血小板单采术治疗原发性血小板增多症对微循环的影响

Effect of Therapeutic Platelet Apheresis on Microcirculation in Primary Thrombocythemia

目的:研究原发性血小板增多症(PT)的微循环改变及治疗性血小板单采术(TPA)对PT微循环异常的影响。方法:39例PT患者分为血红蛋白(HGB)降低组(dHGB组)及HGB正常组(nHGB组),进行TPA治疗。观察治疗前后甲襞微循环和血液流变性变化,并与正常对照组进行统计学比较。结果:PT患者均有甲襞微循环异常,积分值显著高于对照组(P<0.05),dHGB组各项积分均高于nHGB组(P<0.05)。dHGB组全血粘度较对照组降低(P<0.05),其它参数与对照组比较未见显著性差异(P>0.05);nHGB组血液流变学指标与对照组比较未见显著性差异(P>0.05)。TPA后患者甲襞微循环积分值均较治疗前显著降低(P<0.05),dHGB组各项指标仍高于对照组(P<0.05),nHGB组与对照组未见显著性差异(P>0.05);血液流变学指标较治疗前比较未见显著性差异(P>0.05)。结论:PT患者存在明显的微循环学异常,与异常增高的PLT及部分病例并发的血红蛋白减少有关。而TPA对临床症状的改善及微循环异常的纠正作用主要与清除异常增多的PLT有关。

Objective:To study the changes in primary thrombocythemia(PT)and the effect on microcirculation with treatmont of therapeutic platelet apheresis(TPA).Method:39 cases of PT patients were divided into decreased hemoglobin group(dHGB group)and normal Hemoglobin group(nHGB group),two groups were treated by TPA.The microcirculational changes was detected and compared to the control group.Results:The nailfold microcirculational abnormality was observed in all PT patients,the udlue of integral in PT patierts was significantly higher than control group(P<0.05),and the integrals in dHGB group was significantly higher than nHGB group(P<0.05).The viscosity of whole blood in dHGB group was significantly lower than control group(P<0.05),but the other hemorheological parameters were shown no statistical difference(P>0.05).The hemorheological parameters in nHGB group were shown no statistical difference comparea with control group(P>0.05).After treatment with TPA,the nailfold microcirculational integrals in PT patients was significantly lower than pretreatment(P<0.05),dHGB group was significantly higher than control group(P<0.05),however nHGB group was shown no statistical difference to control group(P>0.05).The hemorheological parameters were shown no statistical difference than pretreatment(P>0.05).Conclusion:There are significant abnormal microcirculation in PT patients,and related to the hyperthrombocytosis and anemia in partial patients.The mechanism of TPA in the improvement of clinical symptom and microcirculational abnormality is related to the clearance of abnormal increase of platelet.