成人急性白血病血小板活化和活化功能的研究

Study on Platelet Activated State and Platelet Activated Function in Adults with Acute Leukemia

为了用流式细胞术(FCM)微量全血法检测血小板活化状态和血小板活化功能,探讨其与成人急性白血病出血、浸润的关系,利用FCM检测成人急性白血病(AL)患者初诊期、缓解期(CR1)和持续长期缓解期(CCR)外周血血小板活化标志物CD62P、PAC-1的表达变化,并以健康体检者作对照组。结果表明:与健康组比较ADP激活前,AL组CD62P、PAC1表达高于对照组(P<0.001)。ADP激活后,AL组CD62P表达高于对照组(P<0.05),PAC1表达低于对照组(P<0.001);CR1组PAC1表达仍低于对照组(P<0.001),CD62P无差异;CCR组PAC1、CD62P无差异。无巨核细胞恶性病变组AL与伴有巨核细胞恶性病变组AL比较,血小板ADP激活前两组CD62P和PAC1无显著性差异;激活后伴有巨核细胞恶性病变组PAC1表达低于无巨核细胞恶性病变组(P<0.001)。结论:①AL患者外周血血小板存在较高水平的活化,提示血小板活化与肿瘤细胞相互作用可能是急性白血病患者存在广泛的浸润、出血的原因之一。②AL初发时血小板减少,同时伴有血小板活化功能异常,这种异常可能是骨髓白血病细胞恶性增生,导致骨髓巨核细胞生成减少或功能异常所致。

To investigate the changes of platelet activated state and platelet activated function by trace whole blood flow cytometry (FCM), and to explore the mechanism of hemorrhage and infiltration in adults with acute leukemia, the expression percentage and changes of these expressions of CD62p and PAC-1 on platelet surface were determined by FCM of trace whole blood after platelet activated by ADP in patients with new diagnosed AL (group Ⅰ), complete remission (CR, group Ⅱ) and continuously complete remission (CCR, group Ⅲ). Healthy adults were used as control group. The result showed that the expression of CD62p in groupⅠand Ⅱwas higher than that in control group, before and after platelet activated by ADP (P<0.01). The expression of PAC-1 in groupⅠwas higher than that in control group (P<0.01), the expression of PAC-1 in group Ⅱwas lower than that in control group (P>0.01), There was no significant difference in expression of CD62p and PAC-1 between group Ⅲ and control group (P>0.01), and no significant difference was found between AL group with megakaryocyte malignant pathological changes and AL group without megakaryocyte malignant pathological changes before platelet activated by ADP (P>0.01). After platelet activated by ADP, the expression of PAC-1 in the former was lower than that in the latter (P<0.01). It is concluded that (1) high level activated platelet in peripheral blood of AL patients show that interaction between activated platelet and leukemia cells can be one of reason resulting in widespread hemorrhage and infiltration AL patiens; (2) the decrease of number and activted function of platelet at the first stage of AL patients may be caused by malignant hyperplasia of leukemia cells and damage of megakaryopoiesis in bone marrow.