兒童原發(fā)性免疫性血小板減少癥血小板參數(shù)及膜糖蛋白的研究
發(fā)布時(shí)間：2018-11-20 14:09
【摘要】：目的:原發(fā)性免疫性血小板減少癥(ITP)是一種兒童常見(jiàn)的出血性疾病,其機(jī)制主要是因自身免疫功能紊亂導(dǎo)致血小板減少,臨床主要表現(xiàn)為皮膚黏膜的散在瘀點(diǎn)、瘀斑,目前對(duì)ITP是否需要常規(guī)行骨髓穿刺進(jìn)行診斷仍存在爭(zhēng)議,對(duì)其血小板功能變化的研究也很少,本研究旨在通過(guò)檢測(cè)血小板相關(guān)參數(shù)及膜糖蛋白的變化推測(cè)其功能狀態(tài),為ITP的診斷、病程演變及療效判斷提供依據(jù)。方法:選取18例ITP初發(fā)患者為實(shí)驗(yàn)組,并將實(shí)驗(yàn)組分為ITP組(治療前)及ITP-CR組(ITP治療完全反應(yīng)組),同期本院兒外科17例擇期手術(shù)患者為正常對(duì)照組,應(yīng)用流式細(xì)胞術(shù)(FCM)微量全血法檢測(cè)各組血小板膜糖蛋白(CD62P、PAC-1、CD42b)的百分率及平均熒光強(qiáng)度、網(wǎng)織血小板百分率(IPF%)、網(wǎng)織血小板絕對(duì)計(jì)數(shù)(IPC),全自動(dòng)血細(xì)胞分析儀得出血小板相關(guān)參數(shù)(PLT、MPV、PDW、P-LCR、PCT),應(yīng)用spss17軟件進(jìn)行統(tǒng)計(jì)分析。結(jié)果:(1)ITP組PLT、PCT均低于ITP-CR組和正常對(duì)照組(P㩳0.05),MPV、PDW、P-LCR均高于ITP-CR組和正常對(duì)照組(P㩳0.05),ITP-CR組與正常對(duì)照組比較,MPV、PDW、PCT、P-LCR無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),而PLT降低(P㩳0.05)。(2)ITP組IPF%高于ITP-CR組和正常對(duì)照組(P㩳0.05),IPC低于ITP-CR組和正常對(duì)照組(P㩳0.05),ITP-CR組與正常對(duì)照組比較,IPF%升高,差異有統(tǒng)計(jì)學(xué)意義(P㩳0.05),而IPC降低,但差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。(3)ADP激活前,ITP組CD62p、PAC-1、CD42b表達(dá)均低于ITP-CR組與正常對(duì)照組(P㩳0.05),ITP-CR組與正常對(duì)照組比較,PAC-1表達(dá)降低(P㩳0.05),CD62P、CD42b的表達(dá)差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),ADP激活后,ITP組CD62p、PAC-1、CD42b表達(dá)均低于ITP-CR組與正常對(duì)照組(P㩳0.05),ITP-CR組與正常對(duì)照組比較,PAC-1表達(dá)降低(P㩳0.05),CD62p表達(dá)升高(P㩳0.05),而CD42b的表達(dá)差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。(4)ADP激活前,ITP組PAC-1和CD42b平均熒光強(qiáng)度的表達(dá)低于ITP-CR組和正常對(duì)照組(P0.05),ITP-CR組PAC-1、CD42b平均熒光強(qiáng)度的表達(dá)與正常對(duì)照組無(wú)顯著差異(P0.05);CD62P平均熒光強(qiáng)度的表達(dá)在三組間比較無(wú)顯著差異(P0.05);ADP激活后,ITP組PAC-1、CD62p和CD42b平均熒光強(qiáng)度的表達(dá)均低于ITP-CR組和正常對(duì)照組(P0.05);ITP-CR組與正常對(duì)照組比較,CD62P平均熒光強(qiáng)度的表達(dá)升高(P0.05),PAC-1、CD42b平均熒光強(qiáng)度的表達(dá)無(wú)明顯差異(P0.05)。結(jié)論:(1)ITP初診患兒外周血血小板體內(nèi)外均處于低活化狀態(tài),存在血小板功能異常,提示ITP患兒出血原因不僅與血小板數(shù)量減少有關(guān),還可能與血小板自身功能不足有關(guān)。(2)血小板參數(shù)及血小板膜糖蛋白,可作為判斷ITP患兒療效的有效指標(biāo)。
[Abstract]:Objective: primary immune thrombocytopenia (ITP) is a common hemorrhagic disease in children. At present, it is still controversial whether ITP needs to be diagnosed by routine bone marrow puncture, and there are few studies on the changes of platelet function. The purpose of this study is to speculate the functional status of ITP by detecting platelet related parameters and the changes of membrane glycoprotein (MGP). To provide the basis for the diagnosis, the course evolution and the curative effect judgment of ITP. Methods: eighteen patients with ITP were selected as experimental group. The experimental group was divided into ITP group (before treatment) and ITP-CR group (ITP complete response group). The percentage and average fluorescence intensity of platelet membrane glycoprotein (CD62P,PAC-1,CD42b), reticulocyte percentage (IPF%) and reticulocyte absolute count (IPC),) were determined by flow cytometry (FCM) microanalysis of whole blood in each group. Platelet related parameters (PLT,MPV,PDW,P-LCR,PCT) were obtained by automatic blood cell analyzer and analyzed by spss17 software. Results: (1) PLT,PCT in ITP group was lower than that in ITP-CR group and normal control group (P0. 05), MPV,PDW,P-LCR was higher in ITP-CR group and normal control group (P0. 05), MPV,PDW, in ITP-CR group was higher than that in normal control group (P0. 05). There was no significant difference in PCT,P-LCR (P0.05), but PLT decreased (P0. 05). (2) in ITP group was higher than that in ITP-CR group and normal control group (P0. 05), IPC was lower than that in ITP-CR group and normal control group (P0. 05). IPF% in ITP-CR group was significantly higher than that in normal control group (P0. 05), but IPC was decreased, but there was no significant difference before ADP activation (P0.05). (3). CD62p,PAC-1, in ITP group was significantly higher than that in control group (P0. 05). The expression of CD42b in ITP-CR group was lower than that in normal control group (P0. 05). The expression of PAC-1 in ITP-CR group was lower than that in normal control group (p0. 05). There was no significant difference in the expression of CD62P,CD42b (P0.05 after), ADP activation). The expression of CD62p,PAC-1,CD42b in ITP group was lower than that in ITP-CR group and normal control group (P0. 05). Compared with normal control group, the expression of PAC-1 in ITP-CR group was lower than that in normal control group (P0. 05), and the expression of CD62p was increased (P0. 05). However, there was no significant difference in the expression of CD42b (P0.05). (4) before the activation of ADP, the average fluorescence intensity of PAC-1 and CD42b in ITP group was lower than that in ITP-CR group and normal control group (P0.05), PAC-1, in ITP-CR group was lower than that in ITP-CR group (P0.05). There was no significant difference in the average fluorescence intensity of CD42b between the control group and the control group (P0.05). There was no significant difference in the expression of average fluorescence intensity of CD62P between the three groups (P0.05 after); ADP activation, the average fluorescence intensity of PAC-1,CD62p and CD42b in ITP group was lower than that in ITP-CR group and normal control group (P0.05). The average fluorescence intensity of CD62P in ITP-CR group was higher than that in normal control group (P0.05), but there was no significant difference in the expression of average fluorescence intensity of PAC-1,CD42b in ITP-CR group (P0.05). Conclusion: (1) Peripheral blood platelets in patients with ITP are in low activation state in vivo and in vitro, and platelet function is abnormal. It is suggested that the causes of hemorrhage in children with ITP are not only associated with thrombocytopenia. (2) Platelet parameters and platelet membrane glycoprotein can be used as an effective index to judge the curative effect of ITP.
【學(xué)位授予單位】：四川醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R725.5
本文編號(hào)：2345123
[Abstract]:Objective: primary immune thrombocytopenia (ITP) is a common hemorrhagic disease in children. At present, it is still controversial whether ITP needs to be diagnosed by routine bone marrow puncture, and there are few studies on the changes of platelet function. The purpose of this study is to speculate the functional status of ITP by detecting platelet related parameters and the changes of membrane glycoprotein (MGP). To provide the basis for the diagnosis, the course evolution and the curative effect judgment of ITP. Methods: eighteen patients with ITP were selected as experimental group. The experimental group was divided into ITP group (before treatment) and ITP-CR group (ITP complete response group). The percentage and average fluorescence intensity of platelet membrane glycoprotein (CD62P,PAC-1,CD42b), reticulocyte percentage (IPF%) and reticulocyte absolute count (IPC),) were determined by flow cytometry (FCM) microanalysis of whole blood in each group. Platelet related parameters (PLT,MPV,PDW,P-LCR,PCT) were obtained by automatic blood cell analyzer and analyzed by spss17 software. Results: (1) PLT,PCT in ITP group was lower than that in ITP-CR group and normal control group (P0. 05), MPV,PDW,P-LCR was higher in ITP-CR group and normal control group (P0. 05), MPV,PDW, in ITP-CR group was higher than that in normal control group (P0. 05). There was no significant difference in PCT,P-LCR (P0.05), but PLT decreased (P0. 05). (2) in ITP group was higher than that in ITP-CR group and normal control group (P0. 05), IPC was lower than that in ITP-CR group and normal control group (P0. 05). IPF% in ITP-CR group was significantly higher than that in normal control group (P0. 05), but IPC was decreased, but there was no significant difference before ADP activation (P0.05). (3). CD62p,PAC-1, in ITP group was significantly higher than that in control group (P0. 05). The expression of CD42b in ITP-CR group was lower than that in normal control group (P0. 05). The expression of PAC-1 in ITP-CR group was lower than that in normal control group (p0. 05). There was no significant difference in the expression of CD62P,CD42b (P0.05 after), ADP activation). The expression of CD62p,PAC-1,CD42b in ITP group was lower than that in ITP-CR group and normal control group (P0. 05). Compared with normal control group, the expression of PAC-1 in ITP-CR group was lower than that in normal control group (P0. 05), and the expression of CD62p was increased (P0. 05). However, there was no significant difference in the expression of CD42b (P0.05). (4) before the activation of ADP, the average fluorescence intensity of PAC-1 and CD42b in ITP group was lower than that in ITP-CR group and normal control group (P0.05), PAC-1, in ITP-CR group was lower than that in ITP-CR group (P0.05). There was no significant difference in the average fluorescence intensity of CD42b between the control group and the control group (P0.05). There was no significant difference in the expression of average fluorescence intensity of CD62P between the three groups (P0.05 after); ADP activation, the average fluorescence intensity of PAC-1,CD62p and CD42b in ITP group was lower than that in ITP-CR group and normal control group (P0.05). The average fluorescence intensity of CD62P in ITP-CR group was higher than that in normal control group (P0.05), but there was no significant difference in the expression of average fluorescence intensity of PAC-1,CD42b in ITP-CR group (P0.05). Conclusion: (1) Peripheral blood platelets in patients with ITP are in low activation state in vivo and in vitro, and platelet function is abnormal. It is suggested that the causes of hemorrhage in children with ITP are not only associated with thrombocytopenia. (2) Platelet parameters and platelet membrane glycoprotein can be used as an effective index to judge the curative effect of ITP.
【學(xué)位授予單位】：四川醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R725.5
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