肝素疗法对肾小球肾炎患者血小板活化状态的影响及其临床意义

EFFECT OF HEPARIN THERAPY ON THE PLATELET ACTIVATION IN THE PATIENTS WITH GLOMERULONEPHRITIS

探讨肝素疗法对不同病理类型肾小球肾炎患者血小板活化状态的影响。方法 :用全自动血细胞分析仪测定患者血小板计数、体积和分布宽度 ,用流式细胞技术测定患者血小板表面CD62P、CD63和CD4 1表达水平。结果 :95例肾小球肾炎肝素疗法病人发生肝素诱导性血小板减少症 4你 ,发病率 4 .2 %。肝素疗法对MC病人血小板计数、体积、分布宽度 ,血小板表面CD62P、CD63和CD4 1表达水平无显著影响 (P >0 .0 5) ,部分GS、MN、PGN病人血小板计数减少 (P <0 .0 1) ,体积增大 (P <0 .0 1) ,分布宽度超过正常值 ,GS、MN、PGN病人血小板表面CD62P、CD63和CD4 1表达水平显著高于肝素疗法前表达水平 (P <0 .0 1) ;HIT病人血小板表面CD62P、CD63和CD4 1表达水平是无HIT病人的 2～ 3倍。结论 :肾小球肾炎肝素疗法可使部分GS、MN、PGN病人血小板活化 ,导致血小板破坏增加和血小板 -纤维蛋白原微栓子形成。

Objective: To study the effect of heparin therapy (HT) on the state of platelet activation in patients with varied pathologic types of glomerulonephritis. Methods: We tested platelet counts (PC), mean platelet volume (MPV) and platelet distribution width (PDW) by automatic blood cell analytic apparatus and detected the expressive levels of CD62p, CD63 and CD41 on the surfaces of platelets in the patients. Results: There are four cases suffered from heparin-induced thrombocytopenia (HIT) and the incidence of HIT was 4.2 percent. There were not the effect of HT on the PC, MPV PDW and the expressive levels of CD62p, CD63 and CD41 in the patients with minimal change (MC). However, HT led to PC decreasing, MPV enlarging and PDW exceeding normal value in the patients with glomerulosclerosis (GS), membranous nephropathy (MN) or proliferative glomerulonephritis (PGN), and the expressive levels of CD62p, CD63 and CD41 on the surfaces of platelets are significantly elevated than those before HT in those patients. The patients with HIT were two to three times the expressive levels of CD62, CD63 and CD41 of the patients without HIT. Conclusions: HT could cause the platelet activation in the patients with GS, MN or PGN, resulting in increased removal of activated platelet and formation of platelet-fibrinogen mincroembolus.