急性冠脉综合征患者血小板和白细胞异常表达组织因子的研究  

Tissue Factor Expression of Platelets and Leukocytes in Patients with Acute Coronary Syndromes

作　　者：陆弘逾[1] 陈德[2] 顾俊[1] 宋陆茜[3] 陈梅[1] 

机构地区：[1]上海市杨浦区中心医院血液科,上海200090 [2]上海市杨浦区中心医院心内科,上海200090 [3]上海交通大学附属第六人民医院血液科,上海200233

出　　处：《中国实验血液学杂志》2013年第3期678-683,共6页Journal of Experimental Hematology

摘　　要：本研究观察急性冠脉综合征(ACS)患者,稳定性心绞痛(SA)患者及健康对照循环中血小板、血小板白细胞聚集体(PLA)和血小板单核细胞聚集体(PMP)组织因子(TF)的表达情况,并探讨其在ACS发病机制中的作用。收集26例ACS患者,29例SA患者及25名正常人(作为对照组),外周血标本,分离获得单核细胞及富含血小板血浆,用RT-PCR法分别检测组间单核细胞及血小板TF-mRNA的表达,通过流式细胞仪检测组间血小板、PLA和PMP表达TF的比例。结果表明,ACS组、SA组、正常对照组血小板TF mRNA平均表达水平分别为3.11±0.51、1.88±0.78和0.7±0.10,ACS组单核细胞、血小板TF mRNA表达水平与正常对照组有差异(分别为P=0.03,P=0.05)。ACS组患者血小板表达TF比例明显高于SA组及正常对照组(P=0.02),3组的TF阳性的PLA百分比(%UR)分别为2.7±0.6、0.8±0.2及0.5±0.1(P=0.001)。ACS组TF阳性的血小板单核细胞百分比(%UR)为2.5±0.6,显著高于SA组的1.2±0.3(P=0.02)及对照组的0.8±0.2(P=0.04)。结论:ACS患者血小板及白细胞高表达TF,促进了血小板的活化、凝血和血栓形成,进一步促进高凝状态。TF促血栓形成和促局部炎症作用,协同血小板和白细胞共同参与ACS的发病,最终与ACS疾病发生发展密切相关。The aim of this study was to investigate the tissue factor （TF） expression of platelets and leukocytes in patients with acute coronary syndrome （ACS）, patients with stalbe angina（SA） and healthy subjects （as controls）. 26 patients with ACS, 29 patients with SA, and 25 controls were enrolled in this study. The peripheral blood samples of above-mentioned subjects were collected and isolated to obtain the monocytes and platele-rich plasma, the TF-mRNA expression of monocytes, and platelets among 3 groups was detected by RT-PCR, the TF expression ratio of platelets, platelet-leukocyte aggregates（PLA） and platelet-monocyte aggregates （PMP） was detected by flow cytometry among 3 groups. The results showed that the TF mRNA expression level of platelets in ACS group were significantly higher （ 3.11 ±0.51 relative expression） as compared with SA and control groups （ 1.88 ± 0.78 and 0.7 ±0.1, respectively） （ P = 0. 03）. Expression of TF mRNA of monocytes was higher in ACS group （P =0.05 versus controls） too. ACS group had a significantly higher amount of TF-positive platelets （8.8 ±2.6） than SA （2.6 ±0.5 ,P =0.02） or control groups （2.5 ± 0.4, P = 0. 02 ）. A significantly greater number of TF positive platelet-leukocyte aggregates and plateletmonocyte aggregates were also found by flow cytometry in blood of ACS patients than in either SA patients or controls. It is concluded that the high TF expression of platelets and leukocytes in ACS patients strengthens the platelet activation, blood coagulation, and thrombus formation and may further contribute to the hypercoagulability associated with the disease. The present study further extends the proinflammatory/prothrombotic phenotype of ACS patients showing that new players on the scene.

关 键 词：急性冠脉综合征 组织因子 血小板 白细胞异常 

分 类 号：R543.31[医药卫生—心血管疾病]