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多项临床检查指标在血栓性血小板减少性紫癜中的诊断价值 被引量:2
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作者 张辉 黄铭 +1 位作者 唐宁 张驰 《中国实验诊断学》 2019年第5期829-833,共5页
目的应用Logistic回归和ROC曲线探讨多项临床检查指标,如LDH、IBIL、Cr、BUN、D-D、PLT、HGB、SCH、F、NS等对TTP的诊断价值。方法对28例确诊为TTP者及62例疑似而非TTP者(对照组)的血生化、血栓特检、血常规、外周血形态学进行检查,并应... 目的应用Logistic回归和ROC曲线探讨多项临床检查指标,如LDH、IBIL、Cr、BUN、D-D、PLT、HGB、SCH、F、NS等对TTP的诊断价值。方法对28例确诊为TTP者及62例疑似而非TTP者(对照组)的血生化、血栓特检、血常规、外周血形态学进行检查,并应用Logistic回归分析,绘制ROC曲线并计算曲线下面积(AUC)来评价各临床检查指标的诊断价值。结果通过比较发现,TTP组的LDH、IBIL、SCH、NS均高于对照组(P<0.05),而PLT、HGB则低于对照组(P<0.05),而F、Cr、BUN、D-D两组间差异无统计学意义(P>0.05)。对有差异的指标进行Logistic回归分析,发现PLT、SCH、NS与TTP的诊断呈独立相关(P<0.05)。对PLT进行ROC曲线分析显示,其诊断TTP的AUC=0.789,约登指数最大时PLT值为15.5×109/L;SCH>2%、PLT<15.5×109/L、NS三项指标独立诊断的准确度分别是84.4%、74.4%、83.3%,SCH>2%、PLT<15.5×109/L两项联合应用后准确度增高值91.1%。结论用于诊断TTP的多项指标中,LDH、IBIL、PLT、HGB、SCH、NS与诊断相关,其中SCH>2%、PLT<15.5×109/L、NS与TTP的诊断又呈独立相关;而BUN、Cr、D-D、F与TTP的诊断相关性不大(P>0.05)。重点关注SCH>2%、PLT<15.5×109/L、NS这三项指标对于TTP的早期诊断和及时治疗,以及降低死亡率有着重要的意义。 展开更多
关键词 TTP admats13 碎片红细胞 血小板 神经症状 LOGISTIC回归
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The Mechanical Stabilization and Multi-States of the Stretched VWF A2 Domain
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作者 Xubin Xie Ying Fang Jianhua Wu 《医用生物力学》 EI CAS CSCD 北大核心 2019年第A01期80-81,共2页
At the vascular injury sites,the ultra-large (UL) multimeric von willebrand Factor (VWF) is released in response to physiological and pathophysiological stimuli,and mediates platelet adhesion,aggregation,and cross-lin... At the vascular injury sites,the ultra-large (UL) multimeric von willebrand Factor (VWF) is released in response to physiological and pathophysiological stimuli,and mediates platelet adhesion,aggregation,and cross-linking to maintain hemostasis.This UL-VWF is specifically cleaved by ADAMTS13(A Disintegrin And Metalloprotease with a ThromboSpondintype-1 motif,member 13)to prevent microvascular thrombosis.Each VWF monomer consists of five types of repeat domains in the order of D1-D2-D’-D3-A1-A2-A3-D4-C1-C2-C3-C4-C5-C6-CK,in which the A2 domain contains the ADAMTS13cleavage site(Tyr1605-Met1606),exposure of which requires mechanical or chemical stimuli.Under flows,fluid shear stress regulates VWF degradation and size distribution through opening the A2 domain and exposing its cleavage site for ADAMTS13.VWF A2 domain contains a C-terminal vicinal disulfide bond,a calcium binding sites,and a flexibleα4-less-loop.These unique structure features together make A2 more sensitive to mechanical signal than other VWF A subdomains,i.e.A1 and A3 domains.It is believed that A2 is first bound with and then cleaved by ADAMTS13,together with force-induced conformation transformation.To reveal molecular basis of this two-step model of VWF hydrolyzation by ADAMTS13,we here examined stretch-induced unfolding processes of VWF A2 domain in more detail by Steered molecular dynamics(SMD)simulations,with the use of crystal structure of VWF A2(PDB ID 3GXB),and observed that there were multiple quasi-stable conformations of stretched A2 until itsβ4-strand and a3-helix were pulled away the central hydrophobic core and the cleavage sites were fully accessible to solvent.Our MD simulation data showed that,in unfolding,at first,the cleavage site residue Tyr1605 was exposed partially and binding sites for Spacer domain of ADAMTS13 were exposed to a high level whenα6-helix was separated from A2 body;then,withβ6-strand and a5-helix been pulled away,the binding sites for Cysrich domain of ADAMTS13 was exposed completely while the exposure degree of Tyr1605 was not improved;further,separation ofβ5-strand andα4-less-loop made Tyr1605 and Met1606 and the respective binding sites for ADAMTS13 Spacer domain,Cys-rich domain,and Disintegrin-like domain be fully exposed to reach the optimal catalytic state;lastly,withβ4-strand separation,the cleavage sites and binding sites all were overstretched,leading to mismatch of ADAMTS13 and A2 conformation especially in the binding sites.This conformational mismatch may cause reduction of ADAMTS13 hydrolysis efficiency.Furthermore,the data of SMD simulations under constant forces demonstrated that,the stretched A2 conformation had different quasi-stable states,which all had the better mechanical stability within simulation time of 100 ns;and the conformational transformation from one state to another must overcome their respective potential barriers.The hydrolysis efficiency should depend on each state of the stretched A2 conformation,because of the exclusive matched-degree of A2 and ADMATS13.This computer prediction on the mechanical stability and multi-states of stretched A2 provides a novel insight into the mechano-chemical regulation on cleavage of A2 by ADAMTS13.It would be helpful for design of related drug targeting the binding sites on A2 and exosites on ADAMTS13 for the treatment of patients with acquired TTP. 展开更多
关键词 VWF PROTEIN UNFOLDING SMD admats13 MULTI-STATE of PROTEIN
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