摘要
目的探讨脑小血管病及其亚型与大动脉粥样硬化性卒中患者血小板膜糖蛋白PAC-1和CD62P表达的差异，并对传统血小板活化标记物和炎症趋化因子血小板因子4（plateletfactor4，PF4）进行比较。方法分别采用流式细胞术和酶联免疫吸附法测定30例大动脉粥样硬化性卒中患者、45例脑小血管病患者和30例对照者外周血血小板PAC-1、CD62P阳性率以及血清PF4浓度，比较其组间差异。结果大动脉粥样硬化性卒中组PAC-1、CD62P阳性率和PF4浓度分别为（63．21±9．78）％、（55．91±8．17）％和（30．55±15．56）ng/ml，显著高于脑小血管病组的（40．65±17．42）％、（36．49±14．60）％和（12．59±5．57）ng／m／（P均=0．000），而后者仍高于对照组的（13．55±3．14）％、（9．00±2．32）％和（4．95±2．82）ng／ml（P均=0．000）。PAC-1、CD62P阳性率和PF4浓度在脑小血管病各亚组间存在显著差异，脑白质疏松合并腔隙性梗死组[（47．72±15．52）％、（43．75±12．54）％和（13．96±5．23）ng／nl]和单纯腔隙性梗死组[（49．87±14．65）％、（43．98±10．55）％和（14．41±5．53）ng／ml]显著高于单纯脑白质疏松组[（24．44±8．45）％、（21．74±7．19）％和（9．40±4．99）ng／m1]（P分别为0．000、0．000和0．013），而前两组间无显著差异（P分别为0．658、0．952和0．858）。缺血性脑血管病患者外周血PAC-1与CD62P阳性率显著相关（r=0．964，P=0．000），且血清PF4浓度分别与PAC-1（r=0．846，P=0．000）和c062P（r=0．857，P=0．000）阳性率均呈直线相关。结论血小板膜糖蛋白PAC-1与CD62P表达呈线性相关，并且与PF4浓度变化一致，提示血小板活化及其介导的炎症机制在动脉粥样硬化和血栓形成过程中起着重要的病理生理学作用，该机制在不同病变类型之间存在显著差异。
Objective To investigate the differences of platelet membrane glycoprotein PAC-1 and CD62P expression in patients with cerebral small vessel disease and its subtype and large artery atherosclerotic stroke and to compare the traditional platelet activation markers and inflammatory chemokine platelet factor 4 （PF4）. Methods Peripheral blood platelet PAC-1,CD62P positive rates and serum PF4 concentration in 30 patients with large artery atheroscle- rotic stroke, 45 patients with cerebral small vessel disease and 30 controls were detected using flow cytometry and enzyme-linked irnmunosorbent assay. The differences between the groups were compared. Results The PAC-1, CD62P positive rates and serum PF4 concentration in the large artery atherosclerotic stroke group were 63.21% ± 9. 78%, 55.91% ± 8. 17%, and 30. 55 ± 15.56 ng/ml, respectively. They were significantly higher than 40. 65% ±17.42%, 36. 49%±14. 60%, and 12. 59 ± 5. 57 ng/mlin the cerebral small vessel disease group （all P = 0. 000）, and the latter was still higher than 13.55% ± 3. 14%, 9. 00% ± 2.32%, and 4. 95± 2. 82 ng/ml in the control group （all P = 0. 000）. There were significant differences in all the subtypes groups of cerebral small vessel disease between the PAC-1, CD62P positive rates and serum PF4 concentration. The leukoaraiosis with lacunar infarction group （n = 15; 47. 72%± 15.52%, 43.75%± 12.54%, and 13.96 ±5.23 ng/ml） and the simple lacunar infarction group （n = 15; 49. 87% ± 14. 65%, 43.98% ± 10. 55%, and 14. 41 ± 5.53 ng/ml） was significantly higher than the simple lacunar infarction group （n = 15; 24. 44%±8.45%, 21.74%±7. 19%, and 9. 40 ±4. 99 ng/ml） （P =0. 000, 0. 000, and 0. 013, respectively）. There was no significant difference between the former 2 groups （P = 0. 658, 0. 952, and 0. 858, respectively）. The peripheral blood platelet PAC-1 positive rate had significant correlation with CD62P positive rate in patients with ischemic cerebral disease （r = 0. 964, P = 0. 000）, and the serum PF4 concentration showed linier correlation with the PAC-1 （r =0. 846, P =0. 000） and CD62P （r = 0. 857, P =0. 000） positive rates. Conclusions The platelet membrane gtycoprotein PAC-1 and CD62P expression showed linear correlation, and they were consistent with the changes of PF4 concentration. This suggested that platelet activation and its mediated inflammatory mechanisms played an important pathophysiological role in the processes of atherosclerosis and thrombosis. This mechanism had sigrtificant difference between the different lesion types.
出处
《国际脑血管病杂志》
北大核心
2011年第2期95-100,共6页
International Journal of Cerebrovascular Diseases
