慢性肾病患者循环血小板微颗粒水平的变化

Variation of Circulating Platelet Microparticle in Patients with Chronic Kidney Disease

目的探讨血小板微颗粒(PMPs)在慢性肾病(CKD)中的意义。方法采用流式细胞术及酶联免疫吸附试验(ELISA法)检测72例慢性肾病患者和20名健康对照者血浆PMPs、P-选择素的水平,并分析PMPs水平与血压、肌酐清除率、24h尿蛋白定量、血红蛋白、胆固醇之间的关系。结果 (1)CKD组患者血浆PMPs及P-选择素水平均较对照组明显增高(均P<0.05)。(2)肾病综合征组及慢性肾炎组患者血浆PMPs的含量也显著高于对照组(分别P<0.01和<0.05),肾病综合征组血浆PMPs的含量明显高于高血压肾病组(P<0.05);各临床分类组患者血浆P-选择素的含量均显著高于对照组(P<0.01),其中肾病综合征组血浆P-选择素的含量明显高于狼疮性肾病组、糖尿病肾病组和高血压肾病组(P<0.05或<0.01),慢性肾炎组血浆P-选择素的含量显著高于糖尿病肾病组(P<0.01)。(3)CKD分期I期患者血浆PMPs含量明显高于Ⅳ期患者(P<0.05);不同的CKD分期间P-选择素含量的差异无统计学意义(P>0.05)。(4)PMPs的水平与血压成正相关(P<0.05),与肌酐清除率、24h尿蛋白定量、血红蛋白、胆固醇无明显相关性(均P>0.05)。P-选择素与PMPs成正相关(P<0.05)。结论 CKD患者存在明显的血小板活化,血小板活化参与CKD发生发展的病理生理过程;高血压是使CKD患者血小板活化的重要原因之一;PMPs可作为一种反映血小板活化的新标记,对评估CKD的发展及预后有一定的意义。

Objective To investigate the significance of the platelet micorparticle（PMPs） in chronic kidney disease（CKD）.Methods Both in 72 cases of CKD and 20 cases of healthy controls,circulating PMPs were numerated by flow cytometry.P-selectin was measured by the enzyme-linked immunosorbent assay.The relationships between the level of PMPs and blood pressure,creatinine clearance,24 h urinary protein,hemoglobin,cholesterol was investigated.Results（1） Plasma levels of PMPs and P-selectin were significantly higher in CKD patients than that in the control group（P〈0.05）.（2） The leves of PMPs in nephritic syndrome group was markedly higher than that in the hypertensive renal disease group（P〈0.05）.Meanwhile,the level of P-selectin in nephritic syndrome group was remarkably higher than that in the hypertensive renal disease group and chronic glomerulonephritis group（P 〈0.01 and 〈0.05）.（3） In different stages of CKD,the level of PMPs in stage I was significantly higher than that in stage Ⅳ（P〈0.05）,the plasma P-selentin levels between other stages were not significantly different（P〉0.05）.（4） As for PMPs,a positive correlation was found with blood pressure,no correlation was found among creatinine clearance,24 h urinary protein,hemoglobin and cholesterol.P-selectin has a positive correlation with PMPs.Conclusion Patients with CKD has apparent platelet activity,on the orther hand,the platelet activity is involved in the couse of physiopathologic of CKD.Hypertension is one of the important reason for platelet activity.As a new marker to reflecting the platelet activity,PMPs could evaluate the progress and prognostic of CKD.