老年非瓣膜心脏病心房颤动患者血小板功能及血管性血友病因子的改变

目的探讨老年非瓣膜心脏病心房颤动(房颤)患者血小板活化、内皮细胞功能改变及临床意义. 方法采用全血法流式细胞仪分别测定老年非瓣膜心脏病房颤或无房颤患者及健康老年人血小板膜上活化糖蛋白IIb/IIIa复合物(glycoprotein IIb/IIIa complex, GPIIb/IIIa)和糖蛋白Ib(glycoprotein Ib, GPIb)水平.用全自动细胞分析仪及酶联免疫吸附法分别测定平均血小板体积(MPV)和血浆血管性血友病因子(vWF). 结果老年非瓣膜心脏病房颤患者血小板表面活化GPIIb/IIIa荧光阳性率为9.23%(0.66%～73.89%),显著高于无房颤患者的2.61%(0.58%～17.33%)及健康老年组1.71%(0.45%～6.11%),(均为P<0.01).而老年非瓣膜心脏病房颤患者的GPIb荧光阳性率为(93.66±3.66)%,明显低于无房颤组的(96.65±2.10)%及健康老年组(97.88±1.89)%(均为P<0.01).此外,房颤患者的MPV水平也显著高于无房颤患者及健康老年人(P<0.05). 结论老年非瓣膜心脏病房颤患者存在血小板活性增高及内皮细胞功能受损,这些异常改变可能与老年房颤患者心房内血栓形成及血栓或栓塞并发症有关.

Platelet function and endothelial cell disturbance in older non-valve cardiac patients with atrial fibrillation

Objective To investigate platelet function with special regard to the role of platelet membrane glycoproteins (GPIIb/IIIa?GPIb) and endothelial cell disturbance in the older non valve cardiac patients with atrial fibrillation and their clinical implications. Methods 22 older patients with non valve cardiac atrial fibrillation were studied. There were two age and sex matched control groups, one with 18 patients in sinus rhythm with cardiovascular disease, called the normal sinus rhythm group; the other with 16 health subjects named the health control group. The expression of activated GPIIb/IIIa and GPIb on platelet was analyzed with flow cytometry. Mean platelet volume (MPV) was measured by automatic hematologic analyzer, the plasma vWF was assayed using ELISA. Results The non valve atrial fibrillation group had markedly activated platelet, indicated by increased expression of activated GPIIb/IIIa ( P <0 05), decreased expression of GPIb( P <0 05) and significant increase of MPV( P <0 05). The mean plasma level of vWF in the older patients with chronic atrial fibrillation was significant higher than the levels of the health control group and normal sinus rhythm group ( P <0 05). Conclusions The older patients with non valve atrial fibrillation show evidence of the elevated platelet activation and endothelial cell disturbance, indicated by the increased expression of activated GPIIb/IIIa, MPV and vWF, the decreased amount of the GPIb expression, which may correlate with atrial thrombogenesis.