临床与实验中肺血栓的治疗与预防

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本研究评估了抗凝疗法在预防和治疗肺动脉血栓形成方面的效果，以及抗炎疗法在临床实践和实验中预防这种并发症的可能性。回顾性分析了新型冠状病毒感染患者和确诊肺动脉血栓形成的急性非感染性病症患者的数据。评估了抗凝疗法和抗凝疗法联合糖皮质激素和/或抗细胞因子疗法的效果。对患者肺血管的组织学制备进行了研究。在诱导后腔静脉血栓形成的大鼠实验模型上，研究了在给研究组大鼠服用食用贻贝（Mytilus edulis）水解液和给对照组大鼠服用生理溶液的条件下，肺动脉分支的变化。在 313 名新型感染冠状病毒的患者中，抗凝治疗的治疗、中间和预防方案与死亡率、肺部变化动态以及D-二聚体水平没有统计学意义。在死亡患者中，也没有发现任何抗凝治疗方案占主导地位。39例患者在接受抗凝治疗的同时还接受了糖皮质激素和/或抗细胞因子药物治疗。糖皮质激素和抗细胞因子药物治疗与血栓并发症的发生之间没有明显的统计学意义。在抗凝治疗和抗凝治疗与糖皮质激素和/或抗细胞因子药物联合使用的情况下，药物诱发的肺动脉分支壁病变没有发现差异。所有19例急诊非感染性病理患者都出现了肺动脉血栓，其中11例是在抗凝治疗下发生的。在后腔静脉血栓形成对照组的 15只大鼠中，有 12只在肺动脉分支的管腔中发现了血栓。给研究组的14只大鼠注射食用贻贝水解液后，肺动脉分支中没有血栓形成。因此，抗凝疗法的全身效应被血管壁炎症引起的局部促血栓形成效应所抵消。糖皮质激素和抗细胞因子药物不会影响血管壁的炎症变化，对肺血栓形成无抑制作用。在实验中服用食用贻贝可预防后腔静脉血栓形成条件下的肺动脉血栓形成，这为寻找预防这种并发症的病因指明了一个有希望的方向。

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作者简介

Olga Ya. Porembskaya

North-Western State Medical University named after I.I. Mechnikov

编辑信件的主要联系方式.
Email: porembskaya@yandex.ru
ORCID iD: 0000-0003-3537-7409
SPIN 代码: 9775-1057

MD, Cand. Sci. (Med.)

俄罗斯联邦, Saint Petersburg

Kirill V. Lobastov

Russian National Research Medical University named after N.I. Pirogov; City Clinical Hospital No. 24

Email: lobastov_kv@mail.ru
ORCID iD: 0000-0002-5358-7218
SPIN 代码: 2313-0691

MD, Cand. Sci. (Med.)

俄罗斯联邦, Moscow; Moscow

Sergey N. Tsaplin

Russian National Research Medical University named after N.I. Pirogov; Clinical Hospital No. 1 (Volynskaya)

Email: tsaplin-sergey@rambler.ru
ORCID iD: 0000-0003-1567-1328
SPIN 代码: 8827-1385

MD, Cand. Sci. (Med.)

俄罗斯联邦, Moscow; Moscow

Olga V. Pashovkina

Clinical Hospital No. 1 (Volynskaya)

Email: dr.pashovkina@mail.ru
ORCID iD: 0000-0001-6955-4595
SPIN 代码: 3448-9764

pathologist

俄罗斯联邦, Moscow

Victoria А. Ilina

Saint Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze

Email: profkomniisp@mail.ru
ORCID iD: 0000-0001-7336-8146
SPIN 代码: 8934-1156

MD, Dr. Sci. (Med.)

俄罗斯联邦, Saint Petersburg

Eleonora A. Starikova

Institute of Experimental Medicine

Email: starickova@yandex.ru
ORCID iD: 0000-0002-9687-7434
SPIN 代码: 6488-4036

MD, Cand. Sci. (Biol.)

俄罗斯联邦, Saint Petersburg

Janet T. Mammedova

Institute of Experimental Medicine

Email: jennet_m@mail.ru
ORCID iD: 0000-0003-4381-6993
SPIN 代码: 1418-6373

researcher

俄罗斯联邦, Saint Petersburg

Vsevolod A. Tsinserling

National Medical Research Center named after V.A. Almazova

Email: Tsinzerling_VA@almazovcentre.ru
ORCID iD: 0000-0001-7361-1927
SPIN 代码: 4601-1482

MD, Dr. Sci. (Med.), professor

俄罗斯联邦, Saint Petersburg

Yana G. Toropova

National Medical Research Center named after V.A. Almazova

Email: yana.toropova@mail.ru
ORCID iD: 0000-0003-1629-7868
SPIN 代码: 2020-4213

MD, Cand. Sci. (Biol.)

俄罗斯联邦, Saint Petersburg

Maxim I. Galchenko

State Agrarian University

Email: maxim.galchenko@gmail.com
ORCID iD: 0000-0002-5476-6058
SPIN 代码: 8858-2916

senior lecturer

俄罗斯联邦, Saint Petersburg

Leonid A. Laberko

Russian National Research Medical University named after N.I. Pirogov; City Clinical Hospital No. 24

Email: laberko@list.ru
ORCID iD: 0000-0002-5542-1502
SPIN 代码: 8941-5729

MD, Dr. Sci. (Med.), professor

俄罗斯联邦, Moscow; Moscow

Vyacheslav N. Kravchuk

North-Western State Medical University named after I.I. Mechnikov

Email: kravchuk9@yandex.ru
ORCID iD: 0000-0002-6337-104X
SPIN 代码: 4227-2846

MD, Dr. Sci. (Med.), professor

俄罗斯联邦, Saint Petersburg

Sergey A. Saiganov

North-Western State Medical University named after I.I. Mechnikov

Email: sergey.sayganov@szgmu.ru
ORCID iD: 0000-0001-8325-1937
SPIN 代码: 2174-6400

MD, Dr. Sci. (Med.), professor

俄罗斯联邦, Saint Petersburg

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2. Fig. 1. Structural changes in the wall of pulmonary artery branches in deceased patients with COVID-19: а — without glucocorticoid and anticytokine therapy; b — with glucocorticoid and/or anticytokine therapy; ФН — fibrinoid necrosis; ФЯ — fragmentation of nuclei; НЭ — necrosis of the endothelium; ФВ — fragmentation of collagen fibers. Hematoxylin and eosin staining, magnified × 400

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3. Fig. 2. Branches of the pulmonary artery of rats: а — lungs of rats in the control group; b — lungs of rats in the main group administered with Mytilus edulis hydrolysate; ПС — vessel lumen; CC — vessel wall; Фиб — fibrin; Лей — wall and fibrin-walled leukocytes (indicated by arrows); СЭ — erythrocyte sludge. Coloring of MSB according to Lendrum. The scale range is 200 µm

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