心房颤动患者血小板膜糖蛋白水平及内皮功能改变

Platelet membrane glycoproteins and endothelial cell disturbance in patients with atrial fibrillation

目的 研究心房颤动 (房颤 )患者血小板活化和内皮损伤 ,探讨其临床意义。方法 采用全血法流式细胞术分别测定慢性房颤患者 (35例 )、无房颤组 (19例 )和正常对照组 (17例 )血小板膜上活化糖蛋白Ⅱb/Ⅲa复合物 (glycoproteinⅡb/Ⅲacomplex ,GPⅡb/Ⅲa )和糖蛋白Ⅰb(glycoproteinⅠb ,GPⅠb)水平。房颤患者又根据是否服阿司匹林分为二组 :房颤 1组 (17例 )为未服阿司匹林者 ,房颤 2组 (18例 )为服阿司匹林者。此外 ,用全自动血细胞分析仪测定平均血小板体积 (meanplateletvolume,MPV) ,用酶联免疫吸附法测定血浆血管性血友病因子 (vonWillebrandfactor,vWF)。结果 慢性房颤患者血小板表面活化GPⅡb/Ⅲa水平显著升高 (P <0 0 5 ) ,GPⅠb的水平显著降低 (P <0 0 5 )。此外房颤患者MPV及vWF水平也显著高于心脏病无房颤组及正常对照组 (P <0 0 5 )。以上指标在房颤 1组和房颤 2组之间的差异无显著性 (P >0 0 5 )。vWF水平高于正常的房颤患者活化GPⅡb/Ⅲa水平更高 (P <0 0 5 )。结论 房颤患者存在血小板活性增加和内皮细胞受损 ,这些异常可能与房颤患者心房内血栓形成相关。

Objective To investigate platelet function with special regard to the role of platelet membrane glycoproteins (GPⅡb/Ⅲa,GPⅠb) and endothelial cell disturbance in patients with atrial fibrillation and the clinical significance Methods Thirty five patients with chronic atrial fibrillation were divided into 2 groups based on aspirin therapy, group 1 ( n =17) without and group 2 ( n =18) with aspirin There were two age and sex matched control groups, one of 19 patients in sinus rhythm with cardiovascular disease,the normal sinus rhythm group; the other of 17 healthy subjects, the healthy control group The expression of activated GPⅡb/Ⅲa and GPⅠb on platelet was analyzed with flow cytometry Mean platelet volume (MPV) was measured by automatic hematologic analyzer, the plasma von Willebrand factor (vWF) was assayed using ELISA Results Compared with the healthy control group and the normal sinus rhythm group, platelet in patients with atrial fibrillation was markedly activated indicated by increased expression of activated GPⅡb/Ⅲa ( P <0 05),decreased expression of GPⅠb ( P <0 05) and significant increase of MPV( P <0 05) The plasma level of vWF was also significantly higher ( P <0 05) There were no significant differences in mentioned parameters between group 1 and group 2 ( P >0 05) In atrial fibrillation patients with vWF>150%, the expression of activated GPⅡb/Ⅲa was significantly higher than in those with vWF≤150% ( P <0 05) Conclusions Patients with atrial fibrillation show evidence of platelet activation and endothelial cell disturbance, which may correlate with the atrial thrombogenesis The expression of platelet membrane activated GPⅡb/Ⅲa and GPⅠb and the level of plasma vWF are not affected by low dose aspirin