慢性特发性血小板减少性紫癜患者血小板止凝血功能研究

Study on the hemostasis and procoagulation of platelets in patients with chronic idiopathic thrombocytopenic purpura

目的:观察慢性特发性血小板减少性紫癜(idiopathic thrombocytopenic purpura,ITP)患者血小板活化、聚集和促凝血功能的变化。方法:选取汕头大学医学院第二附属医院确诊的40例慢性ITP患者和40例体检健康志愿者(健康对照)作为研究对象,抽取外周静脉血,分离血小板。采用流式细胞学方法检测血小板表达CD62P和CD63的情况。分别以二磷酸腺苷(adenosine diphosphate,ADP)、凝血酶和胶原作为诱聚剂,检测血小板的聚集率。采用凝血法检测血小板的促血浆凝固时间。结果:流式细胞学检测显示,慢性ITP患者表达CD62P的血小板百分率为(36.15±1.05)%,明显高于健康对照者[(6.61±0.41)%,P <0.01];慢性ITP患者表达CD63的血小板百分率为(25.88±1.52)%,亦显著高于健康对照者[(3.25±0.25)%,P <0.01]。以ADP为诱聚剂,慢性ITP患者血小板的聚集率为(89.8±5.8)%,明显高于健康对照者[(61.8±2.3)%,P <0.01];以凝血酶为诱聚剂,慢性ITP患者血小板的聚集率为(84.5±4.5)%,显著高于健康对照者[(63.7±3.5)%,P <0.01];以胶原为诱聚剂,慢性ITP患者血小板的聚集率为(79.3±2.7)%,明显高于健康对照者[(53.6±3.1)%,P <0.01]。慢性ITP患者血小板的促血浆凝固时间为(56.8±6.8) s,显著短于健康对照者[(87.2±0.6) s,P <0.01]。结论:慢性ITP患者的血小板呈活化状态,其聚集和促凝血功能增强。

Objective:The purpose of the study is to analyze the activation,aggregation and procoagulation of platelets in patients with chronic idiopathic thrombocytopenic purpura(ITP).Methods:40 patients diagnosed with chronic ITP and 40 healthy volunteers(controls)in the Second Affiliated Hospital of Shantou University Medical College were enrolled in the study.Peripheral blood samples were collected and platelets were isolated.CD62P and CD63 on platelets were detected by using flow cytometry.Platelets aggregation rate was determined with adenosine diphosphate(ADP),thrombin and collagen as aggregation inducers respectively.Activated platelet induced plasma clotting time(aPIPCT)was determined by using coagulation test.Results:Flow cytometry showed that percentage of platelets expressing CD62P in patients with chronic ITP was(36.15±1.05)%,which was much higher than that in healthy volunteers[(6.61±0.41)%](P<0.01).The percentage of platelets expressing CD63 in patients with chronic ITP was(25.88±1.52)%,which was obviously higher than that in healthy volunteers[(3.25±0.25)%](P<0.01).With ADP as an aggregation inducer,the aggregation rate of platelets in patients with chronic ITP was(89.8±5.8)%,which was higher than that in healthy volunteers(61.8±2.3)%(P<0.01).With thrombin as an aggregation inducer,the aggregation rate of platelets in patients with chronic ITP was(84.5±4.5)%,which was also higher than that in healthy volunteers(63.7±3.5)%(P<0.01).With collagen as aggregative inducer,the aggregation rate of platelets in patients with chronic ITP was(79.3±2.7)%,which was higher than that in healthy volunteers(53.6±3.1)%(P<0.01).Activated platelet induced plasma clotting time in chronic ITP patients was(56.8±6.8)s,which was obviously shorter than that in healthy volunteers(87.2±0.6)s(P<0.01).Conclusion:Platelets in chronic ITP patients are activated and show enhanced aggregation and procoagulant properties.