correlation was detected with the Gensini score (r = 0.157, P = .141). The sensitivity and specificity of LOX-1 were 81.5% and 55.7%, respectively, with the most optimal threshold (5.04 μg/L). The area under curve (AUC) of the receiver operator characteristic (ROC) curve of LOX-1 was 0.720, and LOX-1 had the highest AUC compared with CREA, UA, and HDL-C, both individually and in combination.A high level of LOX-1 in the early period after PCI has a certain predictive power and diagnostic value for ISR. However, the level of LOX-1 is not related to the Gensini score of coronary artery after PCI, and CREA and UA, which are weakly related to LOX-1, have no obvious synergy in the diagnosis of ISR with LOX-1.

Objective To investigate the diagnosis and prognosis value of plasma microRNA-30d(miR-30d) in acute coronary syndrome(ACS) patients. Methods It retrospectively recruited 170 cases of ACS patients from TEDA International Cardiovascular Hospital between September 2011 to February 2012, including 70 STEMI (male 54, female 16), 52 NSTEMI(male 34, female 18), 48 UAP(male 29, female 19). At the same time, 41 healthy controls (male 24, female 17) were enrolled into the study . Plasma miR-30d levels were determined by real-time quantitative PCR. In order to evaluate the dynamic change of miR-30d and other cardiac biomarkers, 20 plasma samples of AMI patients were collected at 0-3 h, 4-6 h, 7-9 h, 10-12 h after pectoralgia. ROC curves and Kaplan-Meier survival curve were used to investigate clinical value of miR-30d in ACS. Results At 0-3 h after pectoralgia, miR-30d were significant higher in STEMI 7.208(0.170-11 070.735) and NSTEMI 7.989(0.836-151.391) than the controls 1.561(0.044-17.520) (Z1=-5.792, Z2=-6.113, P<0.001), but there were no statistic differences between UAP 1.073(0.051-11.095) patients and the controls (Z=-0.325, P=0.745). In 20 AMI patients, miR-30d levels peaked at 4-6 h and then dropped following 7-9 h, both earlier than cTnI, and the variation tendency was positive correlated with cTnI (r=0.402, P<0.01). At 0-3 h after pectoralgia, the AUC, sensitivity and specificity of miR-30d for differentiating AMI and UAP were 0.882(95% CI: 0.830-0.935), 0.795(95% CI: 0.711-0.861)and 0.854(95% CI: 0.716-0.935) respectively. When combined miR-30d and cTnI, the diagnostic AUC and specificity were 0.937(95% CI: 0.902-0.972)and 0.937(95% CI: 0.818-0.984), both enhanced when compared with miR-30d or cTnI alone. Kaplan-Meier survival curves revealed that there were no significant correlations between the miR-30d levels and MACE in both 30 days and 12 months(χ2=0.506, P=0.477 and χ2=0.002, P=0.963 respectively). Conclusion Plasma miR-30d may be used as a potential biomarker for early diagnosis, but not prognosis in ACS patients.(Chin J Lab Med, 2018, 41: 97-102) Key words: Acute coronary syndrome; MicroRNA-30d; Early diagnosis; Prognosis

急性早期前体T淋巴细胞白血病(early T-cell precursor acute lymphoblastic leukemia,ETP-ALL)属于早期非成熟的急性 T 淋巴细胞白血病(T-cell acute lymphoblastic leukemia,T-ALL)[1],占T-ALL的5.5％～35.0％.此病在2009年由COUSTAN-SMITH等[2]最先诊断.他们认为这是一种独特的生物学亚型白血病,肿瘤细胞非常早地从骨髓游移到胸腺细胞,并表达丰富的T淋巴细胞系标志以及干细胞和髓系的相关标志,有淋巴系和髓系的分化潜能,是一种成熟阻滞、分化很差的干细胞白血病.目前的治疗方法对许多罹患ETP-ALL的患者不起作用,无法使疾病进入缓解期,只有30.0％～40.0％的患者能成为长期幸存者[3].儿童患此病治疗效果差,诱导缓解失败率、复发率均较成人高.此类型白血病没有特殊的临床表现,骨髓像亦无明显的诊断相关性,主要依赖于免疫分型对此类疾病进行诊断[4],我国鲜有报道.我们报道1例伴发白细胞分化抗原(cluster of differentiation,CD)15、CD58、CD123阳性表达的ETP-ALL.

Objective To study the association between CX3CR1 expression in monocytes and coronary artery stenosis (CAS).Methods Seventy patients with their CAS ≥50％ served as a stenosis group,23 patients with their CAS ＜50％ served as a non-significant lesion group and 24 volunteers with no CAS served as a control group.The CX3CR1 fluorescence intensity in monocytes was detected by flow cytometry.The CX3CR1 expression levels in 3 groups were compared.The related risk factors in CAS were analyzed by Spearman correlation analysis,multivariate logistic regression analysis and ROC curve analysis.Results The CX3CR1 fluorescence intensity was 4.94％ (2.41％,6.58％),2.02％ (1.25％,3.57％) and 1.68％ (1.09％,2.24％) respectively in stenosis group,non-significant lesion group and control group (P＜0.01).The CX3CR1 fluorescence intensity was singnificantly higher in stenosis group than in control group (P＜0.01).TG and CX3CR1 were the risk factors for CAS (P=0.048,P=0.026).The area under the ROC curve was 0.810 when the cut-off value was 2.91％,the sensitivity was 64.1％,and the specificity was 91.7％ for the CX3CR1 fluorescence intensity,indicating that CX3CR1 plays a certain role in diagnosis of CAS (P＜0.01).Conclusion The CX3CR1 expression level is significantly higher in CAS patients and is possibly involved in CAS.Elevated CX3CR1 expression level in monocytes is a risk factor for CAS and plays a certain role in diagnosis of CAS.

In this review ,the laboratory tests relevant for the treatment of chronic hepatitis C (CHC) infections in the era of directly acting antiviral (DAA) therapy was discussed ,including viral and host factors .Virus factors in-cluded HCV genotype and viral load as well as drug resistance gene detection .Detection of the causes of hepatitis C virus (HCV) before the DAA treatment of HCV was mainly to diagnose chronic HCV infection and to determine the treatment regimen and the best course of treatment .The patient's resistance to DAA and baseline HCV viral load also should be considered .It was also important to assess host status before DAA treatment of HCV infec-tions .Host factors were mainly related to the relationship between gene polymorphism and interferon therapy ,vi-ral infection ,liver fibrosis laboratory staging ,safety monitoring ,etc .

Objective To investigate the correlation of the expressions of lectin-like oxidized low-density lipoprotein receptor-1(LOX-1) and CX3C chemokine receptor 1(CX3CR1) from monocytes and proximal/middle coronary artery stenosis. Methods A total of 58 patients undergoing coronary angiography were enrolled. According to the results of coronary angiography,47 patients with at least one of main proximal or middle coronary artery stenosis≥50% were as stenosis group,and 11 patients <50% were as non-stenosis group. Totally,26 volunteers were enrolled as control group. General information and parameters of the 3 groups were recorded. LOX-1 and CX3CR1 fluorescence intensities from monocytes in peripheral blood were determined by flow cytometry,and the severity of coronary artery lesion was evaluated by Gensini score. The expression levels of LOX-1 and CX3CR1 of single-branch lesion,double-branch lesion and multiple-branch lesion(3-branch or more) were compared. The correlation of the fluorescence intensities of LOX-1 and CX3CR1 from monocytes and Gensini score was analyzed. Multiple Logistic regression analysis and receiver operating characteristic(ROC) curve analysis were performed. Results The fluorescence intensities of LOX-1 and CX3CR1 from monocytes in peripheral blood in stenosis group were higher than those in non-stenosis group and control group(P<0.01). There was no statistical significance in the fluorescence intensities of LOX-1 and CX3CR1 from monocytes in peripheral blood among single-branch lesion,double-branch lesion and multiple-branch lesion(P>0.05). There was no correlation of the fluorescence intensities of LOX-1 and CX3CR1 from monocytes in peripheral blood with left ventricular ejection fraction(LVEF),left ventricular end diastolic dimension(LVDD) and Gensini score in stenosis group(P>0.05). Multiple Logistic regression analysis and ROC curve analysis showed that CX3CR1 was a factor of proximal/middle coronary artery stenosis with diagnosis efficiency [odds ratio(OR)=1.771, 95% confidence interval(CI) 1.200-2.616]. The area under ROC curve was 0.733. Conclusions LOX-1 and CX3CR1 from monocytes may be involved in the process of proximal/middle coronary artery stenosis,without the correlation with stenosis degree. The high expression of CX3CR1 is a factor of proximal/middle coronary artery stenosis with diagnosis efficiency.

将人工辅助生殖技术运用到临床技术中给不孕不育患者带来了诸多福利,提升其生活质量,但这在客观上对人类绵延已久的繁衍方式带来了冲击,引发了诸多的伦理道德和法律问题,不论是从国内立法或者是国际私法的层面都令人棘手.促进人工生殖技术更好地规范与管理,全世界都以不同的立法形式制定了相应的规则与制度.我国目前人工辅助生殖技术的立法,全部都是以卫生部规章的形式出现,尚未上升到法律层面,影响了对人工生殖技术的调控.由于利益驱使和刚性需求,精子、卵子、胚胎非法买卖、同精多孕、非法鉴别胎儿性别、非法多胎移植生育、非法代孕等逐渐突出,对伦理道德以及基本社会稳定造成了一定的威胁.法律规制是人工辅助生殖技术有效管理的最佳模式,其一,要提高立法级别,健全相关法律体系,适时推出《人工辅助生殖法》;其二,刑法要介入滥用人工辅助生殖技术的行为,增设“滥用人工辅助生殖技术罪”.

目的 探讨高原地区献血对血管性血友病因子(vWF)的影响及其临床价值.方法 收集了西藏昌都地区自愿献血的血液标本82例,其中多次献血标本42例(献血组),分为低频、中频、高频3个献血亚组,其中低频献血为2次,20例;中频献血为3次～9次,13例;高频献血为≥10次,9例.初次献血前体检合格样本40例(对照组).用ELISA方法检测献血组和对照组的vWF与人脂蛋白相关磷脂酶A2(Lp-PLA2)的水平,并记录2组相应的血常规和血脂等指标.结果 多次献血后vWF浓度明显低于对照组,差异有统计学意义(P＜0.05),而献血组LpPLA2浓度和对照组比较差异无统计学意义(P＞0.05);对高原地区献血影响因素的Logistic回归分析表明,vWF下降为多次献血后机体的保护因素;在低频、中频、高频献血亚组的K-M概率分析中,随着献血频次的增加,非血管内皮损伤的概率逐渐升高,差异有统计学意义(x2=40.092,P＜0.01).结论 vWF与高原地区多次献血的关系密切,vWF下降是多次献血后机体的保护因素.随着献血次数增多,机体潜在的不良血管内皮状态可能会得到一定的修正或改善.

Fractalkine(CX3CL1) and its specific receptor CX3C chemokine receptor1(CX3CR1), CX3CL1-CX3CR1 axis are all involved in the formation and development of atherosclerosis,which change the plaque composition and stability of plaques. CX3CR1 V249I and CX3CR1 T280M are associated with coronary artery lesions. In atherosclerotic plaque,CX3CL1 and CX3CR1 were expressed by vascular smooth muscle cells(VSMC) and monocytes/macrophages. Interaction between vascular smooth muscle cells(VSMC) and monocyte needs CX3CL1-CX3CR1 axis,and this mutual effect regulates the survival and differentiation of monocyte. Through a series of mechanism,such as involved nuclear factor-kappa B(NF-κB),activated protein-1(AP-1) and signal transducers and activators of transcription(STAT) 1/STAT3,resistin up-regulates the expressions of CX3CL1 and CX3CR1, and generates pro-inflammatory state of smooth muscle cells. Serum CX3CL1 level is increased in patients with unstable coronary artery diseases and patients with severe coronary artery lesions. Serum CX3CR1 level is increased in patients with coronary artery stenosis,which is not associated with the degree of coronary artery stenosis. The related study on CX3CL1/CX3CR1 shows the potential mechanism and pathogenicity effect of some inflammatory mediators in atherosclerotic heart diseases,so as to provide a reference for clinical treatment strategies and drug intervention studies.

目的 探讨血凝素样氧化低密度脂蛋白受体-1(LOX-1)、CX3C趋化因子受体1(CX3CR1),对经皮冠状动脉介入治疗(PCI)前后冠状动脉狭窄病变的评估作用及应用价值.方法 80例行PCI手术的冠状动脉狭窄疾病患者(病例组)在术前、术后1d～3d和术后30 d～60 d及40例对照组均空腹采集静脉血测定LOX-1、CX3CR1水平.记录2组的一般资料及实验室指标,应用SPSS 17.0软件进行统计分析.结果 PCI术后1 d～3dLOX-1、CX3CR1开始明显下降,到术后30 d～60 d其水平均低于术前及对照组水平.经Logistic回归及ROC曲线分析表明,LOX-1是PCI术前、术后1d～3d冠脉狭窄病变的危险因素,并且具有一定的诊断效力.结论 LOX-1、CX3CR1与PCI前后冠状动脉狭窄病变关系密切,可用于PCI术后冠状动脉病变的评估,从而对PCI术后冠状动脉病变的预防及治疗发挥作用.

Objective To explore the association of lectin-like oxidized low-density lipoprotein (oxLDL) receptor-1 (LOX-1),CX3C chemokine receptor 1 (CX3CR1) with coronary artery stenosis disease and its outcomes.Methods A case-control study was conducted.A total of 176 cases of coronary artery stenosis which were confirmed coronary artery stenosis ≥ 50％ by coronary angiography(CAG) were served as case group from department of cardiology of TEDA International Cardiovascular Hospital of Tianjin from May 2011 to April 2013.A total of 129 patients without coronary artery lesion by CAG from this hospital in the same period were served as control group,which has no history of heart disease,liver and kidney dysfuction,brain disease,hematological disease,other disorders that could bring out atherosclerosis and thrombosis.General information and laboratory parameters,LOX-1,CX3CR1,uric acid (UA) and creatinine (CREA) were measured in 2 groups.These parameters of each group were compared,the levels of LOX-1 and CX3CR1 in one-vessel stenosis were compared than that in multi-vessels stenosis in case group,the correlations between LOX-1,CX3CR1 and Gensini score and other variables were analyzed.Comparison of the levels of LOX-1 and CX3CR1 between major adverse cardiovascular events (MACEs) group and nonmajor adverse cardiovascular event (MACE) group was made during follow up 1.5 years.MACEs in patients with different levels of LOX-1 and CX3CR1 were compared during 1.5-year follow up.All of the data were analyzed by SPSS 16.0 software.The independent-samples T test,Mann-Whitney U test,Chi-square test,Spearman correlation,Binary Logistic Regression and Kaplan-Meier probability were adopted for data analysis.Results Comparison between case group and control group,LOX-1:3.72 (1.44,8.15) μg/L vs 0.75(0.50,1.19) μg/L,z =11.072,P ＜0.001 ;CX3CR1:(2.82 ± 1.85) μg/L vs (2.32 ±0.79) μg/L,t =2.021,P ＜ 0.05 ; UA:(351.34 ± 94.82) μmol/L vs (326.74 ± 79.51) μmol/L,t =2.094,P ＜ 0.05 ;CREA:(70.86 ± 20.94) μmol/L vs (65.55 ± 12.96) μmol/L,t =2.077,P ＜ 0.05.CX3CR1 level was significantly higher in patients with multi-vessels stenosis (2.84 ± 1.78) μg/L than that in one-vessel stenosis(2.48 ± 1.64) μg/L,there was significance in difference (t =2.207,P ＜ 0.05).There were no statistically significant correlation between LOX-1,CX3CR1 and Gensini score (R was 0.032,0.079 respectively,P＞ 0.05).LOX-1 was negatively related to left ventricular ejection fraction(LVEF) (R =-0.272,P ＜ 0.01),but positively related to left ventricular end-diastolic diameter (LVDD)(R =0.190,P＜0.05),positively related to UA (R =0.121,P ＜ 0.05).Comparison between MACE group and nonMACE group,LOX-1:7.38(4.97,11.88)μg/L vs 3.52(1.45,7.75) μg/L,z =2.762,P ＜0.01;CX3CRl:(4.02 ±2.90) μg/L vs (2.67 ± 1.48) μg/L,t =3.086,P ＜0.01.LOX-1 and TG were independent risk effects of coronary artery stenosis disease.MACEs were increased in patients with high levels of LOX-1 after PCI during following up 1.5 years (comparison between high-LOX-1 group and lowLOX-1 group,the probability of non-MACE was 87.1％ (115/132) vs 97.7％ (43/44),Log-ranK test,x2 =6.957,P ＜ 0.01).Conclusions LOX-1 and CX3CR1 may be involved in the process of coronary artery stenosis,and a high level of LOX-1 may be associated with left ventricular systolic dysfunction in patients with coronary artery stenosis.Elevated LOX-1 level are closely related to afterwards MACE incidence after PCI in patients with coronary artery stenosis.

冠心病是导致死亡的原因之一，这种疾病由动脉粥样硬化引起，其特征是脂质和脂肪蓄积在动脉管壁上。一个关键的原因是氧化低密度脂蛋白（ ox-LDL）颗粒在血管细胞积累，这种机制可由清道夫受体介导，血凝素样氧化低密度脂蛋白受体-1（LOX-1）就是这样的清道夫受体之一。 LOX-1由一个很短的N-末端胞质结构域、一个跨膜结构域和一个长的C-末端胞外结构域组成。 LOX-1是一个有多元配体的受体，其配体包括ox-LDL、晚期糖基化终产物、血小板、中性粒细胞、细胞凋亡／老化细胞和细菌。 LOX-1通过独立网格蛋白内化途径介导了ox-LDL内吞作用，并能够最低限度和最大限度地与ox-LDL结合，从而增加血管内皮细胞功能障碍和动脉粥样硬化的程度［1］。本文对近年LOX-1的研究现状中与冠心病损伤机制相关的部分进行综述。

目的 应用血栓前体蛋白(TPP)动态监测冠脉搭桥(CABG)术后血栓病变程度,为临床治疗用药提供支持.方法 33例行CABG病例组患者在手术前、术后1、3、7d及20例对照者准确采集静脉血标本4.7ml,用日本Sysmex-2100血液分析仪测定血小板5项参数:血小板数(PLT)、血小板平均容积(MPV)、血小板分布宽度(PDW)、血小板比积(PCT)、大血小板比率(PLCR),Sysmex公司配套试剂；应用日本Sysmex CA-550凝血分析仪测定纤维蛋白原(Fbg),Siemens公司配套试剂；血栓前体蛋白(TPP)及D-二聚体(D-dimer)用ELISA方法测定,Adlitteram Diagnostic labo-ratories Inc产品.结果 术前病例组患者D-dimer及TPP明显升高；与其他参数相比,术后TPP与PLT的变化趋势一致,变化幅度大,在术后第7天持续升高至新水平；术后各期TPP与D-dimer有良好的正相关关系；Logistic回归分析表明高血压、糖尿病、吸烟是血栓形成的危险因素,TPP、D-dimer是血栓病变的危险因子,并通过ROC曲线显示TPP对诊断CABG术后血栓病变有较高的价值；用COX回归分析9例重新人院不良事件各指标,TPP对术后不良事件无预示作用,术后ld的MPV和术后3d的PDW成为患者不良事件的预示指标.结论 TPP是CABG术后血栓病变的危险因素,TPP在诊断CABG术后各阶段血栓形成,血栓发展趋势及指导临床用药方面有一定的应用价值.

ObjectiveTo explore the clinical value of the different components of glycosylated hemoglobin in pa tients with coronary artery disease(CAD).MethodsA total of 217 patients were divided into 3 groups: CAD group(groupⅠ, n=60), CAD patients without acute coronary syndrome(ACS) and with diabetes mellitus group(groupⅡ, n=60) and ACS patients with diabetes mellitus group(group Ⅲ, n=97). Fifty-eight healthy volunteers in the same time period were selected as control group. The values of fructose glycosylated hemoglobin(HbA1a), lactose glycosylated hemoglobin(HbA1b), glucose glycosylated hemoglobin(HbA1c), hemoglobin P3 component(HbP3), hemoglobin A0 component(HbA0), unstable glycosyl ated hemoglobin(LA1c/CHb1) and alkali-resistant hemoglobin(HbF) were measured. These parameters were compared be tween 4 groups. Logistic regression was used to analyze factors that influencing CAD and CAD with diabetes mellitus. The re ceiver operating characteristic(ROC) curve was used to analyze the diagnostic efficiency of these factors.ResultsThere were significant differences in titers of HbA1b, HbA1c, HbP3 and HbA0 between groupⅠ, groupⅡ, group Ⅲ and control group(P <0.01, or P < 0.05). There were no significant differences in levels of glycosylated hemoglobin parameters between group Ⅱ and group Ⅲ(P > 0.05). Logistic regression and ROC curve analysis showed that HbA1c and HbP3 were indepen dent effects of CAD, and there were some diagnostic efficiency of CAD. The diagnostic efficiency of ROC curve was consis tent in HbA1c and HbP3 between group Ⅱ and group Ⅲ.ConclusionLevels of HbA1b, HbA1c, HbP3 and HbA0 are closely related to CAD and CAD with diabetes mellitus. HbA1c and HbP3 are independent effects of CAD and, there are some diagnostic efficiency in CAD.

冠状动脉旁路移植术(CABG)后,每年有4％～8％的患者可能再次出现心绞痛等心肌缺血症状,血栓形成和再狭窄是其主要原因之一.CABG同时损伤冠状动脉和旁路血管,血流动力学发生紊乱,表现为血管舒张或血管收缩减弱,引起内皮细胞缺乏和吻合口局部血栓形成,同时血管平滑肌细胞的增生使局部内膜增厚,这是形成旁路血管内膜迁移和增生以及导致粥样硬化的基础.再狭窄是一个复杂的生物学过程,血管内皮细胞的损伤破坏了在维持血管正常结构与生物学功能所起的重要作用,并诱发血管痉挛、炎症和血栓形成,内皮细胞覆盖程度与脱落细胞面积,直接关系到内膜增生及血运重建术后近、远期通畅率.因此,急性血栓形成、新生内膜增生和动脉粥样硬化,损害了冠状动脉和外周静脉旁路移植物的长期通畅性.此外,在导致移植物变性以至最终移植失败过程中,通过黏附分子对白细胞-内皮的相互调节;在内皮型一氧化氮合酶和诱导型一氧化氮合酶的表达与活性中,一氧化氮继发信号的改变;随着促炎症作用的环氧化酶2活性增强,环氧化酶功能的变化;蛋白激酶C和丝裂原活化蛋白激酶信号的改变;表达血管渗透性和脆性的血管内皮生长因子的增加,均起到了重要作用[1].我们对近年来此领域的研究进展及现状进行综述.