川崎病患儿血小板CD61和CD62p的变化及其临床意义(1)
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【摘要】 目的 测定血小板CD61和CD62p的阳性率,探讨并总结川崎病病程中血小板活化标志物CD62p的阳性表达率的变化与临床诊断、疗效判定及冠状动脉异常之间的关系。方法 应用流式细胞仪检测25例川崎病患儿和16例正常对照组急性期血小板CD61和CD62p阳性表达率。结果 川崎病患儿全血CD61、CD62p阳性表达率较正常对照儿明显增高,具有统计学意义;合并冠状动脉异常者CD62p阳性表达率增高更加显著,CD62p阳性表达率增高具有统计学意义;CD62p的阳性表达率经丙种球蛋白和阿司匹林治疗后能明显减低,但仍高于正常对照儿,具有统计学意义。 结论 在川崎病免疫性血管炎的病理损害过程中,CD61和CD62p均显著增高,丙种球蛋白和阿司匹林治疗后能抑制KD患儿血小板膜糖蛋白CD62p的高表达,降低血小板的活化过程:川崎病病程过程中动态检测血小板活化标志物CD62p阳性表达率,对川崎病的诊断和疗效判定具有比较重要的临床意义,对预测冠状动脉异常是否发生更具有价值。
【关键词】 川崎病;血小板活化;CD61;CD62p
Clinical Significance ofCD61 and CD62p Variation in Kswasaki Disease
WANG Chun-yan,LI Ya-rui.Dedpartment of Pediatrics,the Shanxi Medical University,Taiyuan 030001,China
【Abstract】 Objective To investigate the clinical significance of plateletCD61 and CD62p variation in Kawasaki disease(KD).Methods The positive expression rates of CD61 and CD62p in KD patients weremeasured by flow cytometry.Results The positive expression rates of CD61 and CD62p in the KD patients were higher than those of normal controls,and they were more higher in coronary artery abnormalities;After aspirin and IVIG treatment,the positive expression rates of CD62p were lower than those before treatment.However,those after treatment were still higher than those in the normal controls.Conclusion Inthe pathological course of immunity vasculitis in KD,the platelet activation participates.The treatment of aspirin and IVIG can inhabit the high expression of CD61 and CD62p,and can degrade the degree of the platelet activation.Itis valuable in diagnosis and treatment effects judgment to have dynamic observation of the positive expression rates of CD62p,which is of high value in prediction of coronary artery abnormalities.
【Key words】Kawasaki disease; Platelet activation; CD61;CD62p
川崎病病理特点为系统性的血管炎,主要累及中等大小动脉,以冠状动脉受累最为常见。研究资料表明川崎病患儿呈高凝状态,处于血栓前状态,血小板显著增多,血小板被激活,血小板膜上出现血小板活化标志物的表达。国内外学者通过动物实验应用异体蛋白激发幼兔免疫性血管炎,发现其病理改变和川崎病的病理改变相似,冠状动脉有扩张,进一步证实了川崎病冠状动脉异常的存在。研究资料表明血小板增多和活化促进血栓形成,易导致动脉狭窄、闭塞、冠状动脉异常,因此血小板的活化和冠状动脉异常有着密切的关系。
1 资料与方法
1.1 一般资料 2009年3~9月在山西省儿童医院心血管科住院确诊为川崎病的25例患儿,符合厚生省川崎病研究课题组修订第5版的诊断标准[1]。其中男性患儿16例,女性患儿9例,男:女=1.8:1;年龄5个月~10岁,平均年龄为(29.68±28.63)月。诊断前发热时间为(6.88±2.78)d 。临床表现:25例川崎病患儿治疗前均有发热,多呈弛张热;12例合并冠状动脉异常,发生率为48%,冠状动脉扩张11例,冠状动脉瘤样扩展1例;出现皮疹20例,占80%;结膜充血22例,占88%,热退后渐消失;口唇皲裂18例,占72%,指趾硬肿及脱屑12例,占48%,淋巴结肿大24例,占96%。其他临床表现有:咳嗽15例,其中9例胸部X线正位片呈肺部炎症征象;腹痛、腹泻6例,出现关节肿痛4例,肝脏肿大2例,出现心脏杂音2例,均为心尖区II~III收缩期杂音;无菌性脑炎1例,心肌酶谱高于正常者11例 ......
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