脑梗死急性期患者血小板活化因子及其超微结构分析

Analysis of platelet activation factor and ultrastructure in patients with acute cerebral infarction

目的：探讨脑梗死急性期患者血小板超微结构和血小板活化因子的表达及意义。方法选择发病在6～24 h 脑梗死患者40例为观察组，选取同期健康成年人20例为对照组，观察组第1～7天给予阿司匹林肠溶片300 mg，1次／d，第8～14天给予阿司匹林肠溶片100 mg，1次／d，对照组健康者及观察组治疗前及治疗第1、7、14天分别釆用透射电镜观察血小板超微结构；于第1、14天采用全自动血细胞分析仪检测血小板平均体积（MPV）、血小板计数（PLT）、血小板体积分布宽度（PDW）；于第1、2、3、7、14天酶联免疫吸附双抗夹心法试验测定血小板活化因子（PAF）的浓度。结果治疗前观察组外周血 MPV、PDW、PAF 分别为（9．22±1．30）fL、（17．89±1．23）％、（211．31±11．22）pg／mL，均显著性高于对照组的（8．68±1．03）fL、（16．06±1．03）％、（155．49±8．70）pg／mL（t ＝2．082、2．563、14．401，均 P ＜0．05），观察组 PLT[（173．22±63．40）×10^9／L]显著低于对照组[（231．22±56．76）×10^9／L]（t ＝3．048，P ＜0．05）；治疗后急性脑梗死患者的外周血 MPV、PDW 分别为（8．43±1．28）fL、（16．11±1．11）％，与治疗前[（9．22±1．30）fL、（17．89±1．23）％]相比，均显著降低（t ＝1．937、3．320，均 P ＜0．05），而治疗后 PLT 为（195．33±61．45）×10^9／L，与治疗前[（173．22±63．40）×10^9／L]比较显著升高（t ＝1．915，P ＜0．05）。PAF 在治疗第3天为（240．12±13．78）pg／mL 达高峰，7 d 后为（215．33±16．43）pg／mL 逐渐下降，14 d 后 PAF 水平（170．27±11．40）pg／mL，与治疗前的（211．31±11．22）pg／mL 相比显著下降，差异有统计学意义（t ＝16．24，P ＜0．05）。治疗前观察组患者血小板形态不规则，伪足增多，多处可见血小板聚集、融合在一起；治疗后14 d 血小板超微结构明显恢复。结论治疗前后监测脑梗死急性期患者外周血的 MPV、PDW、PAF 及 PLT 对于疾病的诊断和治疗均有着重要的临床价值。

Objective To discuss the expression and significance of platelet ultrastructure and platelet acti-vating factor（PAF）relationship in patients with acute cerebral infarction.Methods 40 patients with cerebral infarc-tion were chosen onset in 6-24 hours as the observation group,while at the same time 20 cases of healthy adults were selected as the control group.The observation group was given 1-7d of aspirin enteric-coated metformin hydrochloride 300mg,qd,and 8-14d had worship of aspirin enteric-coated metformin hydrochloride 100mg,qd.And before and 1,7, 14 days after treatment,control group and observation group respectively preclude the use of transmission electron microscopy ultrastructure of platelets,before and 1,14 days after treatment automatic blood cell analyzer test was used to analyze the average platelet volume （MPV）,platelet count （PLT）,platelet volume distribution width （PDW）of the two groups.And 1,2,3,7,14 days after treatment,enzyme-linked immunosorbent determination of double clamp method was used to test the concentration of PAF.Results Before treatment,MPV,PDW and PAF in peripheral blood of the observation group were （9.22 ±1.30）fL,（17.89 ±1.23）%,（211.31 ±11.22）pg/mL,which were sig-nificantly higher than those of the control group （8.68 ±1.03）fL,（16.06 ±1.03）%,（155.49 ±8.70）pg/mL（t =2.082,2.563,14.401,all P 〈0.05）,while PLT was （173.22 ±63.40）×10^9 /L,which was significantly lower than that in the control group （231.22 ±56.76）×10^9 /L（t =3.048,P 〈0.05）.After treatment in patients with acute cer-ebral infarction,the MPV,PDW of peripheral blood were （8.43 ±1.28）fL,（16.66 ±1.11）%,which were signifi-cantly lower than before treatment （9.22 ±1.30）fL,（17.89 ±1.23）% （t =1.937,3.320,all P 〈0.05）,while PLT （195.33 ±61.45）×10^9 /L was significantly higher than before treatment （173.22 ±63.40）×10^9 /L（t =1.915, P 〈0.05）.PAF peaked in the treatment of 3 days,which was （240.12 ±13.78）pg/mL,and gradually declined after 7 days,which was （215.33 ±16.43）pg/mL,and that after 14 days was（170.27 ±11.40）pg/mL,compared with before treatment （211.31 ±11.22）pg/mL,the difference was statistically significant （t =16.24,P 〈0.05）.Before treatment,platelet shape had irregular,increased pseudopodia,several visible platelet aggregation,and was blend together.And after 14 days treatment in the observation group,platelet ultrastructure greatly recovered.Conclusion Monitoring of MPV,PDW,PAF and PLT in peripheral blood of patients with acute cerebral infarction before and after treatment has important clinical value for disease diagnosis and treatment.