老年不稳定型心绞痛患者P-选择素的水平及意义

目的观察老年不稳定型心绞痛(UAP)患者血浆P-选择素、血栓烷(TXB2)、6-酮-前列腺素F1α(6-keto-PGF1α)的水平及其意义. 方法选择2001年5月～2001年9月住院治疗的45例≥60岁的UAP患者为研究对象.采用流式细胞仪式及酶联免疫吸附法测定血中P-选择素、TXB2、6-keto-PGF1α的含量,计算TXB2/6-keto-PGF1α.设老年健康对照30例,青年健康对照30例. 结果老年UAP患者血小板P-选择素表达(55.18±5.32)%明显高于老年对照组(44.18±6.25)%,P＜0.01.TXB2/6-keto-PGF1α水平在老年UAP组(6.54±1.79)%也明显高于老年对照组(5.13±1.31)%,P＜0.05.而且此二者水平在老年健康对照组较青年健康对照组明显升高(P＜0.05). 结论血小板活化与内皮细胞的损伤在老年UAP的发生发展中起重要作用.     

心房颤动病人血栓形成与一氧化氮、血小板P-选择素表达关系研究

目的研究慢性心房颤动(房颤)病人血栓形成与血浆一氧化氮(NO)水平、血小板活化的关系.方法应用流式细胞仪分析窦性心律及房颤病人血小板P-选择素、糖蛋白Ⅱb/Ⅲa(GPⅡb/Ⅲa)表达,同时测定血浆NO、血栓素B2(TXB2)、6-keto-前列腺素F1α(6-keto-PGF1a)含量,计算TXB2/6-keto-PGF1a.应用N-硝基-L-精氨酸甲基酯(N-nitro-L-arginine methyl ester,L-NAME)抑制一氧化氮合酶(NOS),流式细胞仪分析其对血小板P-选择素表达的影响及L-精氨酸(L-arginine,L-Arg)预处理后L-NAME对血小板P-选择素表达的影响.结果房颤组血浆NO水平明显低于窦性心律组[(22.68±9.38)μmol/L对(31.25±14.91)μmol/L,P＜0.05];血小板P-选择素表达明显高于窦性心律组[(6.76±3.36)%对(4.86±2.09)%,P＜0.05];血小板GPⅡb/Ⅲa表达明显增高P＜0.05;血浆TXB2及TXB2/6-keto-PGF1a含量均显著增高(P＜0.001).房颤血栓形成组与房颤无血栓组血小板P-选择素表达差异无显著性[(7.77±2.90)%对(6.53±3.17)%,P＞0.05].应用L-NAME抑制NOS后,血小板P-选择素表达增加,L-Arg预处理可明显阻断这一效应.结论房颤引起的不规则心律能抑制NO合成,使血浆NO水平降低,这可能是房颤病人血小板P-选择素表达增加,血栓形成的原因之一.NO及NO前体可能预防房颤病人的血栓形成.     

不同剂量阿斯匹林对不稳定型心绞痛病人的预后影响

目的：观察阿斯匹林对不稳定型心绞痛病人的疗效。方法：对不稳定型心绞痛病人，每日服用阿斯匹林75mg（20例）、150mg（26例）、300mg（30例），随访三个月。采用抗人血活性血小板α颗粒膜蛋白140（GMP－140）特异单克隆抗体125I-SZ－51，测定三组治疗前、后血小板膜表面GMP－140分子数，常规记录血小板数，并与20名健康人比较。结果；阿斯匹林治疗后，血小板膜表面GMP—140分子数明显降低，而血小板数升高。随药物剂量的增加，二者变化程度增大（P＜0.01）。当剂量达300mg时，前者低于健康人组（P＜0．005），后者已达到健康人水平（P＜0．05），三组近期副作用差别无显著性。结论：每日300mg阿斯匹林对不稳定型心绞痛的预后较好。     

大剂量生脉注射液对不稳定型心绞痛病人P选择素及D-二聚体的影响

目的 研究大剂量生脉注射液对不稳定型心绞痛病人P选择素、D-二聚体的影响。方法 将94例不稳定型心绞痛病人随机分为治疗组57例与对照组37例，两组均予西药常规治疗，治疗组加用生脉注射液100mL静脉输注，15d为1个疗程。两组均分别于治疗前后测定P选择素、D-二聚体的水平。结果两组血浆P选择素、D一二聚体水平治疗后均明显下降（P〈0、05）。结论 生脉注射液具有良好的改善血管内皮功能，抑制细胞因子作用。     

氯吡格雷对不稳定型心绞痛患者血小板功能的影响

目的探讨氯吡格雷对不稳定型心绞痛(UAP)患者血小板功能的影响,比较UAP患者与健康对照组血小板聚集率及血小板活化状态。方法选择住院确诊的UAP患者55例,分别于服药前、服药1周后、服药1月后空腹抽血,检测血小板聚集率和血小板活化状态。结果UAP组患者血小板聚集率及血小板CD63、CD62P、凝血酶敏感蛋白(TSP)水平较正常对照组明显增高(P<0.05),服药前与服药1周及1月后血小板聚集率及血小板CD63、CD62P、TSP水平相比差异有统计学意义(P<0.05)。结论氯吡格雷不仅抑制了血小板的聚集,而且还抑制了血小板的活化,这一作用对于不稳定型心绞痛患者的急诊经皮冠状动脉腔内成形术及支架置入术有重要的意义。     

血小板活化因子和P-选择素在脑梗死中的意义

血小板活化因子广泛存在于人体各种组织，参与多种生理和病理学过程。P-选择素是血小板活化的标志物，在脑缺血再灌注过程中起重要作用。文章对二者在脑梗死中的意义做了综述。     

急性冠状动脉综合征血小板表面P-选择素的变化及意义

急性冠状动脉综合征(acute coronary syndrome,ACS)主要病因是冠状动脉(冠脉)粥样斑块破裂诱发血栓形成.P-选择素作为选择素家族中的一个粘附分子,其介导的细胞间粘附在ACS发病中的作用越来越引起广泛重视.研究P-选择素及其介导的细胞粘附可进一步认识ACS的发病机制,为有效治疗ACS提供新思维、新方法.     

川崎病患儿P-选择素和血小板计数变化的临床意义

对51例川崎病(KD)患儿和45例正常儿童进行P-选择素、PLT值检测.结果KD患儿P-选择素、PLT计数均明显高于正常儿童(P<0.01,<0.05);KD合并冠状动脉瘤或冠状动脉狭窄患儿P-选择素和PLT计数升高明显.提示血小板活化过程参与KD免疫性血管炎的病理损害过程,P-选择素和PLT计数变化与KD病情变化有关,其变化有助于指导KD治疗和预后判断.     

冠心病患者阿司匹林抵抗与血小板P-选择素的相关性研究

目的研究冠心病患者阿司匹林抵抗(Aspirin Resistance,AR)现象与血小板P-选择素(P-selec-tion,PS)表达相关性及其影响因素。方法冠心病患者50例,测定干预前PS水平,阿司匹林100mg1次/晚干预2周,测定血小板聚集率,筛选出AR及敏感(Aspirin Sensitive,AS)两组,测定干预后PS表达。结果 AR的发生率为18%,低密度脂蛋白水平和高血压是AR的独立危险因素。AR组患者服药后PS水平显著高于AS组。结论低密度脂蛋白水平和高血压是发生AR的独立危险因素。PS可作为检测AR的有效指标。     

P-选择素与脑缺血性损伤

脑缺血发生后，出现了缺血区域内白细胞浸润，组织水肿为标志的急性炎症反应。研究表明，粘附分子中P-选择素(P-Selectin)的表达和上调是炎症反应中白细胞(早期主要是中性粒细胞)粘附并穿越血管屏障的起始因素。P-选择素在脑缺血损伤病理过程中的作用越来越引起人们的重视。     

阿托伐他汀对不稳定型心绞痛病人血管内皮功能及血小板活化的影响

目的探讨阿托伐他汀对不稳定型心绞痛病人血管内皮功能及血小板活化的影响。方法 68例不稳定型心绞痛病人随机分成常规组(34例)和阿托伐他汀组(34例)。所有病人分别于入院时及用药4周后取血,行血清一氧化氮(NO)、血浆内皮素-1(ET-1)及血小板胞质内α-颗粒膜糖蛋白(CD62p)测定。另选本院同期健康体检者30名作为对照组,要求采血前两周内未服用任何药物。结果不稳定型心绞痛病人血NO水平显著低于对照组(P<0.01),ET-1、CD62p水平明显高于对照组(P<0.01)。治疗4周后两组病人血清NO水平显著升高,血浆ET-1、血小板CD62水平明显降低(P<0.01),且治疗后两组之间有统计学意义(P<0.01),但治疗4周后两组患者血NO水平仍低于对照组(P<0.01),ET-1、CD62p水平仍高于对照组(P<0.01)。结论阿托伐他汀有改善不稳定型心绞痛病人内皮功能,抑制血小板活性作用,阿托伐他汀10mg/d治疗4周后不稳定型心绞痛病人仍然存在内皮功能障碍及血小板活化的问题。     

Platelet activation in the Dutch haemocytometry quality assessment programme: correlation between P-selectin expression and variation in platelet count

Abstract: Since 1990, our laboratory has prepared a set of 8 fresh whole blood samples for use in a countrywide quality assessment (QA) programme. The samples are intended as external controls for haemocytometry analysers. These samples are of 8 different haematocrit levels and each one is prepared from a single donor. About 210 laboratories participate in this QA programme. From the start of this programme large interlaboratory variations in platelet counts were encountered in some of the samples. This variability was much higher than would be expected and was independent of the platelet count of the samples. The main cause was thought to be formation of platelet aggregates. The aim of the present study was to find a parameter that can predict a high interlaboratory variation in the QA programme. Therefore we investigated the initial platelet activation status in the donors and the activation status of platelets in the prepared QA blood. As a marker for platelet activation P-selectin expression on the platelets was measured using flow cytometry. During 5 rounds of the QA programme we found a good correlation of r = 0.53 (p < 0.001) between P-selectin expression on platelets in the reconstituted QA blood and the interlaboratory platelet count variability. We conclude that P-selectin expression in the prepared QA blood is an important parameter to exclude samples that lead to high CVs of platelet counts in the QA programme.     

皮质下动脉硬化性脑病患者P选择素和血管内皮生长因子的表达及相关性

目的通过对皮质下动脉硬化性脑病(SAE)患者P选择素和血管内皮生长因子(VEGF)表达的测定及相关性比较,探讨二者在SAE中的作用和意义。方法选择SAE患者83例(SAE组)和健康体检者57例(对照组),采用酶联免疫法测定2组空腹血浆P选择素和血清VEGF,同时检测空腹血糖、血脂、C反应蛋白(CRP),并进行相关性分析。结果与对照组比较,SAE组P选择素、VEGF表达水平明显升高,差异有统计学意义(P<0.01)。SAE组轻度痴呆患者P选择素和VEGF表达水平明显低于中、重度痴呆患者,而中、重度痴呆患者间差异无统计学意义。SAE组P选择素与血糖、TG、CRP呈正相关,与年龄、TC、HDL-C不相关;VEGF与TC、CRP呈正相关,与年龄、血糖、TG、HDL-C不相关;P选择素与VEGF呈正相关。结论SAE患者P选择素和VEGF水平明显升高,可能共同参与了SAE的血栓形成和组织修复过程,临床中给予抗血小板药物,对SAE的预防可能有重要意义。     

Microparticle-associated P-selectin reflects platelet activation in preeclampsia

Platelet activation in preeclampsia is reflected by elevated levels of platelets exposing P-selectin. In plasma, a non-cell bound (soluble) form of P-selectin is present. Elevated levels of this soluble form have been reported in preeclampsia. Plasma P-selectin may consist of two fractions: microparticle (MP)--associated P-selectin and non-MP--associated P-selectin. In the present cross-sectional study, we investigated to which extent plasma P-selectin is MP--associated and whether such MP are elevated in preeclamptic patients. Preeclamptic patients (n?=?10) were matched with normotensive pregnant women (n?=?10) and non-pregnant controls (n?=?10). Plasma P-selectin was measured by ELISA. MP were isolated, double labelled with anti-CD61 (GPIIIa) and anti-CD62P (P-selectin) and subsequently analyzed with flowcytometry. Plasma P-selectin concentration was elevated in preeclamptic patients compared to non-pregnant controls (p?=?0.007), but not compared to normotensive pregnant women (p?=?0.210). Plasma P-selectin is partially MP--associated (3–5%). In pregnancy, the fraction of P-selectin exposing platelet-derived MP (PMP) (10.9%) was increased compared to non-pregnant controls (8%). This fraction further increased in preeclamptic patients (15.4%), and significantly differed from normotensive pregnant women (p?=?0.02). A minor fraction of plasma P-selectin is associated with PMP. The fraction of PMP exposing P-selectin is increased in preeclamptic patients and to a lesser extent in normotensive pregnancy. Because MP associated P-selectin exclusively originates from platelets, this fraction indicates platelet activation. Platelet activation is prominent in preeclampsia and this study proves that at least a part of the plasma P-selectin originates from platelets.     

Platelet activation in chronic urticaria and its correlation with disease severity

Abstract

Chronic urticaria (CU) is characterized by the occurrence of wheals lasting for more than 6 weeks. The role of platelet activation in the pathophysiology of this condition has not been clearly studied. We undertook a cross-sectional study among 45 patients with CU and 45 age- and gender-matched healthy controls. The severity of the disease was assessed using the urticaria severity score. The autologous plasma skin test (APST) was done in all cases of CU. The platelet count and indices were estimated by an automated haematological laser optical analyzer. Platelet aggregation and soluble P-selectin levels were estimated in all study participants. It was observed that there was a significantly higher mean platelet volume (MPV) and platelet distribution width (PDW) in patients with CU when compared to controls. Platelet aggregation and soluble P-selectin levels were significantly higher in patients with CU, as compared to controls. Urticaria severity score correlated positively with platelet aggregability and soluble P-selectin levels. APST-positive patients had significantly higher platelet aggregation and higher soluble P-selectin levels, when compared to the APST-negative patients, indicating more platelet activation in the autoimmune group. There is significant platelet activation in patients with CU, especially in those with autoreactivity.     

急性缺血性脑血管病患者P-选择素检测及意义

目的 探索P-选择素在急性缺血性脑血管病发病中的意义.方法 选择急性脑梗死患者28例,短暂性脑缺血发作(TIA)患者21例,正常对照30例,检测血小板膜P-选择素和血浆中可溶性P-选择素的含量.结果 与正常对照组比较,急性缺血性脑血管病患者血小板膜P-选择素表达明显上调,以急性脑梗死为著;急性脑梗死患者可溶性P-选择素明显升高,TIA患者升高不明显.结论 血小板膜P-选择素和血浆中可溶性P-选择素水平可作为评价急性缺血性脑血管病严重程度的生物学指标.     

不同剂量氯吡格雷对不稳定型心绞痛患者血小板功能及血流变的影响

目的 探讨不同维持剂量氯吡格雷对不稳定型心绞痛(UAP)患者血小板功能及血流变的影响.方法 选取100 例UAP患者,随机分为对照组及实验组,每组各50例.在冠心病常规治疗基础上,对照组每日给予氯吡格雷75mg/d,实验组给予氯吡格雷150mg/d.分别于服药前及服药后两周采集两组患者静脉血,采用比浊法测定血小板聚集率(MPAR),同时监测血流变指标.结果 服药前两组MPAR及血流变指标比较,差异无统计学意义(P＞0.05);服药两周后两组上述指标较服药前均明显降低,与服药前比较及两组间比较,差异均统计学意义(P＜0.05).结论 150mg/d维持量氯吡格雷可显著降低UAP患者血小板聚集功能,改善其血液流变学指标,有效缓解症状,减少不良事件的发生.     

Blood Pressure Variations,Hemorheological Determinants,and Platelet Aggregation in Hypertensive Patients with Unstable Angina

Plasma viscosity, fibrinogen, haematocrit and ß-thromboglobulin were assessed on venous blood samples taken within 24 hours of admission from 20 consecutive male hypertensive patients with unstable angina and 20 male hypertensive patients with stable angina, matched for clinical variables.

Besides, all patients underwent automated indirect blood pressure monitoring for 24 hours, starting just after hospitalization.

Despite similar average 24-hour, day-time and night-time systolic and diastolic blood pressure, hypertensive patients with unstable angina showed an increased variability of 24-hour (p<0,01) and day-time (p<0,05) systolic and diastolic blood pressure, together with higher values of all haemorhelogical parameters (plasma viscosity, fibrinogen and haematocrit) (p<0,01) and ß-thrombogobulin (p<0,05), when compared with hypertensive patients with stable angina. Moreover, significant correlations between plasma viscosity and 24-hour systolic (r=0,42, p<0,01) and diastolic (r=0,39, p<0,05) blood pressure variability were shown in hypertensive patients with unstable angina.

Besides, in the same patients, the haematocrit was positively correlated with 24-hour systolic blood pressure variability (r=0,37, p<0,05).

Our data further support the relevance of rheological determinants, platelet activation and haemodynamic factors in the genesis of the high risk condition of unstable angina.     

肺血栓栓塞症患者P选择素和组织因子的表达及相关性

目的：探讨血清P选择素（P-selectin）和组织因子（TF）的表达在肺血栓栓塞症（PTE）的意义。方法：选择PTE患者158例（PTE组）和健康对照者142例（健康对照组）,采用酶联免疫法（ELISA）测定两组空腹血清P-选择素和TF表达水平并进行比较;同时检测空腹血糖、血脂、血常规、纤维蛋白原、D-二聚体等指标,并进行相关分析。结果：与健康对照组相比,PTE组P-选择素[（11.62±2.82）μg/L∶（16.31±1.25）μg/L]、TF[（21.32±6.33）ng/L∶（24.15±5.01）ng/L]表达水平较对照组明显升高（P〈0.01）。大面积和次大面积PTE患者（A组）P选择素[（17.30±1.15）μg/L∶（15.85±2.10）μg/L]和TF[（26.71±5.51）ng/L∶（23.12±3.86）ng/L]表达水平明显高于非大面积患者（B组,P〈0.05）。PTE组P选择素与白细胞计数、血小板计数、纤维蛋白原、空腹血糖、总胆固醇（TC）和高密度脂蛋白胆固醇（HDL-C）呈正相关（r=0.181~0.333,P〈0.05）;TF与白细胞计数、血小板计数、纤维蛋白原、空腹血糖和HDL-C呈正相关（r=0.216~0.384,P〈0.05）,P选择素与TF呈正相关（r=0.244,P〈0.05）。结论：肺血栓栓塞症患者P选择素和组织因子水平显著升高,二者与肺血栓栓塞症病情密切相关,共同参与了肺栓塞的炎症反应和血栓形成过程。