小儿脓毒症血小板膜糖蛋白和溶酶体膜蛋白分子变化及临床意义探讨

摘要

目的：探讨脓毒症患儿血小板α颗粒膜糖蛋白(CD 62 p)、溶酶体膜蛋白(CD 63)的变化及意义。方法选取2010年3月-2013年3月在哈尔滨市儿童医院感染内科收治的脓毒症患儿56例，其中严重脓毒症16例、一般脓毒症40例，另设健康对照组34例。应用流式细胞术检测患病儿童外周血的血小板表面活性标记糖蛋白CD 62 p、CD 63表达及血小板计数(PLT)，并与健康对照组比较。并对严重脓毒症组患儿抗生素治疗前后CD 62 p、CD 63表达及PLT进行了对比。结果严重脓毒症患儿血小板CD 62 p、CD 63水平明显高于一般脓毒症组及健康对照组，差异有统计学意义（P＜0.01），而血小板PLT明显低于一般脓毒症组及健康对照组，差异有统计学意义（P＜0.01）；一般脓毒症组患儿血小板CD 62 p、CD 63水平高于健康对照组，差异有统计学意义（P＜0.01），而血小板PLT低于健康对照组，差异有统计学意义（P＜0.01）；严重脓毒症组治疗第1天CD 62 p、CD 63水平高于入院时水平，差异有统计学意义（P＜0.01），PLT低于入院时水平，差异有统计学意义（P＜0.01），治疗第7天CD 62 p、CD 63水平低于入院时水平，差异有统计学意义（P＜0.01），PLT恢复至正常范围。结论血小板CD 62 p、CD 63的活化在脓毒症患儿的早期发病过程中起重要作用，二者共同参与了疾病早期的高凝状态，从而促使PLT的降低，血小板活化程度与病情的严重程度相关。%Objective To investigate the expression and clinical significance of platelet glycoprotein CD 62 p,CD 63 in septic patients. Methods 56 patients with sepsis from March 2010 to March 2013 in communicable disease department of the hospital were divided into severe sepsis group (n=16) and general sepsis group (n=40), normal control group included 34 subjects from health check.CD 62 p,CD 63 and blood platelet were detected by flow cytometry in sepsis patients, and compared with normal control group. Comparison in CD 62 p,CD 63 and blood platelet between pre-and-post-treatment of antibiotics in severe sepsis groups were also made. Results The levels of CD 62 p and CD 63 in severe sepsis group were significantly higher than those of general sepsis group and normal control group (P<0.01), while the level of platelet was significantly lower than that of general sepsis group and normal control group (P<0.01).The levels of CD 62 p and CD 63 in general sepsis group were higher than those of normal control group (P<0.01), while the level of platelet was lower than that of normal control group (P<0.01). The levels of CD 62 p and CD 63 in 1 thday of post-treatment were higher than those in the pre-treatment in the severe sepsis group (P<0.05),while the level of platelet was lower than that in the pre-treatment in the severe sepsis group (P<0.05). The levels of CD 62 p and CD 63 in 7th day of post-treatment were lower than those in the pre-treatment in the severe sepsis group(P<0.05). And the level of platelet returned to normal range. Conclusion The activation of platelet glycoprotein CD 62 p and CD 63 plays an important role in the process of sepsis,and participates in the early hypercoagulable state. Then it contributes to reduce the platelet PLT. The degree of platelet PLT activation is correlated with the severity of sepsis.