缺血性脑血管病不同时相血小板膜糖蛋白测定的临床意义

Clinical Significance of Platelet Membrane Glycoproteins in Different Period of Ischemic Cerebrovascular Diseases

目的探讨缺血性脑血管病不同时相血小板膜糖蛋白(GP)测定的临床意义。方法采用定量流式细胞仪测定108例缺血性脑血管病患者(包括短暂性脑缺血发作20例、腔隙性脑梗死49例及脑血栓形成39例)和30例正常对照者外周血血小板膜糖蛋白GPⅢa(CD61)、GPⅠb(CD42b)、GPⅠa(CD49b)在病程不同时相〔(急性期(≤3d)、发病1周、2周及恢复期〕的表达。同时采用ESS评分评价神经功能缺损程度及其与GP的相关性。结果脑血栓形成的急性期、短暂性脑缺血发作的急性期和发病后1周,GPⅢa表达明显高于正常对照组(P<0.05);此两种疾病状态急性期均存在GPⅠb下降,差异无统计学意义(P>0.05);腔隙性脑梗死各期均未发现GPⅢa的明显表达。在病变恢复期,脑血栓形成中GPⅠa的表达明显高于腔隙性脑梗死(P<0.05);短暂性脑缺血发作急性期GPⅠa表达略升高,恢复期降低(P>0.05)。Pearson相关分析显示ESS评分与GPⅠb的表达呈正相关(r=0.233,P<0.05),偏相关分析显示GPⅢa、GPⅠb及GPⅠa两两之间均有相关关系。结论脑血栓形成和短暂性脑缺血发作的急性期均有GPⅢa和GPⅠb的明显活化,前者恢复期GPⅠa表达亦显著增加。血小板膜糖蛋白的改变可能反映血栓前状态,可作为一种有效评估某些缺血性脑血管疾病发展及预后的因子。

Objective To investigate the clinical significance of the platelet membrane glycoproteins in various periods of ischemic cerebrovascular diseases. Methods Peripheral blood platelet activation markers GPⅢa（ CD61 ）, GP Ⅰ b（CIM2b） and GP Ⅰ a（CD49b） in 108 patients with ischemie cerebrovaseular diseases （20 TIAs, 49 lacunar infarcts and 39 cerebral thrombosis） were detected in various periods（ acute stage ≤3 days, one week, two weeks and convalescence stage） by the method of quantitative flow cytometry. Thirty normal aged persons served as controls. The degree of neurologic impairment were analyzed by ESS grading. Results GP ⅢIa expression increased significantly（P 〈0.05） within one week of TIA and in acute stage of both cerebral thrombosis. In convalescence stage, the GP Ⅰ a expression in cerebral thrombosis was significantly higher than those of in lacunar infarcts. Peripheral blood GP I a slightly stepped up in acute stage but decreased in convalescence stage（P 〉 0.05 ）. ESS grading was aceociated with GP Ⅰ b（ pearson analysis, r = 0. 233, P 〈 0.05 ） and these GPs were associated with one another by partial correlation analysis. Conclusion GP m a and GP I b were significantly activated in the acute phase of cerebral thrombosis and TIAs, which was very important in the course of thrombosis. The changes in GP may reflect a prothrombotic state and they may be predictive factors to the progress and prognosis of some ischemic cerebrovascular diseases.