The predictive value of liver failure-related etiology for clinical outcomes / 中华危重病急救医学

Objective:To assess the predictors of outcomes for different subtypes of liver failure, and the effectiveness of artificial liver support systems in the treatment of liver failure.Methods:The clinical data of 112 patients with hepatitis B virus (HBV)- and non-HBV-related liver failure admitted to the intensive care unit (ICU) of the Fifth People's Hospital of Wuxi were collected from January to December 2020. The relevant etiologies of acute, subacute, acute-on-chronic, subacute-on-chronic, chronic subtype liver failure were analyzed. The efficacies of artificial liver support systems in the treatment of various subtypes of liver failure were also compared. The correlation of various indicators was analyzed by Spearman correlation analysis, the risk factors affecting the prognosis of patients with liver failure were analyzed by multivariate Logistic regression equation, and receiver operator characteristic curve (ROC curve) of subjects was plotted to evaluate the predictive value of each risk factor for the prognosis of patients with liver failure.Results:Among the 112 liver failure patients, 63 were caused by hepatitis B and 49 were caused by non-hepatitis B. The liver failure caused by hepatitis B was 6 times higher than for men than for women, which was higher than that of non-HBV liver failure group (1.33 times). Antithrombin Ⅲ (AT Ⅲ) and total bilirubin (TBil) levels of subacute liver failure were higher than those of pre-liver failure in the HBV liver failure group [AT Ⅲ: (59.33±14.57)% vs. (35.66±20.72)%, TBil (μmol/L): 399.21±112.94 vs. 206.08±126.96, both P < 0.05]. The levels of AT Ⅲ in patients with pre-liver failure and chronic liver failure in the non-HBV liver failure group were significantly higher than those with acute liver failure [(58.33±15.28%), (44.00±19.10)% vs. (31.33±7.57)%, both P < 0.05], patients with acute liver failure had significantly lower level of TBil than pre-liver failure (μmol/L: 107.83±49.73 vs. 286.20±128.92, P < 0.05), the TBil levels in patients with subacute and acute-on-chronic liver failure were also significantly higher than that in pre-liver failure group (μmol/L: 417.27±118.60, 373.00±187.00 vs. 286.20±128.92, both P < 0.05). Patients with subacute liver failure, subacute-on-chronic liver failure and chronic liver failure in the non-HBV failure group were significantly longer than those in acute liver failure (days: 36.00±8.31, 27.52±11.71, 27.72±22.71 vs. 11.00±1.41, all P < 0.05). There was no statistically significant difference in the case fatality rate of using the artificial liver support system between the HBV failure group and the non-HBV failure group (55.6% vs. 50.0%, P < 0.05), the levels of AT Ⅲ in the two groups of surviving patients were significantly higher than that of the dead [HBV liver failure group: (36.20±6.26)% vs. (27.33±8.87)%, non-HBV liver failure group: (41.06±4.16)% vs. (28.71±12.35)%, both P < 0.01]. Correlation analysis showed that there was a clear positive correlation between AT Ⅲ and TBil in the dead patients of HBV liver failure group and the survival and death patients of non-HBV liver failure group ( r values were 0.069, 0.341, 0.064, and P values were 0.723, 1.196 and 0.761, respectively); there was a significant inverse correlation between AT Ⅲ and TBil in the HBV liver failure group ( r = -0.105, P = 0.745). Multivariate Logistic regression analysis showed that AT Ⅲ was an independent risk factor affecting the prognosis of patients with non-HBV liver failure [odd ratio ( OR) = 1.023, 95% confidence interval (95% CI) was -0.001 to 0.001, P = 0.007]. TBil was an independent risk factor affecting prognosis of patients with HBV liver failure ( OR = 1.005, 95% CI was -0.002 to -7.543, P = 0.033). The analysis of ROC curve showed that AT Ⅲ had a predictive value for the prognosis of patients with non-HBV liver failure, the area under the ROC curve (AUC) = 0.747, the 95% CI was 0.592-0.902, P = 0.009. When the optimal truncation value was 39.5%, its sensitivity and specificity were 83.33% and 56.25%, respectively. Conclusions:Artificial liver support system treatment of liver failure was difficult to effectively reduce the mortality of patients with end-stage liver failure. In addition to AT Ⅲ, TBil also could be used as an indicator to assess liver compensatency and predict prognosis in liver failure patients.

The evaluation value of antithrombin Ⅲ in decompensated stage of hepatitis B liver cirrhosis and complicated with esophagogastric variceal bleeding / 中华消化杂志

Objective:To investigate the value of antithrombin Ⅲ (AT-Ⅲ) in evaluating patients with decompensated hepatitis B liver cirrhosis and complicated with esophagogastric variceal bleeding (EVB).Methods:From January 1, 2018 to December 31, 2021, clinical data of 193 hospitalized patients with hepatitis B liver cirrhosis diagnosed in the Second Hospital of Shanxi Medical University were retrospectively analyzed, which included coagulation indicator (AT-Ⅲ), liver function indicators (total bilirubin, etc.), abdominal ultrasound results (portal vein diameter, portal vein blood flow velocity), and the occurrence of esophagogastric varices. According to the presence or absence of main complications, 193 patients with hepatitis B liver cirrhosis were divided into compensated group (60 cases) and decompensated group (133 cases). According to the presence or absence of EVB, 133 patients of decompensated group were divided into non-bleeding subgroup (96 cases) and bleeding subgroup (37 cases). The above indicators were compared among compensated group, decompensated group and their subgroups. The independent related factors of decompensated hepatitis B liver cirrhosis and EVB were analyzed. The level of AT-Ⅲ of each group were compared, and the relationship between AT-Ⅲ and Child-Pugh score was analyzed. The diagnostic capability of AT-Ⅲ in decompensated hepatitis B liver cirrhosis and complicated with EVB were analyzed. Mann-Whitney U test, independent sample t test, chi-square test, multiple logistic regression analysis, Pearson correlation analysis and receiver operating characteristic curve (ROC) analysis were used for statistical analysis. Results:The total bilirubin level of the decompensated group was higher than that of the compensated group, the portal vein diameter was larger than that of the compensated group, and the portal vein blood flow velocity was lower than that of the compensated group (31.50 μmol/L (21.90 μmol/L, 48.80 μmol/L) vs. 19.40 μmol/L (15.00 μmol/L, 25.50 μmol/L); (14.31±3.53) mm vs. (12.57±3.83) mm; (13.39±3.49) cm/s vs. (15.08±4.28) cm/s), and the differences were statistically significant ( Z=-5.76, t=-2.78 and 2.40; P<0.001, =0.006 and 0.018). The incidence of esophagogastric varices of the compensated group and the decompensated group was compared (40.0%, 24/60 vs. 87.2%, 116/133), and the difference was statistically significant ( χ2=64.06, P<0.001). The diameter of portal vein of the bleeding subgroup was larger than that of the non-bleeding subgroup, and the portal vein blood flow velocity was lower than that of the non-bleeding subgroup ((15.54±4.23) mm vs. (13.87±3.16) mm; (12.05±3.12) cm/s vs. (13.85±3.51) cm/s), and the differences were statistically significant ( t=-2.15 and 2.23, P=0.034 and 0.028). The AT-Ⅲ levels gradually decreased in the non-bleeding subgroup and bleeding subgroup of the compensated group and decompensated group, which were (79.52±16.02)%, (63.91±19.96)% and (35.92±13.69)%, respectively, the difference was statistically significant ( F=5.71, P=0.018). The AT-Ⅲ level of the compensated group was higher than that of the non-bleeding subgroup and the bleeding subgroup of the decompensated group, and the AT-Ⅲ level of the non-bleeding subgroup of the decompensated group was higher than that of the bleeding subgroup, and the differences were statistically significant ( t=5.11, 13.74 and 7.84, all P<0.001). The results of multivariate logistic regression analysis showed that total bilirubin and AT-Ⅲ were independent related factors of decompensation of hepatitis B liver cirrhosis ( OR (95% confidence interval (95% CI) 1.060 (1.018 to 1.104) and 0.945 (0.922 to 0.970), P=0.005 and <0.001). AT-Ⅲ was an independent related factor of decompensation of hepatitis B liver cirrhosis and complicated with EVB ( OR(95% CI) 0.902 (0.856 to 0.950, P<0.001). AT-Ⅲ was negatively correlated with Child-Pugh score ( r=-0.559, P<0.001). ROC analysis showed that the cut-off values of AT-Ⅲ in the diagnosis of decompensated stage of hepatitis B liver cirrhosis and complicated with EVB were 62.5% and 61.5%, the sensitivity was 88.3% and 89.2%, the specificity was 70.7% and 61.5%, and the area under the curve (95% CI) was 0.815 (0.755 to 0.874, P<0.001) and 0.899 (0.828 to 0.971, P<0.001), respectively. Conclusion:AT-Ⅲ is an important indicator in evaluating the severity of disease progression in patients with hepatitis B liver cirrhosis, and it has a certain clinical value in evaluating the bleeding tendency of patients with decompensated hepatitis B liver cirrhosis and complicated with esophagogastric varices.

Influence of different levels of heparin and antithrombin Ⅲ on human coagulation factor Ⅸ activity / 中国输血杂志

【Objective】 To study the effect of different concentrations of heparin, ATⅢ or a mixture of heparin and antithrombin Ⅲ (ATⅢ) (1∶1)on the activity of human coagulation factor Ⅸ (FⅨ). 【Methods】 The heparin or heparin/ATⅢ with different concentrations were added into human coagulation Ⅸ products or human prothrombin complex (PCC) to prepare heparin or heparin/ATⅢ samples, containing 0, 0.1, 0.3, 0.5, 0.8, 1, 2 and 4 IU per unit. ATⅢ with different concentrations were added into FⅨ or PCC to prepare ATⅢ samples containing ATⅢ 0, 0.1, 0.5 and 1 IU per unit. The FⅨ activity of the samples prepared was tested by one-stage coagulation method. Then corresponding amount of protamine sulfate were added to neutralize heparin or heparin/ATⅢ to detect the FⅨ activity again. Their influence of heparin, ATⅢ and heparin/ATⅢ with different concentrations on the activity of FⅨ were analyzed. 【Results】 When the content of heparin or heparin/ATⅢ was 0, 0.1, 0.3 and 0.5 IU per unit of FⅨ, the detection results of FⅨ titer in samples were consistent. When the content of heparin or heparin/ATⅢ per unit of FⅨ was 0.8, 1, 2 and 4 IU, the detection results of FⅨ titer were all lower than those of samples without heparin. When the ATⅢ content was 0, 0.1, 0.5 and 1 IU, the FⅨ titer of the samples was consistent. 【Conclution】 When the content of heparin or heparin/ATⅢ in the product is less than or equal to 0.5 IU per IU of FⅨ, the step of protamine sulfate adding could be omitted as it has little effect on FⅨ activity. When >0.5 IU per IU of FⅨ, however, protamine sulfate adding, to neutralize heparin, is necessary before FⅨ activity testing.

Prospects for plasma protein products in China / 中国输血杂志

Plasma protein products, essential drugs for various clinical diseases, are therapeutic biological products extracted from healthy human plasma. The research and development of new plasma protein products, led by United States and European, has been widely deepened and enhanced. Therefore, accelerating the development of new plasma protein products in China is of great significance. This review summarizes the research and development of plasma protein products that have been marketed abroad but have not produced in China, as well as analyzes the difficulties and prospects of the development of plasma protein products in China.

The relationship between the level of TAT/PIC and utilization rate of mechanical ventilation in critically ill patients / 西安交通大学学报(医学版)

【Objective】 To investigate the relationship between the level of thrombin-antithrombin complex (TAT)/α2-plasmin inhibitor-plasmin complex (PIC) and the utilization rate of mechanical ventilation (MV) in critically ill patients. 【Methods】 For the cross-sectional study, adult patients who had been admitted to the intensive care unit (ICU) for one day or longer and had a record of the first four tests for thrombosis were enrolled. Age, gender, the results of TAT and PIC, disseminated intravascular coagulation score, treatment, and diagnostic information were retrospectively collected from the hospital information system and laboratory information system. Logistic regression model was used to explore the relationship between TAT/PIC and the MV utilization rate. Interaction analysis and subgroup analysis were conducted to explore whether there was any difference between patients with different age and gender, patients with/without DIC, and with/without infection. 【Results】 A total of 1 176 patients were enrolled in this study. The median of the first TAT/PIC was 15.84 (8.13-33.11) in all the patients. The multivariable Logistic regression model results showed that for every 5 increase in TAT/PIC, the possibility of using MV increased by 2.9% (OR=1.029, 95% CI: 1.008-1.050), and the possibility of using MV in Q3 patients was 1.566 times than that in Q1 patients (OR=1.566, 95% CI: 1.095-2.239); the possibility of using MV in Q4 patients was 2.457 times than that in Q1 patients (OR=2.457, 95% CI: 1.694-3.563). Interaction results showed that the relationship between the level of TAT/PIC and MV usage was different in patients with and without infection (Pinteraction=0.02). Further subgroup analysis showed that in the infected patients (674 cases), the possibility of using MV increased by 5.9% for every 5 increase in TAT/PIC (OR=1.059, 95% CI: 1.022-1.097, P=0.001), while there was no significant difference between different TAT/PIC and MV usage in non-infected patients (502 cases) (OR=1.012, 95% CI: 0.984-1.040, P=0.405). 【Conclusion】 There is a correlation between the level of TAT/PIC and mechanical ventilation in patients with infection in the ICU.

Detection and Clinical Significance of Thrombus Molecular Markers in Diffuse Large B-cell Lymphoma / 肿瘤防治研究

Objective To investigate the detection and clinical significance of thrombus molecular markers in diffuse large B-cell lymphoma (DLBCL). Methods We collected the blood specimens of 60 patients with DLBCL, involving 23 cases in the initial treatment group, 24 cases in the remission group and 13 cases in the non-remission group, 23 cases in the thrombus group and 37 cases in the non-thrombus group. We selected 46 healthy people in the same period as the control group. The levels of thrombomodulin (TM), plasmin-α2 plasmin inhibitor complex (PIC), tissue plasminogen activator-plasminogen activator inhibitor-1 complex (t-PAIC) and thrombin-antithrombin Ⅲ complex (TAT) in plasma were detected by chemical immunoassay, and the levels of lactate dehydrogenase (LDH) in serum was detected by automatic biochemical analyzer. We analyzed the differences of thrombus molecular markers among groups and prognostic factors. Results The levels of TM and PIC in plasma of lymphoma patients were higher than those in health control group (P < 0.05). The levels of TM and PIC in the initial treatment and non-remission groups were significantly higher than those in the remission group (P < 0.05). The levels of TM, PIC and TAT in thrombus group were higher than those in non-thrombus group (P < 0.05). TM and PIC levels in plasma were closely related to the prognosis of DLBCL patients. PIC was an independent prognostic factor (P < 0.001). TM and PIC levels were correlated with LDH prognostic indicators in lymphoma patients. Conclusion TM and PIC levels in plasma are significantly increased in DLBCL patients. They are expected to be the indicators for effectiveness and prognosis of DLBCL patients.

Study on risk factors of catheter-related venous thrombosis and prevention effect of low-molecular-weight heparin in patients with hematological malignancies / 肿瘤研究与临床

Objective To investigate the incidence and risk factors of catheter-related venous thrombosis (PICC-DVT) after peripherally inserted central catheter (PICC) in patients with hematologic malignancies, and to analyze the safety of anti-coagulation therapy with low-molecular-weight heparin. Methods From August 2016 to June 2018, 43 patients with hematologic malignancies received PICC in Baoan District People ' s Hospital of Shenzhen City were enrolled. The patients were divided into low-molecular-weight heparin anticoagulation group (22 cases) and blank control group (21 cases) according to the random number table method. The blood routine, coagulation quadruple, D-dimer, protein C activity, protein S activity, and antithrombin Ⅲactivity before and after catheterization were compared between the two groups. Results Of the 43 patients, 5 cases (11.62％) occurred PICC-DVT within 1 month after PICC, including 2 cases (9.09％) in the low-molecular-weight heparin anticoagulation group, and 3 cases (14.29％) in the blank control group, the difference between the two groups was not statistically significant (P=0.664). No pulmonary embolism occurred in all patients with PICC-DVT. One case in the blank control group developed PICC-DVT and catheter-associated staphylococcus aureus infection, the patient was extubated after anti-infection and thrombolytic therapy, the other patients with PICC-DVT were not extubated, and the thrombus was dissolved after anticoagulant therapy. There were no significant differences in the white blood cell count, platelet count,prothrombin time, activated partial thromboplastin time, D-dimer, protein C activity, protein S activity, and antithrombin Ⅲ activity between the low-molecular-weight heparin anticoagulation group and blank control group (all P> 0.05). The anticoagulant index (protein C, protein S or antithrombin Ⅲ activity) was decreased in 5 patients with PICC-DVT, and in 38 non-thrombotic patients, the anticoagulant index was reduced in 16 patients (42.11％), the difference was statistically significant (P= 0.021). Conclusions The incidence of protein C, protein S or antithrombin Ⅲ activity reduction in hematological malignancies patients with PICC-DVT is higher than that in non-thrombotic patients. Low-molecular-weight heparin anticoagulant therapy can not reduce the occurrence of PICC-DVT within 1 month after PICC in patients with hematological malignancies, but the treatment is safe and has no relevant bleeding event.

Study on risk factors of catheter-related venous thrombosis and prevention effect of low-molecular-weight heparin in patients with hematological malignancies / 肿瘤研究与临床

Objective@#To investigate the incidence and risk factors of catheter-related venous thrombosis (PICC-DVT) after peripherally inserted central catheter (PICC) in patients with hematologic malignancies, and to analyze the safety of anti-coagulation therapy with low-molecular-weight heparin.@*Methods@#From August 2016 to June 2018, 43 patients with hematologic malignancies received PICC in Baoan District People's Hospital of Shenzhen City were enrolled. The patients were divided into low-molecular-weight heparin anticoagulation group (22 cases) and blank control group (21 cases) according to the random number table method. The blood routine, coagulation quadruple, D-dimer, protein C activity, protein S activity, and antithrombin Ⅲ activity before and after catheterization were compared between the two groups.@*Results@#Of the 43 patients, 5 cases (11.62%) occurred PICC-DVT within 1 month after PICC, including 2 cases (9.09%) in the low-molecular-weight heparin anticoagulation group, and 3 cases (14.29%) in the blank control group, the difference between the two groups was not statistically significant (P = 0.664). No pulmonary embolism occurred in all patients with PICC-DVT. One case in the blank control group developed PICC-DVT and catheter-associated staphylococcus aureus infection, the patient was extubated after anti-infection and thrombolytic therapy, the other patients with PICC-DVT were not extubated, and the thrombus was dissolved after anticoagulant therapy. There were no significant differences in the white blood cell count, platelet count, prothrombin time, activated partial thromboplastin time, D-dimer, protein C activity, protein S activity, and antithrombin Ⅲ activity between the low-molecular-weight heparin anticoagulation group and blank control group (all P > 0.05). The anticoagulant index (protein C, protein S or antithrombin Ⅲ activity) was decreased in 5 patients with PICC-DVT, and in 38 non-thrombotic patients, the anticoagulant index was reduced in 16 patients (42.11%), the difference was statistically significant (P = 0.021).@*Conclusions@#The incidence of protein C, protein S or antithrombin Ⅲ activity reduction in hematological malignancies patients with PICC-DVT is higher than that in non-thrombotic patients. Low-molecular-weight heparin anticoagulant therapy can not reduce the occurrence of PICC-DVT within 1 month after PICC in patients with hematological malignancies, but the treatment is safe and has no relevant bleeding event.

Factors influencing paediatric antithrombin Ⅲ detection / 国际儿科学杂志

Antithrombin Ⅲ (AT-Ⅲ) is a single chain glycoprotein secreted by liver and vascular endothelial cells with a half-life of 2.69 days and is one of the important members of the broad-spectrum serine protein inhibitor family.AT-Ⅲ plays an important role in anticoagulant regulation in the human body,accounting for about 70％-80％ of the total activity of the plasma anticoagulant system.It is involved in maintaining the homeostasis of the coagulation system and anticoagulant system in the body.In recent years,pediatricians have found that the AT-Ⅲ index has important clinical value in evaluating children's thrombosis,sepsis and nephrotic syndrome.This article mainly reviews the factors influencing the detection of antithrombin Ⅲ in children.

A clinical study of sepsis-related coagulation disorder / 中华急诊医学杂志

Objective To study in the correlation of the laboratory markers of coagulation,fibrinolysis and thrombosis in patients with sepsis and SOFA score,the procalcitonin (PCT) concentration and seven-day survival rate.Methods From February 2017 to March 2018,119 patients with sepsis admitted in ICU and another 119 patients with non-sepsis undergoing selective surgery were enrolled as control in this study.APTT (activated partial thromboplastin time),PT-INR (prothrombin time-international normalized ratio),FIB (fibrinogen),AT-Ⅲ (antithrombin Ⅲ),D-Dimer,FDP (fibrinogen degradation products),sTM (soluble thrombomodulin),TAT (thrombin antithrombin complex),PIC (plasmin-a2 plasminogen inhibitor complex) and t-PAI-C (tissue plasminogen activator and its inhibitor complex),were simultaneously monitored at admission.The correlation between the given laboratory markers mentioned and SOFA score,the PCT concentration and seven-day survival rate were analyzed with the Spearman correlation analysis.Results (① In the patients with sepsis,a positive correlation between SOFA score and sTM,t-PAI-C,TAT respectively was found,and a negative correlation between SOFA score and PLT (platelet count) was observed,and no correlation between SOFA score and PIC was noticed.(②) A positive correlation between PCT and sTM,t-PAI-C respectively was significant,a negative correlation between PCT and PLT was marked,and no correlation between PCT and AT-Ⅲ,TAT,PIC respectively was found.(③) A negative correlation between seven-day survival rate and sTM,t-PAI-C and TAT respectively was obvious,a positive correlation between seven-day survival rate and AT-Ⅲ,PLT respectively was occurred,and no correlation between seven-day survival rate and PIC was determined.Conclusions Soluble thrombomodulin (sTM),thrombin-antithrombin (TAT),antithrombin Ⅲ (AT-Ⅲ) and tissue plasminogen activator inhibitor complex (t-PAI-c) were good clinical monitoring indicators of coagulation disorder in patients with sepsis,which were the representative of the endothelial cell damage with highly activated coagulation,relatively insufficient anti-coagulation function and poor fibrin degradation ability.These were good adjuvants to PLT,INR and APTT for core diagnostic criteria of coagulation disorder in sepsis.

Antithrombin Ⅲ for early diagnosis of DIC in sepsis patients: a retrospective analysis with 445 patients / 中华危重病急救医学

Objective To investigated the role of antithrombin Ⅲ (AT-Ⅲ) levels in the early diagnosis of disseminated intravascular coagulation (DIC) in patients with sepsis and the predictive effect of AT-Ⅲ on the development of DIC.Methods A retrospective study was conducted. Patients admitted to intensive care unit (ICU) of the First Affiliated Hospital of China Medical University from January to December in 2015 were enrolled. The patients were divided into sepsis group and non-sepsis group according to the diagnostic criteria of sepsis. In addition, sepsis patients were divided into 3 subgroups according to the international society on thrombosis and haemostasis (ISTH) scores on the first day: overt DIC (ISTH ≥ 5), non-overt DIC (ISTH 1-4) and none DIC group (ISTH = 0). Blood routine test, prothrombin time (PT), fibrinogen (Fib), D-dimer, fibrin degradation products (FDP), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores, sequential organ failure assessment (SOFA) scores and ISTH scores were recorded on the first ICU day. AT-Ⅲ was recorded during 7 days. The differences were compared among these 3 groups. Correlations of AT-Ⅲ with various parameters were calculated by using Pearson correlation analysis in sepsis group and overt DIC group. Receiver operating characteristic (ROC) curves for diagnosis of DIC with AT-Ⅲ, AT-Ⅲ+PT were drawn to evaluate the diagnostic efficiency. The AT-Ⅲ levels of DIC patients were compared between early-onset DIC and late-onset DIC during their ICU stay. The change of AT-Ⅲ levels with time and prognosis in patients with early-onset DIC was compared between groups.Results Totally 445 patients were recruited, with 138 patients in sepsis group, and 307 in non-sepsis group. There were 20 patents diagnosed with overt DIC on the first ICU day, 115 patients non-overt DIC and 3 patients of none DIC. Twenty-five sepsis patients were diagnosed overt DIC during the ICU days. AT-Ⅲ level in sepsis patients on the first ICU day were lower than that in non-sepsis patients [(55.29±13.92)% vs. (76.54±12.31)%,P < 0.01]. Patients with overt DIC had a lower AT-Ⅲ level than non-overt DIC or none DIC patients [(43.85±13.00)% vs. (56.95±13.03)%, (68.00±16.52)%, bothP < 0.05]. It was shown by Pearson correlation analysis that AT-Ⅲ level of sepsis patients on the first ICU day was negatively correlated to ISTH score and PT (r value were -0.467, -0.654, bothP < 0.01). AT-Ⅲ level of overt DIC patient on the first ICU day was negatively correlated with PT (r = -0.675,P = 0.001). It was shown by ROC curve that area under ROC curve (AUC) of AT-Ⅲ combined with PT for diagnosis overt DIC in sepsis patients was higher than that of AT-Ⅲ or PT alone (0.843 vs. 0.763, 0.834), the sensitivity 90.0%, specificity 73.7%. The cut-off value for overt DIC diagnosis in sepsis patients of AT-Ⅲ level alone was 48.5%, sensitivity was 78.0%, specificity was 70.0%. On the first ICU day, AT-Ⅲ level was risen when ISTH score improved in patients with sepsis. There was similar change of AT-Ⅲ level between patients with early-onset DIC and late-onset DIC. AT-Ⅲ level increased with DIC improvement.Conclusion AT-Ⅲ level can be used for diagnosing sepsis-associated overt DIC independently or with a combination of PT. When ISTH score improved, AT-Ⅲ level was risen in patients with sepsis associated DIC.

Application Value of Plasma Lipoprotein-associated Phospholipase A2 Level and AT- Ⅲ Activity on Risk Stratification and Nearby Risk Assessment in Patients With Non-ST Segment Elevation Acute Coronary Syndrome / 中国循环杂志

Objective: To explore the relationship between lipoprotein-associated phospholipase A2 (Lp-PLA2) level, antithrombinⅢ (AT-Ⅲ ) activity and global registry of acute coronary events (GRACE) score in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS); to analyze the predictive value of Lp-PLA2, AT- Ⅲ on risk stratification and nearby risk assessment in NSTE-ACS patients. Methods: Our research included in 2 groups: NSTE-ACS group, n=260 patients with confirmed diagnosis and regular treatment; Control group, n=50 in-hospital patients with coronary angiography excluded coronary artery disease (CAD).plasma level of Lp-PLA2 and AT-Ⅲ activity were examined in the next morning of admission. GRACE score was calculated in NSTE-ACS patients and based on GRACE score, NSTE-ACS group was further divided into 3 subgroups as Low risk subgroup, GRACE score≤108, n=121, Middle risk subgroup, GRACE score (109-140), n=73 and High risk subgroup, GRACE score>140, n=66. The relationships between Lp-PLA2 level, AT-Ⅲ activity and GRACE score were evaluated and the occurrence of major adverse cardiovascular events (MACE) was recorded within 3 months of discharge. Results: ① Compared with Control group, NSTE-ACS group had increased Lp-PLA2 level, P<0.05 and decreased AT-Ⅲ activity, P<0.01. ② In NSTE-ACS group, Lp-PLA2 levels were elevating from Low risk subgroup to Middle risk subgroup and to High risk subgroup accordingly, all P<0.01; compared with Low risk and Middle risk subgroups, High risk subgroup showed decreased AT-Ⅲ activity, P<0.01 and P<0.05; while AT-Ⅲ activity was similar between Low risk and Middle risk subgroups, P>0.05. ③Partial correlation analysis presented that GRACE score was positively related to Lp-PLA2 (r=0.641, P=0.000) and negatively related AT-III (r=-0.179, P=0.006). ④ The area under ROC curve for MACE occurrence in GRACE score was 0.811, in Lp-PLA2 was 0.862 and in AT- Ⅲ was 0.631, all P<0.01; multivariate Logistic regression analysis indicated that Lp-PLA2, GRACE score and HDL-C were the independent predictors for nearby MACE occurrence in NSTE-ACS patients. Conclusion: Blood Lp-PLA2 level and AT-Ⅲ activity were important for risk stratification in NSTE-ACS patients;AT- Ⅲ had less value than Lp-PLA2 and GRACE score for nearby risk assessment.

Analysis on correlation between lipoprotein associated phospholipase A2,D-dimer and antithrombin Ⅲ with acute cerebral infarction / 国际检验医学杂志

Objective To investigate the levels of lipoprotein associated phospholipase A2(Lp-PLA2),D-dimer(D-D),antithrombin Ⅲ (AT Ⅲ) in acute cerebral infarction (ACI)patients,and to analyzed their correlation with ACI.Methods Sixty-nine patients with ACI(ACI group) and 40 individuals undergoing healthy physical examination(control group) were selected in this study.The levels of Lp-PLA2,D-D and ATⅢ were compared between the two groups and their positive rates were statistically analyzed.Then the correlation between Lp-PLA2,D-D and ATⅢ with ACI was analyzed.Results The levels of Lp-PLA2 and D-D in the ACI group were higher than those in the control group,while the ATⅢ level was lower than that in the control group(P<0.05).Their positive rates in the ACI group were higher than those in the control group (P<0.05).Lp-PLA2,D-D and ATⅢ were correlated with ACI occurrence and had mutual correlation (all P<0.05).Conclusion Lp-PLA2,D-D and AT Ⅲ participate in the occurrence process of ACI,and their detection can be applied to screen out ACI high-risk groups,and may guide early prevention and early diagnosis of ACI.

Association of LP-PLA2 and AT-Ⅲwith the severity of coronary artery in patients with coronary disease: a cross-sectional analysis / 实用医学杂志

Objective To explore the association of Lipoprotein-associated phospholipase A2(LP-PLA2) and Antithrombin Ⅲ(AT-Ⅲ)level with the severity of coronary artery lesion in patients with coronary disease. Methods 276 patients undergoing coronary angiography were recruited in the Affiliated Hospital of Xuzhou Medical University from March,2016 to March,2017. Patients were sent to one of the two following groups according to their CAG reports:the controlled group(n=111)and the CAD group(n=165). Gensini scores were calculated in CAD group,and divided CAD group into 4 groups by quartiles:group 1(n=41),group 2(n=39),group 3 (n=42)and group 4(n=43). LP-PLA2 and AT-Ⅲwere then compared in different groups and correlation was analyzed in deciding the severity of coronary artery disease. Results (1)LP-PLA2 level in CAD group was signifi-cantly higher than the controlled group(342.9 ± 91.9 vs. 131.8 ± 27.0,P<0.05),but AT-Ⅲlevel was lower than controlled group and(91.0 ± 12.9 vs. 97.8 ± 11.0,P<0.05).(2)Both LP-PLA2 and AT-Ⅲlevel were different in groups stratified by the quartiles of Gensini scores,and the difference is statistically significant.(3)LP-PLA2 was a risk factor while AT-Ⅲwas a protectional factor for coronary artery disease(OR=1.08,95%CI:1.05~1.11,P<0.01;OR=0.95,95%CI:0.93~0.98,P<0.01;respectively )analyzed by Logisitic regression model.(4)Correla-tion analysis showed a positive association of LP-PLA2 level with Gensini scores(r=0.48,P<0.01),and a nega-tive association of AT-Ⅲlevel with Gensini scores(r=-0.24,P<0.01). Conclusion LP-PLA2 level was higher in CAD patients compared to normal patients ,while the relationship of AT-Ⅲ level among the two groups was reversed. Elevated LP-PLA2 level was associated with the increased severity of coronary artery and can provide guidance for clinic.

Relationship between antithrombin Ⅲ genetic polymorphism and individual variation in anticoagu-lant effect of heparin in patients of different nationalities / 中华麻醉学杂志

Objective To evaluate the relationship between antithrombin Ⅲ(ATⅢ)genetic pol-ymorphism and individual variation in anticoagulant effect of heparin in the patients of different nationalities. Methods Sixty patients of Uighur nationality and 60 patients of Han nationality, aged 18-64 yr, with body mass index of 21-25 kg∕m2, of American Society of Anesthesiologists physical statusⅠ-Ⅲ, undergo-ing elective cardiac surgery under cardiopulmonary bypass, were divided into Uighur group and Han group, respectively. ATⅢ gene polymorphism was detected by polymerase chain reaction(A∕G was heterozygous, A∕A and G∕G were homozygous). Heparin sodium was intravenously injected at 5 min before the start of cardiopulmonary bypass with an amount of ACT≥480 s. The amount of heparin and protamine, intraoper-ative blood transfusion and postoperative 24 h drainage(pericardium, mediastinum∕thoracic cavity)were recorded. Activated partial thromboplastin time and prothrombin time were measured at 10 min before opera-tion and 24 h after operation. Results Compared with Han group, the amount of heparin, ratio of prota-mine to heparin for heparin neutralization and requirement for intraoperative blood transfusion were signifi-cantly decreased, the postoperative drainage volume was decreased, activated partial thromboplastin time was shortened at 24 h after operation, the frequency of A∕A genotype was increased and the frequency of G∕G genotype was decreased at ATⅢ gene single-nucleotide polymorphism sites rs5877 and rs5878, and the minimum allele(A>G)frequency was increased in Uighur group(P<0.05). Conclusion ATⅢ gene polymorphism may be one of the mechanisms underlying individual variation in anticoagulant effect of hepa-rin between the patients of Uighur nationality and Han nationality.

Correlation among plasma levels of fibrinogen, D -dimer and AT III and carotid atherosclerosis in AMI patients / 心血管康复医学杂志

Objective:To explore the correlation among plasma levels of fibrinogen (Fg) ,D-dimer (DD) and antithrombin III (ATIII ) and carotid atherosclerosis (CAS) in AMI patients .Methods:A total of 147 AMI patients treated in our de‐partment from Jan 2012 to Dec 2014 were enrolled as AMI group ,another 120 patients without myocardial infarction (MI) were treated as control group .According to ACS severity ,AMI group was further divided into normal group (n=22) ,mild group (n=30) ,moderate group (n=40) and severe group (n=55) .Plasma levels of Fg ,DD and ATIII ,and carotid inti‐ma-media thickness (IMT) were measured and compared among all groups .Results:Compared with control group ,there were significant rise in plasma levels of Fg [ (3.12 ± 0.87) g/L vs .(5.01 ± 1.38) g/L] ,DD [ (317 ± 50)μg/L vs .(1530 ± 218)μg/L] and carotid IMT [(0.86 ± 0.41) mm vs .(1.12 ± 0.29) mm] ,and significant reduction in plasma AT Ⅲ level [ (87 ± 18)% vs .(76 ± 19)% ] in AMI group , P<0.01 all. Compared with normal group ,there were significant rise in plasma levels of Fg and DD ,and significant reduction in plasma ATIII level in moderate group and severe group , P<0.05 or <0.01. Spearman correlation analysis indicated that plasma Fg and DD levels were significant positively correlated with CAS severity (r=0.426 ,0.535 ,P<0.01 both) ,ATIII level was significant inversely correlated with CAS severity in AMI patients ,(r= -0.438 ,P=0.005) .Multi-factor Logistic regression analysis indicated that plasma Fg and DD levels were independent risk factors for MI (OR=2.836 ,2.231 , P<0.01 both) ,and plasma ATIII level was independent protective factor for MI (OR=0.899 , P=0.014 ) .Conclusion:Plasma Fg and DD levels are independent risk factors for MI and plasma ATIII level is independent protective factor for MI .

To investigate the relationship of antithrombin-Ⅲ activity and thrombosis risk in liver cirrhosis with child-pugh classification / 国际检验医学杂志

Objective To investigate the relationship of antithrombin‐Ⅲ activity and thrombosis risk in liver cirrhosis with Child‐Pugh classification .Methods In our hospital from June to December 2014 ,60 liver cirrhosis patients were selected randomly included into this experiment group ,The 60 cases of control group were from medical examination of health in our hospital .The plasma AT‐Ⅲ activity and D‐D concentration in all these cases were detected and analyzed .Results The AT‐Ⅲ in cirrhosis patients were significantly lower than which in healthy persons(P<0 .05) .The lower level of AT‐Ⅲ is in these patients which were in seri‐ous condition(P<0 .05) ,the abnormal rate of D‐D concentration is also higher at the same time(P<0 .05) .Conclusion The detec‐tion of AT‐Ⅲ level in patients with liver cirrhosis is directly related to the severity of clinical and thrombosis risk .The AT‐Ⅲ de‐tection level can be used to judge the patient′s condition and develop appropriate treatment strategies .

Effect of Compound Sanggou Granules on the Fibrinogen, Antithrombin Ⅲ and Fibrinolytic Activity in Hyperlipidemia Rats / 中国药师

Objective:To investigate the effect of compound Sanggou granules on the activity of Fib, AT-Ⅲ, t-PA, PAI-1 and t-PA/ PAI-1 in hyperlipidemic rats. Methods: The hyperlipidemic rat model was established by feeding high fat diet to SD male rats. Sixty healthy SD rats were randomly divided into five groups: the normal diet control group, high fat control group, high dose drug group, low dose drug group and fluvastatin sodium group. Four weeks after the administration, the blood samples were withdrawn for the determination of the levels of blood lipid, Fib, A-Ⅲ, t-PA, PAI-1 and t-PA/ PAI-1. Results:Compared with those of the normal diet control group, the levels of TC, LDL-C, Fib and PAI-1 were increased and the levels of HDL-C, t-PA , AT-Ⅲand t-PA/ PAI-1 were decreased significantly (P<0. 01) in the high fat control group. Compared with those of the high fat control group, the levels of TC, LDL-C, PAI-1 and Fib were decreased(P<0. 01 or P<0. 05),and the levels of HDL-C, t-PA AT-Ⅲ and t-PA/PAI-1 were in-creased significantly in the high dose drug group (P<0. 05 or P<0. 01). The similar effects were shown in the fluvastatin sodium group with the stability of AT-Ⅲ. The levels of TC, LDL-C and PAI-1 were decreased and the levels of t-PA/PAI-1 were increased no-tably in the low dose drug group. Conclusion: Compound Sanggou granules exhibit hypolipidemic effect in hyperlipidemic rats, and can improve hypercoagulability and enhance anticoagulation and fibrinolytic activity in hyperlipidemic rats. Furthermore, compound Sanggou granules at high dose show the same effect as fluvastatin sodium, even in anticoagulation, the granules are superior to fluvasta-tin sodium.

The relationships of antithrombinⅢand D-dimer with pediatric critical illness score in children with sepsis / 临床儿科杂志

Objective To explore the relationships between antithrombinⅢ(AT-Ⅲ) and D-dimer (DD) level with pediat-ric critical illness score (PCIS) in children with sepsis, and to evaluate the values in assessing the severity of illness. Methods Sixty-one children with sepsis were included in this study. Within 24 hours after admission, blood samples were tested for the ac-tivity of AT-Ⅲ and DD level. The PCIS was calculated. According to PCIS, the patients were divided into extremely critical group (<70), critical group (71-80) and non-critical group (80-100). According to the prognosis, the patients were divided into survival and death groups. The differences of the activity of AT-Ⅲand DD were compared and the relationship with PCIS were analyzed. Results The activity of AT-Ⅲ was lower and DD level was higher in critical group than in non-critical group (P<0.01) and the changes in extremely critical group were more evident than those in critical group. The activity of AT-Ⅲand PCIS were positively correlated (r=0.548, P<0.01).The DD level and PCIS was negatively correlated (r=-0.657, P<0.01). Compared with survival group, the level of DD was significantly higher in death group (P<0.01), and PCIS and the activity of AT-Ⅲwere significantly lower in death group (P<0.05). Conclusions The patients with sepsis have dysfunctions of coagulation. The activity of AT-Ⅲ, DD level are correlated with illness severity, and can be useful for assessing the severity of sepsis.

The comparison of clinical value of two detection methods for the detection of antithrombin Ⅲ / 国际检验医学杂志

Objective To compare the clinical value of automatic coagulometer and automatic biochemistry analyzer for the de-tection of antithrombin Ⅲ(AT-Ⅲ)in acute myocardial infarction and cirrhosis.Methods 55 cases of acute myocardial infarction and cirrhosis patients were investigated in the study,the healthy people was normal control.The concentration of AT-Ⅲwas detec-ted with automatic coagulometer and automatic biochemistry analyzer at the same time.Results The concentration of AT-Ⅲ detec-ted with automatic coagulometer was (251.2±58.5 )mg/L,(228.0 ±22.6)mg/L in acute myocardial infarction and cirrhosis pa-tients,the concentration of AT-Ⅲ detected with automatic biochemistry analysis was (255.6±54.3)mg/L,(230.3±23.1)mg/L in acute myocardial infarction and cirrhosis patients,and the concentration of AT-Ⅲwas significantly lower than that in normal control (P <0.05).The concentration of AT-Ⅲ detected with two detection methods in acute myocardial infarction patients was signifi-cantly lower than that in cirrhosis patients(P <0.05).There were significant difference between automatic coagulometer and auto-matic biochemistry analyzer for the detection of antithrombin Ⅲ(AT-Ⅲ).Conclusion The detection of AT-Ⅲ with automatic coag-ulometer and automatic biochemistry analyzer could diagnose and identify acute myocardial infarction and cirrhosis.