体外循环对血小板CD40L表达的影响

目的研究体外循环（CPB）过程中血小板膜表达CD40L的变化,及其与血小板激活、全身炎症反应及凝血变化的联系。方法CPB心内直视手术患者40例,分别于麻醉诱导后10min（T1）、CPB后30min（T2）、CPB停机即刻（T3）、CPB后2h（T4）、4h（T5）、8h（T6）,抽取外周动脉血,测定血浆TNF-α浓度、血小板表面CD40L和CD62P表达,计算术后24h纵隔引流量。结果T2时CD40L较CPB前明显升高（P〈0.01）,T3时达到峰值,T6时恢复到T1水平。血小板CD62P表达、血浆肿瘤坏死因子-α的峰值、术后24h引流量均和CD40L表达呈正相关（r=0.610,P〈0.01）。结论CD40L是随着CPB对血小板的激活而表达的,CD40L可能是联系炎性反应和凝血异常这两个导致CPB术后主要并发症的一个重要环节。

The effect of cardiopulmonary bypass in the expression of CD40 ligand on platelet membrane

Objective To observe the effect of cardiopulmonary bypass（CPB）in the expression of CD40 ligand （CD40L） on platelets membrane,and to investigate the correlation between platelet stimulation,systemic inflammation and coagulation.Methods 40 patients undergoing open heart operation by CPB were studied.Blood samples were collected from peripheral arterial 10 minutes after anesthesia induction（T1）,30 minutes after CPB（T2）,instant on the termination of CPB（T3）,after 2 hours（T4）,4 hours（T5）,8 hours and at the termination of CPB（T6）.The expression of CD40L and CD62P on platelet membrane,plasma TNF-α concentration,total amount of bleeding after 24-hour CPB were detected.Results The expression levels of CD40L on platelet membrane were significantly increased after CPB（P0.01）,which reached its peak at the termination of CPB and returned to the baseline after 8 hours.The CD40L was significantly correlated with CD62P,TNF-α and the amount of bleeding respectively（P0.01）.Conclusion The expression of CD40L on platelet membrane increases with the platelet-activation caused by CPB.The platelet-derived CD40L may be involved in both the thrombotic and inflammatory events accompanied with CPB.