丁胺卡那霉素对血小板聚集和凝血功能的抑制作用  

Inhibition of amikacin on platelet aggregation and blood coagulation

作　　者：费鲜明[1] 周永列[1] 邱莲女[1] 吴建国[1] 张可[2] 

机构地区：[1]浙江省人民医院检验医学中心,杭州310014 [2]浙江省人民医院急诊科,杭州310014

出　　处：《中华检验医学杂志》2010年第5期419-424,共6页Chinese Journal of Laboratory Medicine

基　　金：浙江省医学重点学科基金资助项目（07-010）

摘　　要：目的 观察丁胺卡那霉素对血小板聚集和凝血功能试验的抑制作用,探讨其对止血功能的影响及相关作用机制.方法 将不同浓度丁胺卡那霉素分别与献血者富血小板血浆和乏血小板血浆作用,分为4组：0 mg/L组、30 mg/L组、91 mg/L组和910 mg/L组.以血小板聚集分析仪检测ADP诱导的血小板最大聚集率,以流式细胞仪检测活化血小板P-选择素、GPⅡb/Ⅲa及Fg-R表达水平,以血液凝固分析仪测定PT、APTT、TT及Fg水平.以前述4种浓度丁胺卡那霉素以及62.5 U/ml肝素钠和109 mmoL/L柠檬酸钠分别与新鲜全血作用,测定CT及血浆Ca2＋浓度.分别检测10例急性下呼吸道感染患者在丁胺卡那霉素常规剂量治疗前和治疗后30 min ADP诱导的血小板最大聚集率、P-选择素、GPⅡb/Ⅲa及Fg-R表达水平,并测定PT、APTT、CT和血浆Ca2＋浓度.结果 30 mg/L组血小板最大聚集率、P-选择素和Fg-R分别为（65.8±3.9）%、（9.2±1.0）%和（12.6±1.7）%,显著低于0 mg/L组的（88.0±4.6）%、（16.1±1.3）%和（31.0±2.5）%,差异均有统计学意义（t值分别为9.442、8.432和9.993,P均＜0.01）;30 mg/L组APTT（80.5±6.8）s和CT（857±66）s明显高于0 mg/L组的（33.0±3.6）s和（447±35）s,差异均有统计学意义（t值分别为11.312和13.211,P均＜0.01）;丁胺卡那霉素浓度与血小板最大聚集率呈显著负相关,与聚集的抑制率呈显著正相关,与APTT呈显著正相关[r值分别为-0.832、0.939和（＞0.870）,P均＜0.05];30 mg/L组,91 me/L组和910 mg/L组呈剂量依赖性抑制P-选择素和Fg-R表达及使CT增加[F组间=21.44、26.24和（＞29.81）,P均＜0.01].0 mg/L组、30mg/L组、91 mg/L组和910 mg/L组PT值分别为（14.7±1.9）s、（15.2±1.7）s、（15.6±1.5）s、（22.1±2.1）s,差异有统计学意义（F=8.21,P＜0.05）,而GPⅡb/Ⅲa、TT、Fg以及血浆Ca2＋浓度在4组间差异无统计学意义（P均＞0.05）.丁胺卡那霉素治疗后患者血小板最大聚集率�Objective To observe the inhibition of amikacin in vitro on platelet aggregation and blood coagulation tests, and to study its effects on hemostasis and the related mechanisms.Methods Plateletrich plasma and platelet-poor plasma from donors were mixed with different concentration of amikacin, which was divided into four groups：0 mg/L, 30 mg/L, 91 mg/L and 910 mg/L group.The maximial ratio of platelet aggregation induced by ADP were measured with Platelet Aggregation Analyzer.The expression levels of P-selectin, GP Ⅱ b/Ⅲ a and Fg-R were determined with Flow Cytometer.The PT, APTT, TT and Fg of platelet-poor plasma were detected with Blood Coagulation Analyzer. The four concentration of amikacin mentioned above and two anticoagulants （62.5 U/ml of sodium heparin and 109 mmol/L of sodium citrate）were interacted with fresh whole blood, in which the blood CT and plasma Ca2＋ were detected. Blood samples were collected from 10 patients with acute lower respiratory tract infection before and 30 minutes after routine amikcin treatment respectively.The maximial ratio of platelet aggregation, the expression levels of P-selectin, GPⅡ b/Ⅲa and Fg-R induced by ADP were measured; while PT, APTT, CT and plasma Ca2＋ were determined.Results At 30 mg/L of amikacin group, the maximal ratios of platelet aggregation （65.8±3.9）%, the expression levels of P-selectin （9.2 ± 1.0）% and Fg-R （12.6 ± 1.7）% were statistically lower than those [（88.0 ±4.6%, （16.1 ± 1.3）% and （31.0 ±2.5）%]at 0 mg/L of amikacin group （ t = 9.442,8.432,9.993,P 〈 0.01 ）.At 30 mg/L of amikacin group, the APTT （80.5 ±6.8） s and CT （ 857 ± 66） s were significantly higher than those [（33.0 ± 3.6） s and （447 ± 35 ） s] at 0 mg/L of amikacin group （ t = 11.312, 13.211, P 〈 0.01 ）. There was a negative correlation between amikacin concentration and maximial ratio of platelet aggregation （ r = - 0.832, P 〈 0.05 ）, but a positive correlation between amikacin concentration and inhibitory rate

关 键 词：丁胺卡那霉素 血小板聚集 血液凝固 受体 纤维蛋白原 

分 类 号：R965[医药卫生—药理学]