维持性血液透析患者血小板膜糖蛋白Ibα和相关标志物的表达及意义

Expression and significance of platelet GPIb alpha,CD62P and CD63 in maintenance haemodialysis patients

目的研究维持性血液透析(MHD)患者外周血血小板膜糖蛋白Ibα(GPIbα)、α颗粒膜糖蛋白(CD62P)和溶酶体膜蛋白(CD63)的表达及检测血小板最大聚集率,分析其与健康对照组的差异。方法选取2015年8月至2016年12月期间在中山大学附属第八医院接受MHD的慢性肾衰竭患者49例和体检中心健康人群33例作为研究对象,采用流式细胞术检测MHD患者组和健康对照组外周血血小板膜糖蛋白GPIbα、CD62P和CD63的表达。采用电阻法检测血小板最大聚集率。结果相较于健康对照组,MHD患者组血小板膜糖蛋白GPIbα表达量降低,差异具有统计学意义(P<0.01)。CD62P表达升高,差异无统计学意义(P=0.08)。CD63的表达升高,差异具有统计学意义(P<0.05)。血小板最大聚集率下降,差异具有统计学意义(P<0.01)。MHD患者与健康对照组之间的血小板膜糖蛋白GPIbα、CD63表达和血小板最大聚集率的差异明显。结论MHD患者血小板GPIbα表达下降,血小板最大聚集率降低,血小板聚集功能紊乱激活血小板,而血小板CD63表达升高,血小板进一步活化导致患者高凝状态加剧,可能增加血液透析患者动静脉内瘘血栓形成等事件的发生率。

Objective To explore the differences of platelet membrane glycoprotein Ib alpha（GPIbα）,alpha particle membrane glycoprotein（CD62 P）and lysosomal membrane protein（CD63）in patients with maintenance hemodialysis（MHD）and healthy controls.Methods Forty-nine patients with chronic renal failure given MHD from August 2015 to December 2016 in the Department of Nephrology in Eighth Affiliated Hospital of Sun Yat-sen University and 33 healthy people from the Physical Examination Center were enrolled in this study.We used flow cytomery to test the expression of platelet GPIb alpha,CD62 Pand CD63,and used resistivity method to test the maximal platelet aggregation rate（MAR）.Results The expression of platelet GPIb alpha in MHD group was significantly lower than in healthy group（P〈0.01）.The expression of CD62 Pwas increased in MHD group,but no significant difference was found between two groups（P=0.08）.The expression of CD63 was significantly higher in MHD group than in healthy group（P〈0.05）.The MAR was significantly decreased in MHD group as compared with that in healthy group（P〈0.01）.Conclusions The expression of platelet GPIb alpha and MAR was decreased and CD63 was increased in MHD patients,which resulted in further activation of platelet,and could lead to higher coagulation state.As a result,the probability of arteriovenous fistula thrombus may be greatly increased in MHD patients.