体外ADP对多发性骨髓瘤患者血小板刺激后P-选择素表达及患者血浆对自身血小板的活化功能影响

Expression Level of Multiple Myeloma Platelet Activation Markers after ADP Stimulation and the Effect on Platelet Activation Function Itself by Patient Plasma

目的 探讨初诊未治或复发多发性骨髓瘤（multiple myeloma,MM）患者血小板在受到二磷酸腺苷（adenosine diphosphate,ADP）刺激后P-选择素（P-selectin）的表达,并探讨血小板活化差异是血小板原因还是血浆对血小板产生了干扰.方法 选择2009年1月～8月确诊为MM患者30例,正常对照30例.设计四组实验进行比较：A组为MM患者富血小板血浆;B组为相应MM富血小板血浆＋对照乏血小板血浆（V：V=1：4）;C组为正常富血小板血浆;D组为正常富血小板血浆＋MM乏血小板血浆（V：V=1：4）,对ADP刺激前后血小板活化标志物P-selectin的表达进行流式分析,计算各组P-selectin相对升高值,相对升高值=（刺激后P-selectin-刺激前P-selectin）/刺激前P-selectin.结果 A组与C组比较差异有统计学意义（t=2.67,P＜0.05）;A组与B组、A组与D组比较,差异无统计学意义（t=1.34,1.41;P＞0.05）;C组与D组比较t=2.98,P＜0.01,C组与B组比较t=2.61,P＜0.05,差异均有统计学意义.结论 MM与正常血小板在ADP的刺激下发生活化的程度是不一致的,MM的血小板活化功能受到影响;用正常人血浆对MM血小板进行稀释,对血小板的活化功能并没有什么实质性改变,在MM的血小板表面可能存在不能够轻易去除的包裹蛋白,而MM的血浆对正常血小板是有干扰的,可能通过附着在正常血小板表面而影响其功能.

Objective To study the platelet activation markers of the newly diagnostic group and the recurrence group in mul- tiple myeloma patients by the ADP stimulated,and to study the difference was from the platelet itself or plasma interference. Methods 30 multiple myeloma patients and 30 normal control groups Were used for research from January to August in 2009, to design four groups：group A for multiple myeloma patients with platelet rich plasma; Group B for the corresponding multiple myeloma platelet rich plasma ＋ control lack of platelet plasma （V ： V= 1 ： 4） ;group C for the platelet rich plasma from normal group;Group D for the corresponding controls platelet rich plasma ＋ multiple myeloma platelet poor plasma （V ： V= 1 ： 4） and to verify the expression of P-selection before and after ADP stimulation,the relative value of P-selection is calculated, relatively value= （P-selection value after ADP stimulation-before ADP stimulation）/before ADP stimulation. Results The relative value of group A and C was statistically significant（t= 2.67, P〈0. 05）, group C and D（t= 2.98, P〈 0.01） ,group B and C（t=2.61,P〈0.05） were the same way. But,group A and B（t=1.34,P〉0. 05） ,group A and D（t=1.41, P〉0.05） were not statistically significant. Conclusion The platelet activation function by ADP stimulated was incon-sistent in multiple myeloma and normal group, the platelet activation function was affected in multiple myeloma. In Group B, the platelet activation function was not changed obviously when the platelet from multiple myeloma was diluted by the nor-mal group plasma. It would be that the protein packaged on the platelet surface from multiple myeloma would not be easily removed. But,the platelet activation function of normal group was interfered by the plasma from multiple myeloma. It would affect platelet activation function through the protein adhered on normal platelet surface adhesion protein.