原发性血小板增多症血小板功能变化及与血栓的关系

The study of relationship between platelet function and thrombus in patients with essential thrombocythaemia

目的观察原发性血小板增多症（essential thrombocythaemia，ET）患者血小板功能的变化及对血栓形成的影响，探讨奥扎格雷钠在ET患者中防治血栓发生的作用。方法采用流式细胞仪（FCM）测定患者CD62P、PAC-1的水平；采用ELISA方法测定血浆血栓素A2（TXA2）代谢产物TXB2和前列环素（PGl2）代谢产物6-K-PGF1α水平；观察奥扎格雷钠干预治疗对ET患者血小板活性及血栓发生率的影响。结果治疗前两组ET患者CD62P、PAC-1、TXB2、6-keto—PGF1α和TXA2／PG12指标均明显高于正常组（P〈0．01）；奥扎格雷钠干预治疗后CD62P、PAC-1、TXB2、TXA2／PG12均较治疗前明显降低（P〈0．01），奥扎格雷钠干预治疗后CD62P、PAC-1和TXA2／PG12与正常相比差异无统计学意义，而TXB2、6-keto—PGF1α仍高于正常，差异有统计学意义（P〈0．05），常规治疗组治疗后与治疗前相比，各项指标均无明显变化。奥扎格雷钠干预治疗组后期血栓发生率为12．5％，常规治疗对照组血栓发生率为54．1％，差异有统计学意义（P〈0．05）。结论ET患者存在血小板异常活化现象和一定的血栓形成危险，临床上除常规治疗减少血小板数量外，还应重视血小板功能的干预治疗，以改善血小板功能、防止血栓发生。

Objective To observe the influence of the plasma thromboxane B2 （TXB2）, 6-keto- PGF1α, CD62P and PAC-1 and Thrombus in patients with primary thrombocytosis（ET）. To observe the effect of sodium ozagrel to prevent and treat thrombosis in patients with ET. Methods The subjects including 48 patients with ET. All patients were measured the plasma TXB2, 6-keto-PGF1α, CD62P and PAC-1 before and after treatment with or without sodium ozagrel. Results The plasma levels of CD62P, PAC-I, TXB2, 6-keto-PGF1α and TXA2/PGL2 in the patients with ET were significantly higher than the normal people （P 〈 0.01 ）. The levels of CD62P, PAC-1, TXB2, TXB2/6-keto-PGF1α in patients with treatment of sodium ozagrel were higher than patients without treatment of sodium ozagrel （ P 〈 0. 01 ）. The plasma levels of CD62P, PAC-I and TXA2/PGI2 in patients with treatment of sodium ozagrel and that in normal people had no significant distinction （ P 〈 0. 01 ）. All the index of conventional therapy group were higher than normal people（P 〈0. 01 ） but had no significant distinction with the patients before conventional treating. The incidence of thrombus in patients treated with sodium ozagrel was lower than patients treated without sodium ozagrel （P 〈 0. 05 ）. Conclusion With the treatment of sodium ozagrel in patients with ET, the CD62P, PAC-1, TXB2 and TXA2/PGI2 of plasma could be decreased. And the incidence of thrombus was decreased.