儿童原发性免疫性血小板减少症血小板参数及膜糖蛋白的研究
发布时间：2018-11-20 14:09
【摘要】：目的:原发性免疫性血小板减少症(ITP)是一种儿童常见的出血性疾病,其机制主要是因自身免疫功能紊乱导致血小板减少,临床主要表现为皮肤黏膜的散在瘀点、瘀斑,目前对ITP是否需要常规行骨髓穿刺进行诊断仍存在争议,对其血小板功能变化的研究也很少,本研究旨在通过检测血小板相关参数及膜糖蛋白的变化推测其功能状态,为ITP的诊断、病程演变及疗效判断提供依据。方法:选取18例ITP初发患者为实验组,并将实验组分为ITP组(治疗前)及ITP-CR组(ITP治疗完全反应组),同期本院儿外科17例择期手术患者为正常对照组,应用流式细胞术(FCM)微量全血法检测各组血小板膜糖蛋白(CD62P、PAC-1、CD42b)的百分率及平均荧光强度、网织血小板百分率(IPF%)、网织血小板绝对计数(IPC),全自动血细胞分析仪得出血小板相关参数(PLT、MPV、PDW、P-LCR、PCT),应用spss17软件进行统计分析。结果:(1)ITP组PLT、PCT均低于ITP-CR组和正常对照组(P㩳0.05),MPV、PDW、P-LCR均高于ITP-CR组和正常对照组(P㩳0.05),ITP-CR组与正常对照组比较,MPV、PDW、PCT、P-LCR无统计学意义(P0.05),而PLT降低(P㩳0.05)。(2)ITP组IPF%高于ITP-CR组和正常对照组(P㩳0.05),IPC低于ITP-CR组和正常对照组(P㩳0.05),ITP-CR组与正常对照组比较,IPF%升高,差异有统计学意义(P㩳0.05),而IPC降低,但差异无统计学意义(P0.05)。(3)ADP激活前,ITP组CD62p、PAC-1、CD42b表达均低于ITP-CR组与正常对照组(P㩳0.05),ITP-CR组与正常对照组比较,PAC-1表达降低(P㩳0.05),CD62P、CD42b的表达差异无统计学意义(P0.05),ADP激活后,ITP组CD62p、PAC-1、CD42b表达均低于ITP-CR组与正常对照组(P㩳0.05),ITP-CR组与正常对照组比较,PAC-1表达降低(P㩳0.05),CD62p表达升高(P㩳0.05),而CD42b的表达差异无统计学意义(P0.05)。(4)ADP激活前,ITP组PAC-1和CD42b平均荧光强度的表达低于ITP-CR组和正常对照组(P0.05),ITP-CR组PAC-1、CD42b平均荧光强度的表达与正常对照组无显著差异(P0.05);CD62P平均荧光强度的表达在三组间比较无显著差异(P0.05);ADP激活后,ITP组PAC-1、CD62p和CD42b平均荧光强度的表达均低于ITP-CR组和正常对照组(P0.05);ITP-CR组与正常对照组比较,CD62P平均荧光强度的表达升高(P0.05),PAC-1、CD42b平均荧光强度的表达无明显差异(P0.05)。结论:(1)ITP初诊患儿外周血血小板体内外均处于低活化状态,存在血小板功能异常,提示ITP患儿出血原因不仅与血小板数量减少有关,还可能与血小板自身功能不足有关。(2)血小板参数及血小板膜糖蛋白,可作为判断ITP患儿疗效的有效指标。
[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.
【学位授予单位】：四川医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R725.5
本文编号：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.
【学位授予单位】：四川医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R725.5
【参考文献】
相关期刊论文 前6条
1 郭新红;哈力达·亚森;马艳;刘洋;陈tb;迪力娜孜·阿布来提;段显琳;张雪;;血小板特异性抗体对特发性血小板减少性紫癜诊断价值的研究[J];中华实用诊断与治疗杂志;2009年05期
2 王传新;牛爱军;卢振铎;杨晓静;王立水;邹雄;;PAIgG及血小板活化标志物PAC-1、CD62P检测在原发性血小板减少性紫癜患者临床意义[J];浙江检验医学;2005年01期
3 郑敏;林希平;;儿童难治性特发性血小板减少性紫癜的治疗进展[J];临床儿科杂志;2008年08期
4 蔡早育;戴伟良;;XE-5000检测网织血小板在血液病中的临床应用[J];检验医学与临床;2013年01期
5 王天有;张朝霞;鲁杰;;儿童特发性血小板减少性紫癜血小板功能研究[J];中国小儿血液与肿瘤杂志;2006年01期
6 白静;刘文君;;原发性免疫性血小板减少症血小板参数及功能的改变[J];中国实用儿科杂志;2015年02期
，本文编号：2345123
本文链接：https://www.wllwen.com/yixuelunwen/eklw/2345123.html
最近更新
教材专著
