慢性阻塞性肺疾病急性加重患者血浆血小板因子4及β凝血球蛋白水平的变化及其意义

Platelet factor 4 and β-thromboglobulin in blood plasma of patients with acute exacerbation of chronic obstructive pulmonary disease

目的观察慢性阻塞性肺疾病（COPD）急性加重患者血浆血小板因子4（PF4）及B凝血球蛋白（β-TG）水平的变化，探讨其意义。方法将2008年1月至2010年6月北京朝阳医院呼吸与危重症医学科收治的71例COPD急性加重患者作为急性加重组，50例缓解期患者为缓解组，同期40名健康体检者为对照组。分别收集各组一般人口学资料、动脉血气分析及肺功能的相关指标。用酶联免疫吸附（ELISA）法检测其血浆PF4、β-TG水平，用全自动血液分析仪检测血小板计数。对各组患者的PF4及β-TG水平及血小板计数进行统计学分析，并对PF4、β-TG、动脉血气指标、肺功能指标等进行相关性分析。结果急性加重组、缓解组、对照组间性别、年龄构成差异均无统计意义，具有可比性（均P〉0．05）。急性加重组、缓解组、对照组血浆PF4和β-TG水平分别为2．28、2．01、1．57μg /L和2．32、1．85、1．29μg /L，急性加重组均高于其他2组（均P〈0．05）；3组血小板计数分别为（196±67）×10。／L、（194±50）×10^9／L、（190±48）×10^9／L，差异无统计学意义（P〉0．05）。极重度急性加重组患者血浆PF4与β-TG水平均高于中度及重度患者，差异均有统计学意义（均P〈0．05）。PF4与β-TG水平呈正相关（P〈0．01），PF4及β-TG水平与第1秒用力呼气量（FEV1）占预计值的百分比、FEV1与用力肺活量（FVC）的比值（FEV1／FVC）和氧分压均呈负相关（均P〈0．05）。结论COPD急性加重患者存在异常血小板活化，PF4和β-TG水平的增高可作为反映疾病严重程度、判断患者血栓前状态的指标。

Objective To explore the role of platelet factor 4 （PF4） and β-thromboglobulin （ β- TG） in patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD）. Methods A total of 71 AECOPD patients and 50 chronic obstructive pulmonary disease （COPD） patients within a stable stage were admitted into Beijing Chaoyang Hospital from January 2008 to June 2010. And another 40 healthy volunteers were selected as control group. The data of demographics, arterial blood gas analysis and pulmonary function parameters was colleeted and analyzed. The plasma levels of PF4 and β-TG were measured by enzyme-linked immunosorbent assay （ ELISA ）. Platelet count was measured by hematology analyzer. Statistical analysis was used for PF4, β-TG and platelet count. Spearman rank correlation was used for correlation analysis. Results No differences in age and gender existed among the AECOPD, stable and control groups. The plasma level of PF4 in the AECOPD group （2. 28 μg/L） was significantly higher than that of the stable group （2. 01 μg/L） and control group （ 1.57 μg/L） （both P 〈0. 05）. The level of β-TG in AECOPD was 2. 32 μg/L and it was significantly higher than that of the stable group （ 1.85μg/L） and control group （1.29μg/L） （both P 〈0.05）. The differences in platelet counts were insignificant between the AECOPD group （ （ 196 ±67） ×10^9/L）, stable group （ （ 194 ±50）×10^9/L） and control group （ （ 190 ±48） ×10^9/L）. AECOPD group was divided into moderate, severe and very severe groups by pulmonary function parameters. The levels of PF4 and β-TG in very severe group were significantly higher than those in moderate and severe groups （ P 〈 0. 05 ）. A significant positive correlation was observed between PF4 and β- TG （r =0. 518, P 〈0. 01 ）. The levels of PF4 and β-TG were negatively correlated with FEVI% , FEV1/ FVC and PaO2 （ all P 〈 0. 05 ）. Conclusion Abnormal platelet activation exists in AECOPD. And the levels of PF4 and β-TG may reflect the severity of AECOPD and can be used as the markers of estimating nrethrombotic state.