不稳定型心绞痛的研究

不稳定型心绞痛临床表现危险,极易发生急性心肌梗塞和猝死。因此了解其发病机理以采取正确的治疗具有重要的临床意义。本文概述近年来不稳定型心绞痛发病机理和治疗的某些进展。

急性肾功能衰竭兔血小板聚集功能、PGI_2、TXA_2、ET的变化

目的:探讨实验性急性肾功能衰竭 (Acuterenalfailure, ARF)兔血小板聚集功能、PGI2、TXA2、内皮素(Endothelins,ET)的变化与心肌组织形态学变化的关系。方法:实验分为 2组。对照组 (8只 ):用生理盐水 10ml/ 行后肢肌肉内加压注射。ARF组(12只):用 50%甘油 10mg/kg后肢肌肉内加压注射。检测各组不同时相血小板聚集功能等指标。结果: 2h、24hARF组与对照组比较:ARF组血小板聚集性明显增高(P<0. 01),TXA2、ET明显升高(P<0. 01), 6 Keto PGF1a明显降低(P<0. 01)。心肌组织出现严重的缺血性损害,主要为:心肌细胞弥漫性变性、心肌纤维间质水肿、血管周围水肿等。结论: ARF时血小板聚集性改变以及血管活性物质和氧自由基增高可能是造成心肌组织缺血性损害的直接原因之一。

Bayesian Joint Modelling of Survival Time and Longitudinal CD4 Cell Counts Using Accelerated Failure Time and Generalized Error Distributions

Survival of HIV/AIDS patients is crucially dependent on comprehensive and targeted medical interventions such as supply of antiretroviral therapy and monitoring disease progression with CD4 T-cell counts. Statistical modelling approaches are helpful towards this goal. This study aims at developing Bayesian joint models with assumed generalized error distribution (GED) for the longitudinal CD4 data and two accelerated failure time distributions, Lognormal and loglogistic, for the survival time of HIV/AIDS patients. Data are obtained from patients under antiretroviral therapy follow-up at Shashemene referral hospital during January 2006-January 2012 and at Bale Robe general hospital during January 2008-March 2015. The Bayesian joint models are defined through latent variables and association parameters and with specified non-informative prior distributions for the model parameters. Simulations are conducted using Gibbs sampler algorithm implemented in the WinBUGS software. The results of the analyses of the two different data sets show that distributions of measurement errors of the longitudinal CD4 variable follow the generalized error distribution with fatter tails than the normal distribution. The Bayesian joint GED loglogistic models fit better to the data sets compared to the lognormal cases. Findings reveal that patients’ health can be improved over time. Compared to the males, female patients gain more CD4 counts. Survival time of a patient is negatively affected by TB infection. Moreover, increase in number of opportunistic infection implies decline of CD4 counts. Patients’ age negatively affects the disease marker with no effects on survival time. Improving weight may improve survival time of patients. Bayesian joint models with GED and AFT distributions are found to be useful in modelling the longitudinal and survival processes. Thus we recommend the generalized error distributions for measurement errors of the longitudinal data under the Bayesian joint modelling. Further studies may investigate the models with various types of shared random effects and more covariates with predictions.

Platelets and depression in cardiovascular disease:A brief review of the current literature

Major depression is an independent risk factor for cardiovascular mortality and morbidity. The exact mechanisms linking depression and increased cardiovascular risk remain poorly understood. Several mechanisms have been proposed including increased platelet reactivity. This review focuses on the current literature that examines the platelet hypothesis of depression. To date studies show increased serotonin response, increased platelet serotonin receptor density, decreased serotonin transporter binding, and decreased platelet serotonin levels in individuals with depression. However other studies have shown no change in serotonin uptake. In addition to platelet serotonin specific pathways, other platelet pathways that have shown significant changes in depressed individuals include blunting of the platelet adenosine response, increased platelet thrombin response, increased glycoprotein Ⅰb expression, increased P-selectin, β thromboglobulin, and platelet factor four, as well as decreased platelet brain derived neurotrophic factor. However there are other studies that show conflicting evidence of increased platelet activation as measured by integrin receptor α2b β3. Other conflictingdata include α adrenergic density and platelet response to augmented serotonin. The direction of future research in platelet functional changes in depression and coronary artery disease should continue to focus on serotonin specific pathways with emphasis on potential mechanisms of specific pathway changes.

Organ transplantation and drug eluting stents:Perioperative challenges

Patients listed for organ transplant frequently have severe coronary artery disease(CAD), which may be treated with drug eluting stents(DES). Everolimus and zotarolimus eluting stents are commonly used. Newer generation biolimus and novolimus eluting biodegradable stents are becoming increasingly popular. Patients undergoing transplant surgery soon after the placement of DES are at increased risk of stent thrombosis(ST) in the perioperative period. Dual antiplatelet therapy(DAPT) with aspirin and a P2Y12 inhibitor such as clopidogrel, prasugrel and ticagrelor is instated post stenting to decrease the incident of ST. Cangrelor has recently been approved by Food and Drug Administration and can be used as a bridging antiplatelet drug. The risk of ischemia vs bleeding must be considered when discontinuing or continuing DAPT for surgery. Though living donor transplant surgery is an elective procedure and can be optimally timed, cadaveric organ availability is unpredictable, therefore, discontinuation of antiplatelet medication cannot be optimally timed. The type of stent and timing of transplant surgery can be of utmost importance. Many platelet function point of care tests such as Light Transmittance Aggregrometry, Thromboelastography Platelet Mapping, VerifyN ow, Multiple Electrode Aggregrometry are used to assess bleeding risk and guide perioperative platelet transfusion. Response to allogenic platelet transfusion to control severe intraoperative bleeding may differ with the antiplatelet drug. In stent thrombosis is an emergency where management with either a drug eluting balloon or a DES has shown superior outcomes. Post-transplant complications often involved stenosis of an important vessel that may need revascularization. DES are now used for endovascular interventions for transplant orthotropic heart CAD, hepatic artery stenosis post liver transplantation, transplant renal artery stenosis following kidney transplantation, etc. Several antiproliferative drugs used in the DES are inhibitors of mammalian target of rapamycin. Thus they are used for post-transplant immunosuppression to prevent acute rejection in recipients with heart, liver, lung and kidney transplantation. This article describes in detail the various perioperative challenges encountered in organ transplantation surgery and patients with drug eluting stents.

Platelets and Alzheimer's disease:Potential of APP as a biomarker

Platelets are the first peripheral source of amyloid precursor protein(APP). They possess the proteolytic machinery to produce Aβ and fragments similar to those produced in neurons, and thus offer an ex-vivo model to study APP processing and changes associated with Alzheimer's disease(AD). Platelet process APP mostly through the α-secretase pathway to release soluble APP(s APP). They produce small amounts of Aβ, predominantly Aβ40 over Aβ42. s APP and Aβ are stored inα-granules and are released upon platelet activation by thrombin and collagen, and agents inducing platelet degranulation. A small proportion of full-length APP is present at the platelet surface and this increases by 3-fold upon platelet activation. Immunoblotting of platelet lysates detects APP as isoforms of 130 kD a and106-110 kD a. The ratio of these of APP isoforms is significantly lower in patients with AD and mild cognitive impairment(MCI) than in healthy controls. This ratio follows a decrease that parallels cognitive decline andcan predict conversion from MCI to AD. Alterations in the levels of α-secretase ADAM10 and in the enzymatic activities of α- and β-secretase observed in platelets of patients with AD are consistent with increased processing through the amyloidogenic pathway. β-APP cleaving enzyme activity is increased by 24% in platelet membranes of patients with MCI and by 17% in those with AD. Reports of changes in platelet APP expression with MCI and AD have been promising so far and merit further investigation as the search for blood biomarkers in AD, in particular at the prodromal stage, remains a priority and a challenge.

异型南五味子丁素、五味子酚和(+)-安五脂素对血小板聚集的影响

目的观察3木脂素类成分:异型南五味子丁素(heteroclitin D,HD)、五味子酚(schisanhenol,SAL)和(+)-安五脂素[(+)-anwulignan,AN]对血小板聚集的影响.方法采用Born比浊法,观察此3种木脂素在0.05～25 mg/L时对腺苷二磷酸(adenosine diphosphate,ADP)和血小板活化因子(platelet activating factor,PAF)诱导的兔血小板1、3、5 min聚集率和最大聚集率以及最大聚集时间的影响.结果①HD和SAL可呈剂量依赖性抑制ADP和PAF诱导的血小板最大聚集率,AN的抑制作用较弱.②对ADP诱导的血小板1、3、5 min聚集率,HD和SAL均可全程稳定抑制,AN 5mg/L在3、5min时有较明显的抑制作用;对PAF诱导的血小板1、3、5 min聚集率,HD在1、3 min时抑制作用较强,SAL在3、5 min时抑制作用较强.③HD、SAL和AN对ADP和PAF诱导的血小板最大聚集时间无明显影响.结论HD、SAL和AN在离体水平可不同程度抑制ADP和PAF诱导的兔血小板聚集.HD的抑制作用最强,可视为南五味子属药用植物的重要活性成分之一.

不同检测系统白细胞计数结果的偏倚评价

目的了解不同检测系统白细胞(WBC)计数结果的偏倚评价。方法分别在7个检测系统(Bayer120,3台CD1700,Coulter,CD3500,Bayer60)检测质控物和55例临床标本的WBC并对数据进行相关的统计学分析。结果不同水平的质控物和不同浓度的患者全血的WBC测定结果在各检测系统间差异均有显著性(P<0.01);各检测系统间的相关系数均大于0.975;可靠性分析除Bayer60外可靠性系数α均接近1;以Bayer120作标准检测系统对其他检测系统作临床可接受性能评价,Coulter临床接受,CD3500,Bayer60临床部分可接受,3台CD1700临床都不接受。结论7个检测系统测定WBC结果精密度符合临床要求,但临床可接受性能评价存在不可比性,需要采取整改措施。

冠心病患者血小板CD62p及GpⅡb/Ⅲa的变化

目的 观察冠心病患者血小板膜P选择素(CD62p)和GpⅡb/Ⅲa(PAC 1)的变化及其临床意义。方法 采用流式细胞术(FCM)三色荧光标记技术检测40例冠心病患者及30名正常人血小板膜CD62p和PAC 1的阳性百分率。结果 冠心病组血小板CD62p[ (27. 6±14. 0)% ]与PAC 1[ (31. 8±16. 7)% ]阳性百分率显著高于对照组[ (3. 1±1. 5)%, (7. 0±1. 8)%,P均<0. 01]。结论 CD62p和PAC 1是血小板活化的敏感和特异指标,全血流式细胞术测血小板功能可用于冠心病的监测和评价抗血小板药物的疗效,监测治疗干预的效果和预测并发症。

Tumor-infiltrating platelets predict postoperative recurrence and survival in resectable pancreatic neuroendocrine tumor

BACKGROUND Platelets have been reported to participate in tumor cell growth,extravasation,epithelial–mesenchymal transition,metastasis,and drug resistance.However,the importance of platelets in pancreatic neuroendocrine tumor(pNET)lacks adequate literature support.The predictive value of tumor-infiltrating platelets(TIPs)in pNET remains unclear.AIM To investigate the relationship between TIPs and the prognosis of patients with pNET following radical resection.METHODS In total,113 patients who had undergone radical surgical resection with a pathologic diagnosis of pNET were enrolled in this study.Immunohistochemical analysis of cluster of differentiation 42b(CD42b)expression in the tumor specimens was performed to determine the presence of TIPs.Univariate and multivariate analyses were used to analyze the prognostic value of TIPs.RESULTS TIPs were observed in intratumoral areas in 54 patients.Neither basic characteristics nor preoperative platelet-associated indicators showed a significant relationship with the presence of TIPs(all P>0.05).Patients with positive intratumoral CD42b expression had worse overall survival(P=0.005)and recurrence-free survival(P<0.001)than those with negative intratumoral CD42b expression.Multivariate analysis demonstrated that TIPs were independent prognostic factors for overall survival(P=0.049)and recurrencefree survival(P=0.003).Nevertheless,platelet count,mean platelet volume,and platelet-to-lymphocyte ratio were not associated with postoperative survival or recurrence in pNET patients(all P>0.05).CONCLUSION TIPs are a useful prognostic biomarker for patients with resectable pNET,and their detection represents a promising tool for pNET treatment strategy decisions.

血小板直方图异常及其相关参数对血小板计数结果的影响

目的提高实验室的检测质量,保证检验结果的准确性。方法用 EDTA.2K 抗凝的血标本,分成四组分别在CD-1600血液分析仪上测定血小板及直方图分析,并同时做显微镜计数血小板并将两法结果进行 T 检验。结果显示小红细胞对血小板计数的影响,要结合 MCV 值和 RDW 来综合考虑当 MCV>65,RDW<20%时,其仪器法与显微镜计数比较 P>0.05,两组结果无明显差异,而当 MCV<65,RDW<20%时血小板计数两组比较 P<0.05,其结果显示有明显差异。结论必须正确分析血小板结果,对于血小板计数应结合直方图及相关参数进行判断分析,并结合临床病史,体征,样本采集过程,排除各种干扰因素进行全面的综合分析,以确保检验结果的准确性。

Unimolecular Dissociation of H⁺<sub style="margin-left:-6px;">2n+1</sub>Hydrogen Clusters: Measured Cross Sections and Theoretically Calculated Rate Constants

In this paper, we studied the process of dissociation unimolecular of the evaporation of H+2n+1 hydrogen clusters according to size, using the Rice-Ramsperger-Kassel-Marcus (RRKM) theory. The rate constants k(E) were determined with the use of statistical theory of unimolecular reactions using various approximations. In our work, we used the products frequencies instead of transitions frequencies in the calculation of unimolecular dissociation rates obtained by three models RRKM. The agreement between the experimental cross section ratio and calculated rate ratio with direct count approximation seems to be reasonable.

再论罪名变更的法理基础及其模式选择——刑事一体化角度的思考

在法院能否变更起诉指控的罪名以及如何变更起诉指控罪名的问题上,一些国家和地区存在着立法上的差别和理论上的分野。我国目前在程序设计上对法院的罪名变更权缺乏制约,理论界提出的种种改革方案也都值得商榷。我国罪名变更制度的建构,应当立足于我国特有的法文化传承和法治土壤,应当建立以四要件犯罪构成模式为基石并与诉因制度相整合的“诉因制度本土化”模式。

Human platelets inhibit liver fibrosis in severe combined immunodeficiency mice

AIM:To investigate the role of human platelets in liver fibrosis.METHODS:Severe combined immunodeficiency(SCID)mice were administered CCl4and either phosphate-buffered saline(PBS group)or human platelet transfusions(hPLT group).Concentrations of hepatocyte growth factor(HGF),matrix metallopeptidases(MMP)-9,and transforming growth factor-β(TGF-β)in the liver tissue were compared between the PBS and the hPLT groups by enzyme-linked immunosorbent assay(ELISA)and Western blotting.The effects of a human platelet transfusion on liver fibrosis included the fibrotic area,hydroxyproline content,and-smooth muscle actin(α-SMA)expression,which were evaluated by picrosirius red staining,ELISA,and immunohistochemical staining using an anti-mouse-SMA antibody,respectively.Phosphorylations of mesenchymal-epithelial transition factor(Met)and SMAD3,downstream signals of HGF and TGF-β,were compared between the two groups by Western blotting and were quantified using densitometry.Hepatocyte apoptosis was evaluated by terminal deoxynucleotidyl transferase dUTP nick end labeling.Furthermore,the accumulation of human platelets in the liver 2 h after platelet transfusion was compared between normal and fibrotic livers by immunohistochemical staining using an anti-human CD41 antibody.RESULTS:The fibrotic area and hydroxyproline content in the liver were both significantly lower in the hPLT group when compared to the PBS group(fibrotic area,1.7%±0.6%vs 2.5%±0.6%,P=0.03;hydroxyproline content,121±26 ng/g liver vs 156±47 ng/g liver,P=0.04).There was less α-smooth muscle actin staining in the hPLT group than in the PBS group(0.5%±0.1%vs 0.8%±0.3%,P=0.02).Hepatic expression levels of mouse HGF and MMP-9were significantly higher in the hPLT group than in the PBS group(HGF,109±13 ng/g liver vs 88±22 ng/g liver,P=0.03;MMP-9,113%±7%/GAPDH vs 92%±11%/GAPDH,P=0.04).In contrast,the concentration of mouse TGF-β in the liver tissue was significantly lower in the hPLT group than in the PBS group(22±5ng/g liver vs 39±6 ng/g liver,P=0.02).Phosphorylation of Met was more prevalent in the hPLT group than in the PBS group(37%±4%/GAPDH vs 20%±8%/GAPDH,P=0.03).Phosphorylation of SMAD3was weaker in the hPLT group than in the PBS group(60%±12%/GAPDH vs 84%±12%/GAPDH,P=0.1),although this difference was not significant.Furthermore,a lower rate of hepatocyte apoptosis was observed in the hPLT group than in the PBS group(5.9%±1.7%vs 2.9%±2.1%,P=0.02).Significant human platelet accumulation was observed in the fibrotic liver tissues,whereas few platelets accumulated in the normal liver.CONCLUSION:Human platelets inhibit liver fibrosis in SCID mice.Increased concentration of HGF in the liver suppresses hepatic stellate cell activation,induces MMPs,and inhibits hepatocyte apoptosis.

糖耐量减低患者颈动脉内膜中层厚度与血小板活化的关系

目的:观察糖耐量减低患者(IGT)血小板活化和颈动脉内膜中层厚度的变化,以探讨两者的相关性。方法:选择76 例IGT患者,测定其血小板α颗粒膜蛋白(GMP 140)的变化。同时应用高频超声测量颈动脉内膜中层厚度(IMT)。取35 例查体健康者为对照组,进行对比分析。比较IGT组患者IMT<0.9mm组和IMT≥0.9mm组患者血小板GMP 140 的变化,以及75g糖负荷后对血小板活化的影响。结果:IGT组血小板GMP 140 水平和IMT较正常对照组显著增加(P<0.01)。在IGT患者中,IMT≥0.9mm组较IMT<0.9mm组血小板GMP 140 升高更明显(P<0.01)。75 g糖负荷后可显著升高IGT组血小板GMP 140水平(P<0.01),且IMT≥0.9mm组升高更显著(P<0.01)。相关分析表明血小板GMP 140 与IMT之间显著正相关。多因素逐步线性回归分析表明,血小板GMP 140 是影响IMT的独立危险因素。结论:IGT患者存在血小板活化增强和颈动脉内膜中层厚度增加。糖负荷后可显著增加血小板活化程度。血小板活化是IMT增加的独立危险因素。

醛糖还原酶(AR)基因对大鼠肾系膜细胞的转染及AR抑制剂对其增殖的影响

目的观察醛糖还原酶(AR)基因转染及AR抑制剂(ARI)对体外培养大鼠肾系膜细胞(MsC)增殖的影响。方法应用Westernblot检测转基因MsC及PDGF作用MsC后AR的表达。四唑蓝比色法(MTT法)检测细胞增殖,流式细胞术分析细胞周期,对比大鼠正常MsC和转基因MsC的生长情况,并观察ARI———Sorbinil和Zopolrestat对血小板源性生长因子(PDGF)和小牛血清(NBS)促细胞增殖作用的影响。结果①Westernblot鉴定转基因MsCAR表达较正常MsC明显增高;②转染组较正常组生长速度快;③PDGF作用MsC后可上调AR的表达;④PDGF和10%NBS均可显著刺激两组细胞的增殖,ARI可部分抑制PDGF对正常组和转染组的促增殖作用,对10%NBS,ARI可部分抑制其对转染组的促增殖作用,而对正常组无显著影响,抑制作用呈剂量依赖性。结论AR可能参与了MsC在病理状况下的过度增殖过程。

血小板聚集功能生物参考区间验证

目的对血小板聚集仪CHRONO-LOG CA 560的生物参考区间进行验证,以保证其适用于临床。方法按美国临床实验室标准化委员会NCCLS C28-A2推荐的方法,验证项目选择健康参考个体20例,用仪器CHRONO-LOGCA 560血小板聚集仪进行检测。结果 20例健康个体数据中,以胶原作为聚集剂95%结果符合厂家提供的生物参考区间,而另外两个聚集剂二磷酸酰苷(ADP)和肾上腺素的结果则100%符合该生物参考区间。结论原厂家提供的生物区间适用于广东省地区人群,可供使用。实验验证简单易行,容易发现生物参考区间的偏离,值得建立完善的验证制度和程序,并推广应用。

皮瓣缺血再灌注损伤的发病机制及治疗进展

背景:皮瓣移植技术是治疗严重组织缺损的常用外科手术方式,但术后因缺血再灌注损伤容易引发皮瓣坏死,因此提高移植皮瓣的存活率仍是目前重要的研究课题。目的:综述皮瓣缺血再灌注损伤的发病机制及最新治疗进展。方法:检索CNKI、万方和PubMed数据库中2014-2024年发表的相关文献,中文检索词为“皮瓣,缺血再灌注损伤,炎症反应,氧化应激反应,Ca^(2+)超载,细胞凋亡,间充质干细胞,富血小板血浆,信号通路,冲击波,预处理”,英文检索词为“flap,ischemia-reperfusion injury,inflammatory response,oxidative stress,Ca^(2+)overload,apoptosis,mesenchymal stem cells,platelet-rich plasma,signaling pathways,Shock wave,Pretreatment”。通过阅读文章剔除研究内容与文章主题关系不大、质量较差及内容陈旧文献,最终纳入77篇文献进行归纳总结。结果与结论:皮瓣缺血再灌注损伤损伤可能与炎症反应、氧化应激反应、Ca^(2+)超载、细胞凋亡等病理因素有关,引起皮瓣血管内皮细胞凋亡、血管损伤和微循环障碍,最终导致皮瓣坏死。研究发现,间充质干细胞移植、富血小板血浆、信号通路调节剂、冲击波及预处理等治疗方法均可以从不同方向在不同程度上缓解皮瓣缺血再灌注损伤,降低移植皮瓣的坏死率和坏死面积。关于皮瓣缺血再灌注损伤的治疗方法虽然很多,然而临床还未形成统一有效的治疗方法,各种治疗方法的优缺点也未进行对比研究,并且大部分研究都停留在动物实验阶段,临床观察研究甚少,因此未来还需要进行大量研究,逐步由动物实验向临床迈进,以便更好地为临床服务。

树鼩脑局部血栓性缺血的扩布性抑制机制探讨

目的:观察树鼩血栓性脑缺血时,对侧神经元血小板活化因子(PAF)受体活化和神经元线粒体呼吸功能改变,探讨皮层扩布性抑制的可能机制。方法:采用光化学法诱导脑血栓形成,分别观察脑缺血对侧神经元超微结构、脑细胞膜PAF受体、单胺氧化酶(MAO)活性、单胺类递质含量以及神经元线粒体呼吸功能。结果:树鼩脑缺血时对侧皮层淤血,神经元线粒体肿胀;脑缺血4h对侧神经元PAF受体亲和量降低,其变化以24 h最为显著(P<0.01);缺血区线粒体Ⅲ态呼吸速率、呼吸控制率(RCR)及氧化磷酸化效率(P/O)均明显降低;缺血对侧皮层的P/O降低(P<0.05),Ⅲ态呼吸速率明显抑制(P<0.01);伴随着对侧脑组织MAO活性的升高(P<0.01),对侧皮层的去甲肾上腺素(NA)和5-羟色胺(5-HT)含量降低而5-羟吲哚乙酸(5-HIAA)含量明显升高(P<0.01)。结论:树鼩脑缺血时对侧皮层神经元PAF受体的活化以及MAO活性的增强可能在扩布性抑制的发生中具有重要作用。

富血小板血浆来源的血小板细胞外囊泡分离技术与应用

背景:血小板细胞外囊泡是循环中最丰富的囊泡,富含丰富的生物活性分子、遗传物质及蛋白质等信息分子,参与细胞通讯和物质交换,不仅具有良好的促凝活性,还具有促进组织修复和再生的巨大潜力,在再生医学具有广泛的应用前景。目的:从血小板细胞外囊泡的分泌机制、在再生医学领域的应用及临床转化的限制因素进行阐述,为血小板细胞外囊泡的临床转化提供一些理论支撑。方法:应用计算机检索2005年1月至2023年8月PubMed数据库与血小板细胞外囊泡有关的文章,英文检索词为“platelet-derived,plateletrich plasma,extracellular vesicles,isolated,microvesicles exosomes,applications”,最后纳入符合主题标准的文献62篇进行综述分析。结果与结论:(1)活化的血小板细胞外囊泡可产生血小板微囊泡和血小板外泌体两种类型的囊泡,前者的分泌可能与肌动蛋白细胞骨架的不对称性相关,后者的分泌可能与H^(+)-ATP酶的调节相关。(2)血小板细胞外囊泡是血小板浓缩物和血小板本身的潜在效应物,可能通过促进血管生成、影响细胞行为、促凝与止血以及发挥炎症作用等几方面影响组织再生。(3)血小板细胞外囊泡在组织损伤、肌肉再生、软骨再生、骨关节炎等再生医学领域已有临床前报道,作为伤口愈合的潜在治疗方法已有临床试验数据,但血小板细胞外囊泡的分离方法、样本来源以及激活剂的种类等因素限制了血小板细胞外囊泡在再生医学领域的临床转化。(4)未来血小板细胞外囊泡可能成为再生医学中替代富血小板血浆的无细胞疗法,其临床转化还需要积极寻找鉴别血小板细胞外囊泡和血小板外泌体的特异性标志物,在激活剂刺激血小板细胞外囊泡产生的机制以及血小板细胞外囊泡的最佳收集方式、最佳储存方法、保质期限、临床应用的推荐剂量和最佳临床适应证还需要继续深入研究。