高血压病患者的血小板功能改变

对高血压病患者血浆血小板球蛋白、血栓烷B_2(TxB_2)及体外ADP诱导血小板聚集(PA)和生成TxB_2量测定,表明高血压病一期组仅PA明显增加,而二期组所有指标均显著增加。提示适当的抗血小板药物配合降压治疗对控制高血压病的发展及并发症的发生可能有益。     

糖尿病微血管病变发病机理研究——微血管病变与血小板功能、内皮损伤关系

糖尿病微血管病变是糖尿病患者致死、致残的重要并发症,其发病机理仍未明了。作者针对这方面进行了系列的研究。本研究分3个部分:①糖尿病病人的纤维蛋白原、纤维蛋白(原)降解产物、第Ⅵ因子相关抗原的临床研究;②糖尿病患者血小板聚集、血栓素B生成与。cAMP含量关系;③NIDDM病人血小板聚集、第Ⅵ因子相关抗原的临床研究。分别从糖尿病病人的内皮损伤、血小板功能的改变及其可能的发病机制和磺脲类药物对它们的作用等进行了系统和深入的探讨。结果揭示糖尿病患者存在着磷脂酶活性异常,使TXA2升高,     

2型糖尿病患者尿中11-去氢血栓烷B2的研究

目的 检测血小板活化的分子标记物11-去氢血栓烷B2(11一DH—TXB2)在2型糖尿病患者尿中的变化,探讨尿11-DH—TXB2水平与2型糖尿病及其微血管病变的关系。方法 应用酶联免疫法检测患者尿11-DH-TXB2的水平,同时用生化分析仪检测尿肌苷,对11-DH—TXB2的结果标准化。结果 2型糖尿病患者尿11-DH—TXB2的水平明显高于正常对照;有微血管并发症的患者尿11-DH—TXB2的水平明显高于无微血管并发症的患者和正常对照。结论 2型糖尿病患者中普遍存在血小板的活化,尿11-DH—TXB2水平与微血管病变相关,可作为判断微血管病变存在的指标。     

糖尿病患者微血管病变的血小板参数分析

糖尿病并发大血管和微血管病变以及动脉粥样硬化与高凝状态有密切关系。文献报道血小板许多功能异常对糖尿病微血管病变的发生起着重要作用，笔者对糖尿病微血管病变患者血小板参数及其聚集率进行测定，结果报道如下。     

高敏C反应蛋白与2型糖尿病微血管病变的相关性

目的 研究高敏C反应蛋白与2型糖尿病微血管病变的相关性.方法 收集2型糖尿病患者61例,分别测定尿微白蛋白、血小板聚集率和高敏C反应蛋白,比较高敏C反应蛋白与尿微白蛋白及血小板聚集率的关系.结果 2型糖尿病微血管病变患者总体高敏C反应蛋白增高,且与病变程度成正相关.结论 高敏C反应蛋白具有很高的灵敏性,可提示慢性炎症与2型糖尿病微血管并发症的联系,以及可提示病变的严重程度,改善微循环及减轻炎症的治疗可能延缓慢性并发症的进展.     

2型糖尿病血小板α颗粒膜蛋白测定的临床意义

以毛细血管增殖、基底膜增厚、微血栓形成为特点的微血管病变是糖尿病慢性并发症的基础病变,其发生机理涉及多种因素.研究认为,血小板活化与血管内皮细胞损伤是微血栓形成的始动环节,而血小板聚集功能亢进在微血管病变的整个病理过程中起重要作用.本组通过测定46例2型糖尿病患者的血小板α颗粒膜蛋白(GMP-140),探讨血小板活化在糖尿病微血管病变的早期诊断和病情分析中的临床意义.     

槲皮素对血小板的抑制作用及其机理分析

作者在以往工作的基础上,采用体内外试验观察了槲皮素对血小板的作用。结果发现,槲皮素可显著抑制二磷酸腺苷、胶原、钙离子载体和花生四烯酸诱导的血小板聚集及血小板5—羟色胺的释放反应;槲皮素能减少血小板血栓烷B_2量、升高6—酮—前列腺素F_(1α)量和6—酮—前列腺素F_(1α)/血栓烷B_2的比值。初步探讨了槲皮素的作用机理,认为其主要是通过影响ADP 和TXA_2途径抑制血小板活化。     

2型糖尿病微血管病变患者血小板参数及红细胞水平的变化

目的探讨2型糖尿病微血管病变患者血小板参数及红细胞的变化及其临床意义。方法选择100例2型糖尿病患者分为微血管病变组和无微血管病变组及90例正常对照组为研究对象,采用全自动血细胞分析仪测定血小板计数(PLT)、血小板平均体积(MPV)、血小板平均分布宽度(PDW)、血小板压积(PCT)及红细胞平均体积(MCV)和红细胞分布宽度(RDW)。结果2型糖尿病患者MPV、PDW、MCV、RDW升高,PCT减低,有微血管病变者MPV、PDW、RDW与正常对照组比较升高更加明显(P<0.01,P<0.05)。其中MPV、PDW和FPG与无微血管病变组比较增加显著(P<0.05),MPV与PDW呈正相关(r=0.4,P<0.01),MPV与FPG呈正相关(r=0.77,P<0.01)。结论血小板参数及红细胞测定对2型糖尿病微血管病变的早期诊断和病情分析有临床参考意义。     

Ⅱ型糖尿病合并微血管病变血液流变学、血小板聚集率与性激素变化探讨

目的 :探讨Ⅱ型糖尿病合并微血管病变时血液流变学、血小板聚集率与性激素变化。方法 :测定 75例Ⅱ型糖尿病患者空腹血糖 (FBG) ,糖化血红蛋白 (HbA1c) ,纤维蛋白原 ,血液流变学各项指标 ,血小板聚集率 ,睾酮 (T) ,促卵泡刺激素 (FSH)。将 75例Ⅱ型糖尿病患者分为合并微血管病变组、男性组、女性组、无合并症男性组、女性组。结果 :Ⅱ型糖尿病合并微血管病变组病程、FBG、HbA1c、FSH、血液流变学各项指标、血小板聚集率均显著高于无合并症组 (P <0 .0 1) ,合并微血管病男性组T值较无合并症男性组明显降低 ,差异显著 (P<0 .0 1) ,而在女性两组间T值无统计学差异。结论 :在Ⅱ型糖尿病合并微血管病变的发生和发展中 ,除了长期高血糖外 ,血液流变性异常、血小板聚集率升高起着极为重要的作用 ,性激素内环境失衡可能与微血管病变的发生有关。     

2型糖尿病患者微血管病变与血小板参数关系初探

众所周知,糖尿病(DM)已日渐成为1种常见病〔1〕,严重影响人们的健康。微血管病变是2型DM患者的重要并发症之一,DM微血管病变与患者体内的血栓前状态、血管内皮细胞损伤、血小板(PLT)黏附、聚集和释放等活化功能及抗凝功能减退等因素有密切关系〔2〕。PLT在血栓形成过程中起着关键作用。近年来的研究表明,2型DM患者血小板平均体积(MPV)增大,在2型DM微血管病变的发生和发展过程中起着重要作用。本文测定270例2型DM患者外周血PLT及其参数-平均血小板容积(MPV)、血小板分布宽度(PDW)等的改变,探讨其在2型DM微血管病变早期诊断和病…     

Platelet aggregation, platelet cAMP levels and thromboxane B2 synthesis in patients with diabetes mellitus.

Platelet aggregation, platelet cAMP levels and thromboxane B2 (TXB2) synthesis had been investigated in 40 diabetics (20 with microangiopathy and 20 without) and 24 normal controls. The washed platelets, but not platelet rich plasma (PRP), from the diabetics show greater sensitivity to aggregation in response to thrombin, collagen and arachidonic acid than controls (P less than 0.05). Platelets from the diabetics contain the significantly decreased cAMP levels (P less than 0.01) and synthesize the significantly greater amount of TXB2 (P less than 0.01) when induced by thrombin or collagen. Conversion of exogenously added arachidonic acid to TXB2 remained unchanged (P greater than 0.05). cAMP levels in platelets from the diabetics exhibited a significant negative linear correlation with thrombin- and collagen-induced TXB2 synthesis. There was no significant difference in platelet aggregation, platelet cAMP levels and platelet TXB2 synthesis between the diabetics with and without microangiopathy. It was suggested that in the diabetic platelets: The observed increase in platelet thromboxane A2 (TXA2) synthesis should be due to the increased activity of arachidonic acid-metabolizing system, most likely at phospholipase site; the elevated platelet TXA2 levels should inhibit platelet membrane-associated adenylate cyclase which lowered the cAMP levels in platelets; and this alternation should be the mechanism of platelet hyperaggregability, which might contribute in some way to diabetic microangiopathy.

     

Antithrombotic effects of Andrographis paniculata nees in preventing myocardial infarction.

In 16 dogs the endothelium of the left anterior descending coronary artery was injured mechanically. Then a copper wire was inserted into the lumen as a choke of flow and the vessel was slightly compressed from outside by a constrictor. Eight dogs had been treated beforehand with a preparation of flavone extracted from the root of the Chinese medicinal herb Andrographis paniculata (TFAP). In the control group, saline solution was given, the epicardially recorded ST segment started to elevate within 15 minutes, the platelet aggregation rate and the plasma levels of TXB2 increased rapidly, whereas the level of 6-k-PGF1 alpha remained stable. Platelet cGMP rose continuously; however, platelet cAMP rose only at 60 minutes. Histological findings confirmed the occurrence of arterial thrombus and myocardial necrosis. Contrariwise, in the pretreated group there was no elevation of the ST segment, plasma 6-k-PGF1 alpha and platelet cAMP were increased, the production of TXB2 and aggregation of platelets were inhibited, and no thrombus or myocardial infarction was induced. All data suggest that TFAP might promote the synthesis of PGI2, inhibit the production of TXA2, stimulate the synthesis of cAMP in platelets, impede aggregation of platelets, and thereby prevent the formation of thrombi as well as the development of myocardial infarction.

     

反复心绞痛患者服用阿司匹林后尿11-脱氢血栓素B_2及血小板聚集功能的变化

目的评价血小板聚集功能和尿11-脱氢血栓素B2在评定反复心绞痛患者服用阿司匹林方面的价值。方法 48例反复心绞痛患者和50例一次心绞痛患者服用阿司匹林(100 mg/d)至少7d以上,测定血小板聚集功能和尿11-脱氢-血栓素B2的含量。结果花生四烯酸作诱导剂时,反复心绞痛患者与一次性心绞痛患者相比其血小板聚集功能的差异有统计学意义(P<0.01);反应敏感者尿11-脱氢血栓素B2与反应不敏感者相比其差异有统计学意义(P<0.01)。结论服用阿司匹林后,需检测血小板聚集功能和尿11-脱氢-血栓素B2。     

糖尿病患者血小板游离钙变化与血栓素B2生成的关系

为了探讨糖尿病患者血小板胞浆内游离Ｃａ￣（２＋）浓度（［Ｃａ￣（２＋）］ｉ）与血栓素Ｂ＿２（ＴＸＢ＿２）生成的关系，及其在糖尿病微血管病变发病中的作用，作者用Ｃａ￣（２＋）荧光指示剂ｆｕｒａ－２直接测定２７例糖尿病患者（合并微血管病变苔１３例，无微血管病变者１４例）血小板［Ｃａ￣（２＋）］ｉ，并且同步测定ＴＸＢ＿２。结果：以钙载体Ａ＿（２３１８７）诱导，糖尿病组血小板［（Ｃａ￣（２＋）］ｉ峰值为１１４７±５２ｎｍｏｌ／Ｌ，高于对照组（８９７±４９ｎｍｏｌ／ＬＰ＜０．０１），且与ＴＸＢ，生成呈正相关：而用花生四烯酸诱导，糖尿病组血小板［Ｃａ￣（２＋）］ｉ峰值为３５３±１４ｎｍｏｌ／Ｌ，虽高于对照组（３１２±１６ｎｍｏｌ／Ｌ，Ｐ＜０．０５），但与ＴＸＢ＿２生成未呈显著相关。上述改变在糖尿病有或无微血管病变两组之间比较无显著性差异，提示糖尿病患者血小板［Ｃａ￣（２＋）］ｉ变化可能通过膜磷脂酶环节致使ＴＸＢ＿２生成增多，参与微血管病变的发病。     

Low phospholipid arachidonic acid values in diabetic platelets

Platelet aggregation is enhanced in diabetes mellitus, and platelets may be implicated in the pathogenesis of diabetic angiopathy. Increased platelet aggregation is probably mediated by the production of the proaggregatory prostaglandin thromboxane, which is synthesised from arachidonic acid (C20:4) by the action of the platelet enzymes cyclo-oxygenase and thromboxane synthetase. The fatty acid composition of platelet phospholipid was measured in 20 normal controls, 10 insulin-treated diabetics with no or minimal retinopathy, and 10 insulin-treated diabetics with proliferative retinopathy. The percentage of arachidonic acid was significantly higher in controls (mean 22.6%) than in the diabetics with no or minimal retinopathy (mean 18.5%; p less than 0.025) and the diabetics with proliferative retinopathy (mean 14.6%; p less than 0.001). The percentage of linoleic acid was lower in controls (mean 8.9%) than in the diabetics with no or minimal retinopathy (mean 12.6%; p less than 0.01) and diabetics with proliferative retinopathy (mean 13.1%; p less than 0.001). The mean percentage of linolenic acid was significantly lower in the diabetics with proliferative retinopathy (2.7%) than in the normal control group (4.4%; p less than 0.01). A significant negative correlation was found between the percentages of arachidonic acid and glycosylated haemoglobin (Rs = -0.58; p less than 0.001). A significant positive correlation was found between linoleic acid and the percentage of glycosylated haemoglobin (Rs = 0.51; p less than 0.01). The reciprocal correlation between percentages of arachidonic acid and glycosylated haemoglobin suggests that diabetic control may influence thromboxane release and platelet activity directly and that low percentages of arachidonic acid reflect the increased degree of in-vivo activation.     

不同方法调整血小板数量对血小板聚集功能检测的影响

目的寻求更好的方法调整富血小板血浆（PRP）中的血小板数量,以满足光透射血小板聚集检测（LTA）对样本的质量要求。方法收集18~50岁健康人血样36例。分别以乏血小板血浆（PPP）和生理盐水（PS）调整PRP中血小板数量,调整（稀释）倍数为1.5倍、2倍、2.5倍和3倍,以终浓度5 μmol/L二磷酸腺苷（ADP）、0.5 mmol/L花生四烯酸（ARA）、2 μg/mL胶原（COL）、5 μmol/L肾上腺素（EPI）以及1.2 mg/mL瑞斯托霉素（RIS）为诱导剂,测定调整前后PRP的血小板最大聚集率（MA）的差异。用PRP离心制备的PPP（离心PRP-获取-PPP）,比较其与传统方法（离心全血-获取-PPP）对RIS诱导血小板聚集的影响。结果当ADP、ARA或EPI为激活剂时,PS各调整倍数的PRP与原PRP相比,其MA值的差异无统计学意义（P>0.05）;而PPP各调整倍数的PRP与原PRP相比,其MA值均下降,在调整倍数为2~3倍时,差异有统计学意义（P<0.05）。当激活剂为RIS时,PS各调整倍数的PRP 与原PRP相比,其MA值均下降,且差异有统计学意义（P<0.05）;而PPP各调整倍数的PRP与原PRP相比,其MA值的差异无统计学意义（P>0.05）。当激活剂为COL时,PS和PPP各调整倍数的PRP与原PRP相比,其MA值的差异均无统计学意义（P>0.05）。全血或PRP离心制备的PPP,均不影响RIS诱导血小板聚集的MA值（P>0.05）。结论以ADP、ARA、COL或EPI为诱导剂检测MA时,推荐使用PS调整血小板数量;而以RIS为诱导剂时,应使用自身PPP调整血小板数量;2 100×g,5 min条件下用传统离心全血制备的PPP方便可行。     

心绞痛患者PAF、GMP140和TXB2检测的临床意义

目的探讨稳定型和不稳定型心绞痛患者血小板的活性状态。方法检测40例稳定型心绞痛患者和62例不稳定型心绞痛患者血清中血小板活化因子(PAF)、血小板а-颗粒膜蛋白(GMP140)及血栓烷B2(TXB2)水平,并与正常对照组30例进行对比分析。结果两组心绞痛患者血清PAF、GMP140及TXB2水平显著高于正常对照组(P<0.05),且不稳定型心绞痛组高于稳定型心绞痛组,不稳定型心绞痛危险分层越高,升高越显著,差异均有统计学意义(P<0.05)。结论心绞痛患者血小板活性升高,其中不稳定型心绞痛患者血小板活性升高更为显著,血小板活性状态与不稳定型心绞痛的危险分层相关。     

Platelet adhesiveness in diabetes mellitus with relation to treatment.

To determine whether diabetes mellitus alters the function of platelets, a study on platelet adhesiveness in 30 controls and 75 newly diagnosed diabetics (25 cases of type-1 and 50 cases of type-II) before and after treatment was undertaken. The platelet adhesiveness was 68.83 +/- 6.09% (mean + SD) in type-I diabetics, 72.43 +/- 6.10% in type-II diabetics and 56.31 +/- 9.62% in controls (p less than 0.001 for all comparisons). In complicated diabetics (54 cases) the platelet adhesiveness was 72.33 +/- 5.99% and in uncomplicated diabetics (21 cases) it was 67.33 +/- 5.82% (p less than 0.05). Platelet adhesiveness was significantly reduced after treatment (with insulin it was 62.12 +/- 7.46%, with phenformin 62.10 +/- 8.63 and with tolbutamide 67.12 +/- 7.97%) when compared with pretreatment values. Platelet adhesiveness had no significant correlation with blood sugar and serum cholesterol levels. These results support the concept that platelet adhesiveness is high in diabetes mellitus and is reduced with control of diabetic state after treatment.     

高血压对糖尿病微血管病变患者血浆TXB2浓度的影响

用放射免疫法测定２０４例糖尿病人的血浆ＴＸＢ２和６－Ｋｅｔｏ－ＰＧＦ１ａ浓度。各组的ＴＸＢ２水平，随糖尿病视网膜病变或糖尿病肾病加重而升高。各糖尿病微血管病变组中高血压组ＴＸＢ２水平均高于血压正常组（Ｐ＜０．０５）。提示ＴＸＢ２在糖尿病微血栓形成中起重要作用，合并高血压时对糖尿病微血管病变的发生和进展有明显的促进作用。     

当归注射液对冠心病患者血超氧化物歧化酶活性和脂质过氧化物的影响

２４例冠心病患者静脉滴注当归注射液治疗后，血超氧化物歧化酶（ＳＯＤ）、６－酮前列腺素Ｆ１α（６－Ｋ）和６－Ｋ／血栓素Ｂ２（ＴＸＢ２）均升高，丙二醛（ＭＤＡ）、ＴＸＢ２和血小板最大聚集率均降低（Ｐ均＜０．０５～０．０１）。结果表明，当归注射液有增加ＳＯＤ活性，清除氧自由基，抗脂质过氧化反应，减低ＭＤＡ水平，升高ＰＧＩ２，降低ＴＸＡ２，调整ＰＧＩ２／ＴＸＡ２平衡和抑制血小板聚集的作用。