体外循环期间血小板膜糖蛋白的定量研究及临床意义

The quantitative research of platelet membrane glycoproteins during cardiopulmonary bypass

目的 探讨体外循环 (CPB)对血小板膜糖蛋白的影响。方法 用流式细胞术对 40例先天性心脏病房、室间隔缺损患者在 CPB下行心内修补术时的血小板膜糖蛋白 CD41 a、CD42 b、CD6 2 p和CD6 3的含量免疫荧光定量测定 ,同时与本组患者和健康供血者试管内血小板膜糖蛋白进行比较。结果 在 CPB中血小板总数明显下降 ,从术前值的 (310± 91)× 10 3/ m l降至术后值的 (181± 44 )× 10 3/ml,CD41 a无明显变化 ,CD42 b明显降低 (P<0 .0 5 ) ,CD6 2 p和 CD6 3明显增加 (P<0 .0 5 )。本组和健康供血者的试管内血小板膜糖蛋白 CD41 a、CD42 b、CD6 2 p和 CD6 3均呈平行变化。结论 CPB期间既有粘附凝集功能下降 ,也有粘附凝集功能增强的血小板膜糖蛋白 ,而凝血机制缺陷的原因可能与血小板总数下降、低温及肝素的后续作用有关。

Objective To explore the effect of platelet membrane glycoproteins(PMG) during cardiopulmonary bypass(CPB).Methods The CD 41a ,CD 42b ,CD 62p and CD 63 of PMG were measured with flow cytometry in 40 patients with arterial or ventricular septation defect during operation and compared with PMG in vitro.Results Blood platelet count and CD 42b level decreased,CD 62p and CD 63 levels increased at CPB end and immediately after operation. The variations of PMG in vitro were parallel between the patients and health blood donor.Conclusion During CPB agglutination defect may result from platelet counts decrease hypothermia and heparin administration,not from the PMG changes.