流式细胞术检测儿童急性白血病血小板活化功能的研究

ASSESSMENT OF PLATELET ACTIVATED FUNCTION IN ACUTE LEUKEMIA BY FLOW CYTOMETRY

建立微量全血血小板活化功能流式细胞术 (FCM)检测方法 ,探讨儿童急性白血病 (AL)不同阶段血小板活化状态及活化功能的变化。利用FCM检测微量全血中血小板活化特异性单克隆抗体CD62P、PAC 1在AL初论未治 ( 2 1例 )、诱导缓解后(CR1、14例 )、及持续完全缓解 (CCR) 2年以上 ( 6例 )患儿血小板表面表达百分比和ADP激活后表达变化 ,并以 16例外科畸形择期手术前患儿作为对照组。结果 ,AL初诊未治和CR1时ADP激活前后血小板CD62P表达均高于对照组 (P <0 0 5 ) ,AL初诊未治ADP激活后血小板PAC 1表达低于对照组 (P <0 0 5 ) ,CCR 2年以上者ADP激活后血小板CD62P 表达高于对照组 (P <0 0 5 )。结果表明 :AL初诊未治时体内血小板活化增强 ,ADP激活后血小板活化功能降低 ;AL缓解后ADP激后ADP激活后血小板活化功能恢复 ,但体内血小板活化状态仍高于对照组 ,CCR 2年以上者ADP激活后血小板活化功能增强。提示血小板功能异常在AL初诊未治时出血的发生中起一定作用。AL时伴有血小板功能异常 ,化疗后血小板活化功能有所恢复。本研究为AL时血小板功能的研究开辟了一种可靠简捷的方法。

To investigate the changes of platelet activated state and p la telet activated function in different stage in children with acute leukemia (AL) by trace whole blood flow cytometry(FCM). Method: To exam the expression percen tage of monoclonal antibodies CD 62P and PAC 1 on platelet surface in trac e whol e blood by FCM, and the changes of these expressions after platelet activated by ADP in patients with AL first diagnose without treatment ( n =21), after i nducing treatment with complete relaxation (CR1, n =14), continuously complet e remission more than 2 years(CCR, n =6), and exam them in children with malf ormation before operation ( n =16) as control group. Result: The expression of CD 62P in first diagnose without treatment group and CR1 group was high er tha n control group, before and after platelet activated by ADP ( P <0 05). The expression of PAC 1 in first diagnose without treatment group was lower than control group after platelet activated by ADP ( P <0 05), The expression of CD 62P in CCR group was higher than control group after platelet activated by AD P ( P <0 05). Conclusion: The platelet activation was increased in the first diagnose without treatment stage, but decreased after platelet activated by ADP. The platelet activated function was restored after activated by ADP in CR1 group, while the activated state was still higher than the control group. The pl atelet activated function was enhanced in CCR group. This suggests that abnormal platelet function may play a role in bleeding in first diagnose without treat ment stage. The platelet function is abnormal in patients with AL, and can be re stored after chemotherapy. Our study provided a simple and reliable means of ass essing platelet function.