血小板胞浆钙离子与脑梗塞

为研究血小板活化程度与脑梗塞临床严重程度之间的关系,选择２６例健康对照者和３０例脑梗塞患者,以Ｍａｔｈｅｗ、Ｔｏｒｏｎｔｏ和Ｂａｒｔｈｅｌ计分代表临床严重程度,水母发光蛋白导入－凝胶过滤法测量血小板胞浆钙离子浓度。结果表明,脑梗塞组血小板胞浆钙离子浓度明显高于对照组,脑梗塞组是（２．８７±０．３５）μｍｏｌ／Ｌ,对照组是（２．０１±０．３１）μｍｏｌ／Ｌ,两组间有极显著差异（Ｐ＜０．００１）。血小板胞浆钙离子与３种临床计分之间均无明显相关性。脑梗塞组血小板胞浆钙离子明显升高,显示脑梗塞患者急性期血小板处于易激活状态。血小板胞浆钙离子与３种临床计分无明显相关,表明血小板活化指标不能预示临床严重程度。     

Relation between malondialdehyde generation by platelets and plasma thromboxane B2 and diagnostic classification by syndrome differentiation of traditional Chinese medicine in stroke during acute stage]

The malondialdehyde generation by platelets and TXB2 in poor platelet plasma were examined in 36 patients with stroke during acute stage. By CT examination 19 cases were diagnosed hemorrhagic, 17 cases ischemic; while by syndrome differentiation of TCM 16 cases belonged to Zhongzangfu(middle internal organs), 20 cases Zhongjingluo (middle channels). Results showed that the malondialdehyde generation by platelets was reduced, TXB2 in poor platelet plasma increased in patients, compared with those in the healthy controls. This finding was common in stroke during acute stage and was not related to diagnostic classes by either CT examination or syndrome differentiation of TCM. This study indicates that maintenance of normal platelet function may have significant implication in the prevention and treatment of cerebrovascular disease.     

缺血性脑卒中患者血小板各参数的变化及其临床意义

目的 探讨缺血性脑卒中患者血小板计数（PLT）、血小板平均体积（MPV）及血小板最大聚集率（PAGm）的变化规律及其临床意义。方法 检测168例缺血性脑卒中患者（急性期及恢复期）及40名健康体检者（对照组）PLT、MPV及PAGm，并与神经功能缺损程度进行相关分析。结果 缺血性脑卒中患者急性期MPV及PAGm显著高于其恢复期（P＜0.01）及对照组（P＜0.01），恢复期MPV及PAGm仍高于对照组（P＜0.01）。缺血性脑卒中组急性期患者按牛津郡社区卒中计划（OCSP）分为4个亚型，MPV及PAGm在完全前循环梗死（TACI）组明显高于部分前循环梗死（PACI）组（P＜0.01）、后循环梗死（POCI）组（P＜0.01）及腔隙性梗死（LACI）组（P＜0.01）,PACI组及POCI组明显高于LACI组（P＜0.01），而PACI组与POCI组之间差异无显著性（P＞0.05）。MPV及PAGm与神经功能缺损程度评分呈正相关（r=0.684、0.698,均P＜0.01）。缺血性脑卒中患者PLT在急性期、恢复期与对照组之间均无显著性差异（P＞0.05），TACI组、PACI组、POCI组及LACI组之间差异亦无显著性（P＞0.05）；神经功能缺损程度评分与PLT不存在相关性（r=0.32,P＞0.05）。结论 与PLT相比,MPV及PAGm更能反映缺血性脑卒中的严重程度，可以判断预后，是外周血中较好的血小板参数指标。     

采用抗GMP_(140)单克隆抗体和流式细胞仪技术研究冠心病人体内的血小板活化状态

采用抗人活化血小板α颗粒膜蛋白(GMP__140)特异的单克隆抗体(SZ_(51),CD(62P))和流式细胞术的方法,检测了30例冠心病患者及6例经皮冠状动脉血管成形术(PTCA)患者术前、术后静脉血中血小板活化状态,发现稳定型心绞痛、不稳定型心绞痛、急性心肌梗塞病人的GMP__140阳性表达率明显高于正常对照组(P<0.001),且各组之间相互比较也有显著差异。PTCA术后GMP_140的表达水平高于术前(5/6,83.3％),1例术前已呈高血小板活化状态的患者在术中发生急性缺血性闭塞意外。提示冠心病的发病与血小板活化有着密切的关系。用免疫荧光标记单抗和流式细胞仪技术可特异、准确地检测出冠心病人体内血小板的活性,对临床早期诊断、预测介入治疗的危险性以及指导抗血小板药物的应用,均提供了重要的价值。     

噻氯匹啶对脑血栓病人的血栓烷B_2的抑制

应用噻氯匹啶250mg/d 治疗急性脑血栓15例,疗程3个月。结果,血浆中血栓烷B_2浓度于治疗2周后开始持续性降低,对于ADP 诱导的血小板血栓烷B_2生成量,也有显著的抑制作用,提示噻氯匹啶的抗血栓作用与抑制血小板花生四烯酸代谢有关。     

缺血性脑血管病血小板形态变化的临床观察

目的探讨血小板形态在脑梗死发病中的变化及作用。方法观察缺血性脑血管病(ICD)短暂性脑缺血发作(TIA)、急性进展型缺血性脑卒中、急性稳定型缺血性脑卒中患者及健康对照组的血小板计数(PLT)、血小板平均体积(MPV)和血小板体积分布宽度(PDW)。结果脑梗死急性期PLT明显低于TIA组和健康对照组(P<0.05,P<0.01),TIA组低于健康对照组(P<0.05);脑梗死急性期MPV和PDW明显高于TIA组和健康对照组(P<0.01),TIA组高于健康对照组(P<0.01);急性进展型缺血性脑卒中PLT低于急性稳定型缺血性脑卒中(P<0.01),MPV和PDW高于急性稳定型缺血性脑卒中(P<0.01)。结论血小板的形态在脑梗死之前就发生变化,动态观察血小板3项参数对脑梗死的预防、诊断及判断预后有指导意义。     

急性脑梗塞静脉溶栓期间血小板活化状态的动态观察

目的为了探讨急性脑梗塞患者溶栓过程中血小板活化状态。方法采用ＥＬＩＳＡ法测定了１３例急性脑梗塞患者尿激酶静脉溶栓前后血浆中ＧＭＰ－１４０、血栓素Ｂ２水平的改变。结果脑梗塞急性期血浆ＧＭＰ－１４０、ＴＸＢ２水平明显高于正常人，说明血小板处于高活化状态，尿激酶溶栓期间血浆ＧＭＰ－１４０、ＴＸＢ２升高，血小板再次被激活。结论急性脑梗塞早期静脉溶栓期间纤溶增加的同时伴有血小板再次被激活，这对指导临床用药，提高溶栓成功率具有重要意义     

缺血性中风时血液流变学和血小板聚集性的研究

对90例缺血性卒中患者做了多项血液流变学及血小板聚集性实验室研究,发现与对照组有明显的统计学差异,认为血液流变学的变化是导致脑血栓的重要因素,并认为血小板功能亢进应视为发病原因,而非结果。本文采用公式推算法认为红细胞压积及纤维蛋白元两个指标,有利于推算脑血流及血液的变应力,故这种推算有利于中风预报。     

急性缺血性脑血管病血小板活化状态胞浆游离钙离子浓度观察

以胶原和凝血酶为活化剂，采用水母发光蛋白导入和凝胶过滤法对３２名健康人和３３例急性缺血性脑血管病患者进行了血小板活化状态胞浆游离Ｃａ~（２＋）浓度观察。结果表明，脑血管病组血小板胞浆游离Ｃａ~（２＋）浓度高于健康对照组（Ｐ＜０．０５），说明缺血性脑血管病患者的血小板对某些活化因素敏感。     

A study of platelet organelles and membrane glycoprotein in patients with Binswanger''s disease

OBJECTIVE To discuss the possible role of platelets in Binswanger's disease by studying the changes of organelles and membrane glycoprotein in platelets.

METHODS The organelles (dense bodies, alpha granules, and mitochondria) within platelets were measured with transmission electron microscopy in 25 patients with Binswanger's disease and matched controls, while alpha granule membrane glycoprotein CD62 and lysosomal integral membrane glycoprotein CD63 on platelet membrane were analyzed by flow cytometry.

RESULTS The percentage of CD62-positive platelets was 3.6% +/- 2.1% and 5.7% +/- 2.4% in controls and in patients, respectively (P < 0.01). The percentage of CD63 expression platelets was 3.1% +/- 2.2% and 3.2% +/- 2.3% in controls and patients, respectively (P > 0.05). When compared with controls, platelets of patients contained fewer alpha granules (P < 0.01), and had no changes in dense bodies and mitochondria (P > 0.05). CD62 levels were different among patients with regarding to the degree of white matter low attenuation.

CONCLUSIONS There is selective degranuation of platelets in patients with Binswanger's disease and the abnormalities of platelet secretion may play a role in the pathophysiology of this illness.