脑梗死急性期血小板超微结构与功能的研究

Platelet ultrastructural and functional studies in patients with acute cerebral infarction

关键词:  脑梗死  血小板  超微结构  GMP-140

Key words:  cerebral infarctions  platelet  ultrastructure  GMP-140

摘要:

探讨脑梗死急性期血小板超微结构改变与功能变化的关系及意义。方法：对大灶脑梗死组22例，小灶脑梗死组25例，对照组20例进行研究，分别于发病后3 d内及2周采静脉血，采用透射电镜观察血小板超微结构，酶联免疫吸附竞争法测定血小板GMP-140、酶联免疫吸附双抗体夹心法测定血浆GMP-140的浓度。结果：发病后3 d内血小板超微结构改变明显，伪足增多，聚集融合成片，α颗粒明显减少，大灶组改变尤为明显。大灶组血小板GMP-140、血浆GMP-140浓度、血小板粘附率(PAdT)、血小板聚集率(PAgT)较对照组非常显著升高(P＜0.001)，小灶组上述指标也较对照组显著升高(P＜0.05)，但较大灶组低。2周后，血小板超微结构大灶组无明显变化，小灶组则明显恢复，2组血小板GMP-140、血浆GPM-140浓度均明显下降，但仍较对照组高，PAdT、PAgT均降至正常。结论：脑梗死急性期血小板功能增强伴明显结构改变；血小板超微结构的改变可以作为判断病情轻重的一个可靠指标；血浆GMP-140浓度比PAdT和PAgT更能准确地反应血小板

Abstract:

Objective:To explore the significance and the relationships between the functions and ultrastructural changes of platelets in patients with acute cerebral infarction. Methods: We investigated 47 patients(large(n=22)and small(n=25)size cerebral infarction groups)and 20 healthy age-and sex-matched control subjects, the vein blood were obtained within 3 days and in 2 week after stroke,the platelet GMP-140 was measured with enzyme-linked immunosorbent assay (ELISA) competitive method and GMP-140 in plasma by two-antibody-sandwich method of ELISA, the changes of platelet ultrastructure was investigated by OLYMPUS BH-2 type transmission electron microscopy. Results: The ultrastructural changes of platelets was significant within 3 days after onset,including more pseudopodium, aggregation and fusion, significantly fewer alpha granules and also mitochondria.The degree of changes of platelets was accord with severity and sizes of cerebral infarctions. The platelet GMP-140,GMP-140 in plasma, PAdT and PAgT in large cerebral infarction group were much higher than control group(P＜0.001), and small group were higher (P＜0.05) than control but lower than large group. The ultrastructural changes of platelets was remained in large size group and got back in small size group in 2 weeks. The platelet GMP-140,GMP-140 in plasma in 2 groups were much lower than before but higher(P＜0.05)than control, the PAdT and PAgT were normal in 2 weeks. Conclusions: These observations showed that the presence of increased platelet functions associated with ultrastructural changes of platelets.The ultrastructural changes of platelets may regarded as an objective index in the judgment of severity and prognosis of cerebral infarctions.The concentration of GMP-140 in plasma can reflect the degree of platelets activities more well and truly than PAdT and PAgT