新型布尼亚病毒感染患者血小板膜糖蛋白的表达及临床意义

Expression of platelet membrane glycoproteins and their clinical significance in patients infected by severe fever with thrombocytopenia syndrome virus

目的 探讨新型布尼亚病毒感染患者血小板膜糖蛋白表达的意义。方法 收集2011年5月至2013年5月浙江省舟山医院收治的并发多器官功能障碍综合征(MODS)(8例)和未并发MODS(20例)新型布尼亚病毒感染患者。对两组患者血小板进行常规检测并比较,检测两组患者二磷酸腺苷(ADP)诱导前后的血小板膜糖蛋白(CD41a、CD42a、CD61、CD62p)的阳性表达率和平均荧光强度(MFI),采用独立样本t检验比较两组间的差异。结果 MODS组与非MODS组ADP诱导前比较,血小板的计数差异无统计学意义(t=0.139,P＞0.05),但平均体积偏大(t=6.417,P＜0.01),血小板分布宽度大(t =9.664,P＜0.01);MODS组患者血小板膜糖蛋白阳性表达率和MFI较非MODS组患者显著增高(CD41a:t=14.486和49.419,P＜0.01;CD42a:t =41.693和58。160,P＜0.01;CD61:t=15.452和19.251,P＜0.01;CD62p:t 18.230和24.258,P＜0.05);经ADP诱导活化处理后MODS组患者血小板膜糖蛋白阳性表达率和MFI未出现明显变化(CD41a:t=1.364和1.237,P＞0.05;CD42a:t=1.247和1.448,P＞0.05; CD61:t=1.258和1.354,P＞ 0.05;CD62p:t=1.213和1.147,P＞0.05),而非MODS组患者经ADP诱导活化处理后血小板膜糖蛋白阳性表达率和MFI均明显升高(CD41a:t=15.891和18.417,P＜0.01;CD42a:t=54.367和14.217,P＜0.01;CD61:t=16.257和21.348,P＜0.01;CD62p:t =58.268和18.145,P＜0.01)。结论 新型布尼亚病毒感染并发MODS患者血小板膜糖蛋白阳性表达率和MFI较轻症患者高,而且持续活化表达能力极低,血小板膜糖蛋白的检测可以作为判断新布尼亚病毒感染患者疾病严重程度的重要指标之一。

Objective To investigate the expression of platelet membrane glycoproteins in patients infected with severe fever with thrombocytopenia syndrome virus (SFTSV).Methods Twenty-eight SFTSV infected patients,including 8 cases with multiple organ dysfunction syndrome (MODS) and 20 without MODS,were collected from Zhoushan Hospital during May 2011 and May 2013.Platelet routine test and the detection of the positive rates and mean fluorescence intensity (MFI) of platelet membrane glycoproteins (CD41a,CD42a,CD61,CD62p) were performed before and after adenosine diphosphate (ADP)-induced activation treatment.Independent-samples t test was used to compare the results between two groups.Results Compared with non-MODS group,the platelet count had no difference in MODS group (t =0.139,P ＞0.05),but the mean platelet volume was larger (t =6.417,P ＜0.01),and the platelet distribution width was wider (t =9.664,P ＜ 0.01).The positive expression rate and MFIs of membrane glycoproteins were higher in MODS group than those in non-MODS(CD41a:t =14.486 and 49.419,P ＜ 0.01 ; CD42a:t =41.693 and 58.160,P ＜ 0.01 ;CD61:t =15.452 and 19.251,P ＜ 0.01 ; CD62p:t =18.230 and 24.258,P ＜ 0.05).After ADP-induced activation treatment,the positive expression rate and MFI did not significantly changed in MODS group (CD41a:t =1.364 and 1.237,P ＞ 0.05 ; CD42a:t =1.247 and 1.448,P＞0.05; CD61:t =1.258 and 1.354,P＞0.05; CD62p:t =1.213 and 1.147,P＞0.05),while there were significant changes in non-MODS group (CD41a:t =15.891 and 18.417,P ＜ 0.01 ;CD42a:t =54.367 and 14.217,P＜0.01; CD61:t =16.257 and 21.348,P＜0.01; CD62p:t =58.268 and 18.145,P ＜ 0.01).Conclusions Platelet glycoprotein expression and MFI in SFTSV infected patients with MODS are higher than those without MODS,and the sustained activation expression ability is extremely low in patients with MODS.Detection of platelet membrane glycoprotein may be used to evaluate the disease severity for patients infected with SFTSV.