Correlation of Serum Hs-CRP, D-dimmer and Lp-PLA2 Levels with Vulnerable Plaque of Coronary Artery Atherosclerosis in Patients with Coronary Heart Disease / 现代生物医学进展

Objective:To investigate the correlation of serum hs-CRP,D-dimmer and Lp-PLA2 with vulnerable plaque of coronary artery atherosclerosis in patients with coronary heart disease.Methods:Selected 106 cases of patients in our hospital from January 2014 to December 2015,all taken coronary angiography and intravascular ultrasound.Divided into three groups according to the results of the examination,the levels of serum hs-CRP,D-dimmer and Lp-PLA2 were examined and compared,and the correlation with fiber cap thickness,plaque eccentricity index,and vascular remodeling index were tested by Pearson correlation analysis.Results:Serum levels of hs-CRP,D-dimmer and Lp-PLA2 of vulnerable plaque group and stable plaque group were significantly higher than that of the control group (P＜0.05),and the serum levels of hs-CRP,D-dimmer and Lp-PLA2 of vulnerable plaque group were significantly higher than that of stable plaque group (P＜0.05);hs-CRP was negative correlated with the thickness of fibrous cap (r=-0.712,P＜0.05),and positive correlated with eccentric plaque index and vascular remodeling index (r=0.813,0.756;D-,P＜0.05),D-dimmer was negative correlated with the thickness of fibrous cap (r=-0.654,P＜0.05),and positive correlated with eccentric plaque index and vascular remodeling index (r=0.912,0.853,P＜0.05);Lp-PLA2 was negative correlated with the thickness of fibrous cap (r=-0.796,P＜0.05),and positive correlated with eccentric plaque index and vascular remodeling index (r=0.836,0.729,P＜0.05).Conclusion:Hs-CRP,D-dimmer and Lp-PLA2 have high correlation with vulnerable plaque in coronary artery disease,can be used as reference indexes for assessing the instability of coronary atherosclerotic plaque.

Correlation analysis of the level of high sensitivity C reactive protein, D-dimer and carotid atherosclerotic plaque in patients with acute cerebral infarction / 中国基层医药

Objective To explore the treatment and diagnostic value of combined detection of high sensitivity C reactive protein(hs-CRP) and D-dimer (DD) levels for carotid artery plaque (CAS) in patients with acute cerebral infarction(ACI).Methods 48 patients with ACI were selected as the observation group,while 48 healthy people who excluded ACI were selected as the control group.The vascular ultrasonography and serum levels of hs-CRP and DD were detected within 3 days,and the observation group was classified according to TOAST.Results The hs-CRP and DD levels in the observation group were (7.88 ±2.54)mg/L and (1 286.2 ±233.4) μg/L,respectively,which were significantly higher than (1.14 ± 0.32) mg/L and (462.8 ± 147.2) μg/L in the control group (t =15.53,20.67,all P ＜ 0.05).The differences of hs-CRP and DD levels in different TOAST subtypes ACI patients were not statistically significant(P ＞0.05).The hs-CRP level was positively correlated with the number of instability carotid plaque(r =0.465,P =0.000),and DD level had no significant correlation with the number of instability carotid plaque.Conclusion Elevated serum hs-CRP and DD levels in ACI patients confirmed its participation in the acute inflammatory response,and hs-CRP can better reflect the instability of ACI patients with CAS.

Assessment the value of serum Lp-PLA2,hs-CRP and D-D dimer on the severity of coronary artery lesion of coronary heart disease / 重庆医学

Objective To investigate the assessment value of serum Lp-PLA2 ,hs-CRP and D-D dimer on the severity of cor-onary artery lesion .Methods A total of 136 patients with coronary heart disease acute myocardial infarction (AMI) group 46 ca-ses ,stable angina pectoris (SAP) group 38 cases and unstable angina pectoris (UAP) group 52 cases from the inpatient of cardiolo-gy department in our hospital were selected as observation group ,and 135 healthy subjects were selected as control group ,serum Lp-PLA2 was detected by enzyme kinetic method ,Serum hs-CRP and plasma D-D dimer were detected by immune turbidimetric method ,of the severity of coronary artery lesion was evaluated by the Gensini integrations .Results Serum Lp-PLA2 ,hs-CRP ,D-D dimer level and Gensini score of observation group were significantly higher than those of control group ,above indexes of AMI group were higher than those of SAP group and UAP group ,UAP group were significantly higher than SAP group ,with statistical significance between the two groups(P<0 .05) .Serum Lp-PLA2 ,hs-CRP ,D-D dimer level and Gensini score of patients with heart functional class Ⅱwere significantly lower than those of Ⅲ and Ⅳ patients ,above indexes of patients with heart functional class Ⅲwere significantly lower than Ⅳ patients ,the difference between two groups was significant(P<0 .05) .Compared with severity of coronary artery lesion ,serum Lp-PLA2 hs-CRP and D-D dimer levels of mild coronary artery lesions were significantly lower than those of moderate and high coronary artery lesions ,and moderate coronary artery lesions was obviously lower than high coronary artery lesions (P<0 .05) ,Pearson correlation analysis also found that ,Lp-PLA2 ,hs-CRP ,D-D dimer levels had positive correlation with Gensini score (r=0 .642 ,0 .651 ,0 .608 ,P<0 .05) .Conclusion The assessment of serum Lp-PLA2 ,hs-CRP and D-D dimer level in the severity of coronary artery lesion has important significance .

The effect of anticoagulant therapy on coagulation and inflammation markers in sepsis patients and its significance / 中华危重病急救医学

ObjectiveTo study the effect of anticoagulant therapy with low molecular weight heparin (LMWH) on coagulation and inflammation markers in sepsis patients.Methods A prospective randomized controlled trial was conducted. Sixty sepsis patients admitted to intensive care unit (ICU) of Zhengzhou University People's Hospital from March 2012 to May 2014 were divided into control group and observation group, with 30 cases in each group. The observations were begun as soon as the diagnosis of sepsis was established, and the observation time was 7 days. All sepsis patients were treated according to the 2008 international sepsis treatment guidelines. Every patient in the observation group was subcutaneously injected with LMWH 0.6 mL on the first day of ICU admission, twice a day for 7 days. The blood from peripheral vein was collected at 1, 3, 5, 7 days of treatment, and CD62p, interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) were determined by enzyme linked immunosorbent assay (ELISA), D-dimmer was determined by immunoturbidimetry, acute physiology and chronic health evaluationⅡ (APACHEⅡ) score was recorded, and incidence of multiple organ dysfunction syndrome (MODS) was also evaluated.Results There were no significant differences in values of all parameters, including CD62p, D-dimmer, IL-6, TNF-α, and APACHEⅡ score at 1 day of treatment. The values of all parameters in observation group were gradually decreased. CD62p at 3 days of treatment and D-dimmer, IL-6, TNF-α, and APACHEⅡ score at 5 days of treatment were significantly lower than those at 1 day of treatment. The values in the control group were decreased at first and then increased, as D-dimmer, IL-6 and TNF-α were significantly higher on the 5th day than those at 1 day of treatment. Compared with control group, CD62p, D-dimmer, IL-6, TNF-α and APACHEⅡ score on the 7th day of treatment were significantly lowered in observation group [CD62 (μg/L): 22.64±2.88 vs. 31.52±2.81, D-dimmer (g/L): 1.32±0.46 vs. 4.79±0.82, IL-6 (ng/L): 5.84±1.87 vs. 49.64±3.12, TNF-α (ng/L): 21.04±3.15 vs. 130.58±6.26, APACHEⅡ score: 9.71±2.02 vs. 14.17±2.38, allP< 0.05]. Correlation analysis showed that in observation group, CD62p, D-dimmer, IL-6, and TNF-α were positively correlated with APACHEⅡ score (r value was 0.907, 0.868, 0.880, 0.693, respectively, all P=0.000). The incidence of MODS in observation group was significantly lower than that in the control group [26.7% (8/30) vs. 46.7% (14/30),χ2=3.943,P= 0.028].Conclusions LMWH, which was given early in sepsis, can significantly down-regulate the expression of CD62p, D-dimmer, IL-6 and TNF-α, and reduce the incidence of MODS. Some indicators regarding coagulation and inflammation can be used as supplementary indicators to severity scores, and it may be able to improve the accuracy of scoring systems for sepsis.

The clinical significance on changes of plasma fibrinogen,plasminogen and D-dimmer before and after thrombolytic therapy in patients with acute myocardial infarction / 国际检验医学杂志

Objective To explore the changes of plasma fibrinogen ,plasminogen and D-dimmer before and after thrombolytic therapy in patients with acute myocardial infarction (AMI) ,to provide the evidence for treatment and prognosis AMI .Methods 93 cases of patients with AMI were divided into twe groups ,reperfusion group of 77 cases ,obstract group of 16 cases .At the same pe-riod ,30 cases myocardial infarction of patients with non thrombolytic therapy were selected as control group .The levels of plasma Fib ,Plg and D-dimer in each group were detected at different times .Results The levels of Fib and D-D in AMI patients were higher than those in the control group before thrombolysis therapy (P<0 .05) .Compared with before thrombolysis therapy ,the Fib and Plg levels of AMI patients were decreased significantly after thrombolytic therapy 6 h(P<0 .01) ,and returned to the normal level after 48 h .The D-dimmer level of AMI patients was increased significantly after thrombolytic therapy 6 h(P<0 .01) ,and returned to the normal level after 7 d .After thrombolytic therapy 6 h ,the levels of Fib and Plg of reperfusion group were decreased signifi-cantly(P<0 .05) ,the level of D-dimmer was increased significantly (P<0 .05) .Conclusion The levels of plasma fibrinogen ,plas-minogen and D-dimmer have important reference value for monitor the thrombolytic therapy effect in patients with AMI .

Analysis of Factors That Affect Plasma D-Dimmer Level in Acute Aortic Syndrome / 天津医药

Objective To explore the factors that could affect plasma level of D-dimmer test in acute aortic syn-drome. Methods Blood samples (2 mL) from acute aortic syndrome patients (n=76) obtained immediately after admission to detect D-dimmer using ELISA. Blood routine test and biochemical indicators tests including creatinine were also performed. White blood cell (WBC), serum value of creatinine, aortic contrast-enhanced CT, incidence of Shock and death were all re-corded. The receiver-operating characteristic curve (ROC) was established to assess the potency of D-dimmer to predict hospital mortality. Results According to ROC analysis, the optimal cut-off value of D-dimmer to predict hospital mortality was >2 988.6 μg/L (FEU), with 86.7% sensitivity and 70.5% specificity. The patients were divided into group A (D-dim-mer<2 988.6μg/L FEU, n=45) and group B (D-dimmer≥2 988.6μg/L FEU,n=31). Onset timing was longer in group A than that in group B(P<0.01). Involvement of ascending aorta was less common in group A than in group B(P<0.05). Aortic intramural hematoma was less common in group A than in group B(P<0.05). Logistic analysis demonstrated that short time of onset, involvement of ascending aorta, non-aortic intramural hematoma were all independent factors of higher D-dimmer (≥2 988.6μg/L FEU). Conclusion Patients with long time of onset, without involvement of ascending aorta, with intramural hematoma are liable to have lower values of plasma D-dimmer.

Dímero D: su importancia en el tromboembolismo venoso / D-Dimer: Its importance in venous thromboembolism

El tromboembolismo venoso es una condición frecuente en la práctica clínica. La determinación del Dímero D ha sido utilizada como prueba para el diagnóstico del tromboembolismo venoso. El Dímero D se origina a partir del proceso de fibrinólisis del coagulo mediado por la plasmina. La detección se logra a través de anticuerpos que detectan los antígenos libres de Dímero D. En general, la fortaleza diagnóstica de la prueba se fundamenta en una sensibilidad mayor a 90% y un valor predictivo negativo cercano al 100% cuando se utilizan pruebas de alta sensibilidad en pacientes con probabilidad clínica baja o intermedia de presentar un tromboembolismo venoso. La Sociedad Europea de Cardiología ha revisado la metodología diagnóstica del tromboembolismo pulmonar, sugiriendo el uso del Dímero D en pacientes con baja o intermedia probabilidad clínica de tromboembolismo pulmonar, o en la sala de emergencia, para reducir estudios por imágenes o irradiación innecesaria, excluyendo el tromboembolismo venoso con resultados negativos. Adicionalmente, más allá del rol diagnóstico, existe evidencia que sugiere, que el valor del Dímero D se correlaciona con la probabilidad que distintas patologías protrombóticas desarrollen tromboembolismo venoso. De manera similar, valores elevados parecen correlacionarse con la severidad y mortalidad del tromboembolismo venoso, así como con la recurrencia del mismo al retirarse la medicación anticoagulante. Finalmente, nuevas técnicas para la determinación del Dímero D han sido publicadas y se ha planteado que asociar pruebas que permiten evaluar la activación de la coagulación podría potenciar el valor diagnóstico del Dímero D. La presente revisión evalúa la importancia del Dímero D en el tromboembolismo venoso.

Venous thromboembolism is a common condition in clinical practice. The determination of D-dimer (DD) has been usedas evidence for the diagnosis of venous thromboembolism. The D-dimer originates from the process of clot fibrinolysis mediated by plasmin. Detection is achieved through antibodies that detect antigens D-dimer free. In general, the strength of evidence is diagnosed based on sensitivity greater than 90% and negative predictive value approaching 100% using sensitivity testing in patients with low or intermediate clinical probability of presenting a venous thromboembolism. The European Society of Cardiology has revised the methodology diagnosis of pulmonary embolism, suggesting the use of D-dimer in patients with low or intermediate clinical probability of pulmonary embolism, or in the emergency room, to reduce imaging or radiation unnecessary exclusion of venous thromboembolism with negative results. Additionally, beyond the diagnostic role, there is evidence that suggests that the value of D-dimer is correlated with the probability of developing venous thromboembolism by other prothrombotic pathologies. Similarly, high values appear to correlate with the severity and mortality of venous thromboembolism, as well as recurrence of the anticoagulant medication to withdraw. Finally, new techniques for the determination of D-dimer have been published and has been raised to associate tests to assess coagulation activation could enhance the diagnostic value of D-dimer. This review evaluates the importance of the D-dimer in venous thromboembolism.

The research of the correlation of the changes of routine coagulation index and D-dimmer with postpartum hemorrhage / 中国基层医药

Objective To study the correlation of the changes of routine coagulation index and D-dimmer(D-D) with postpartum hemorrhage. Methods 37 patients with postpartum hemorrhage were divided into 2 groups ac-cording to the quantity of bleeding(group 1,27 patients, postpartum hemorrhage 500 ～ 800ml; group 2,10 patients, postpartum hemorrhage more than g00ml) and 30 patients with normal deliveries as control. Routine congulation in-dex, activated partial thromboplastin time(APIT) ,prothrombin time(PT) ,thrombin time(13") ,fibrinogen(Fg) and D-D were detected during the end of delivery and 48 hours after delivery. Results Compare with control group at the end of the delivery in group 1 ,the D-D was remarkably increased (P<0.05) ,but there was no significant difference of the routine coagulation index compared with control group (P > 0.05), in group 2, the D-D, PT, APTT were in-creased, whereas the Fg was decreased (P < 0.05). 48 hours after delivery, compared with control group,the D-D was significantly higher(P < 0.05), whereas the routine coagulation index had no significant difference (P > 0.05). The lowering of D-D, increase of Fg were higher in group 2 than those in group 1 (P < 0.05). Conclusion It has impor-tant clinical significance to timely monitor routine coagulation index and D-D at the end of delivery and after delivery for understanding the coagulation function of parturient and preventing disseminated intravascular coagulation.

A correlative study on the changes of blood gas, plasma fibrinogen and D-dimmer in neonates with hya-line membrane disease / 中国小儿急救医学

Objective To explore the changes of blood gas, plasma fibrinogen and D-dimmer levels in neonates with severe hyaline membrane disease (HMD). Methods Forty - three neonates with severe HMD(treated by mechanical ventilation) ,26 neonates with mild HMD( without treated by mechanical venti-lation) and 31 controls were studied. The blood gas,plasma fibrinogen and D-dimmer levels were measured. Results Compared with other two groups, the levels of blood pH, PaO2 and FBG decreased significantly in neonates with severe HMD (P<0.01). The levels of PaCO2 and D-dimmer increased significantly (P<0.01). The blood pH was negatively correlated with plasma D-dimmer level,but it was positively correlated with plasma FBG level in neonates with severe HMD. Conclusion There are coagulation abnormalities in neonates with severe HMD. Hypoxemia and acidosis have close relationship with the coagulation abnormali-ties.

Clinical analysis of 122 cases of acute pulmonary thromboembolism / 中国实用内科杂志

Objective To discuss clinical characteriistics of APE and therapeutic effect of thrombolysis or anticoagulation so as to reduce false or misdiagnosis rate and improve survival rate.Methods The clinical data of 122 inpatients with APE were reviewed.Results The most common risk factors were deep venous thrombosis,age over 60 years old,cardiac disease,surgical operation,diabetes,fracture,long-term immobilization,etc.The most frequent symptom was dyspnea.D-dimmer measure had high sensitivity.By means of color Doppler echocardiography,spiral computed tomography,pulmonary ventilation/perfusion scanning,the cases were finally diagnosed.Positive treatment of thrombolysis and anticoagulation could reduce mortality.Conclusion As clinical manifestations of APE are non-specific,clinician should be alert.D-dimmer measue could be screening.The standardized treatment can improve prognosis significantly.

Values of fibrinogen degradation products (FDPs) and D-dimmer in healthy people

The study involved 32 healthy blood donors (16 men and 6 women). Plasma D-dimer and FDPs levels were determined by semi-quantitative method, using chemical procedure of the Stago Inc., France. The results showed that plasma FDPs level in healthy people was lower than 40 g/ml (93.75% of the participants had lees than 20 g/ml). Plasma D-dimer level was 1-4 g/ml, with 75% of the participants had D-dimer values ranged from 1 to 2 g/ml.