基于血小板活化功能探讨从脾论治原发性免疫性血小板减少症止血机制  

Hemostatic Mechanism of Spleen in the Treatment of Immune Thrombocytopenia Based on Platelet Activation Function

作　　者：严香 赵倩[1] 陈信义[1] 张雅月[1] YAN Xiang;ZHAO Qian;CHEN Xin-yi;ZHANG Ya-yue(Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700)

机构地区：[1]北京中医药大学东直门医院,北京100700

出　　处：《世界中西医结合杂志》2023年第3期516-520,534,共6页World Journal of Integrated Traditional and Western Medicine

基　　金：国家重点基础研究发展计划项目(2013CB531705);国家自然科学基金(81703903);北京中医药大学东直门医院青苗人才培养计划(DZMYS-201807)。

摘　　要：目的从血小板活化角度探索从脾论治原发性免疫性血小板减少症(Immune thrombocytopenia,ITP)的可能止血机制。方法将120只BALB/c小鼠随机分为正常组、模型组、强的松组、非从脾论治组、健脾益气摄血组、归脾汤组,每组各20只小鼠。除正常组外,向小鼠注射豚鼠抗小鼠血小板血清(GP-APS)建立ITP模型。在建模成功后的第8天,正常组、模型组小鼠予生理盐水0.1 ml/10 g体积灌胃,其余各组均按照0.1 ml/10 g体积灌胃给药,1次/d,持续8 d。评估出血程度、采用全自动血液分析仪检测血小板计数、ELISA检测模型小鼠血清血小板活化因子(Platelet activating factor,PAF)、钙离子(Ca^(2+))、蛋白激酶C(Protein kinase C,PKC)、血小板颗粒膜蛋白(Granule membrane protein-140,GMP-140),观察相应指标变化。结果(1)出血程度:给药第8天各组小鼠与模型组出血程度比较,强的松组、健脾益气摄血组、归脾汤组出血程度改善,差异有统计学意义(P<0.01)。(2)血小板计数:强的松组、健脾益气摄血组、归脾汤组、非从脾论治组用药前与用药第4天比较,差异无统计学意义(P>0.05),用药第8天较用药前及用药第4天血小板计数明显上升,差异有统计学意义(P<0.01)。(3)血小板活化相关指标:与正常组比较,模型组小鼠PAF、Ca^(2+)、PKC表达均降低,GMP-140表达稍升高。与模型组比较,除非从脾论治组外(P>0.05),其他干预组PAF、Ca^(2+)、PKC、GMP-140表达均升高(P<0.05,P<0.01)。与非从脾论治组比较,健脾益气摄血组在升高PAF、PKC水平有一定优势,差异有统计学意义(P<0.05,P<0.01);归脾汤组在升高PAF、Ca^(2+)水平有一定优势,差异有统计学意义(P<0.05,P<0.01)。GMP-140中药干预组间比较,差异无统计学意义(P>0.05)。结论从脾论治方能有效降低出血程度、提高ITP模型小鼠外周血小板计数,升高PAF及血小板内Ca^(2+)水平,激活PKC,促进血小板上GMP-140表达。调节血小板活化功Objective To explore the possible hemostatic mechanism of spleen in the treatment of primary immune thrombocytopenia(ITP)from the perspective of platelet activation.Methods A total of 120 BALB/c mice were randomly divided into a normal group,a model group,a prednisone group,a non-spleen treatment group,a Jianpi Yiqi Shexue group,and a Guipi Decoction group,with 20 mice in each group.Except the normal group,the mouse model of ITP was established by injecting guinea pig anti-mouse platelet serum(GP-APS)into mice.On the 8th day after successful modeling,mice in the normal group and the model group were given 0.1 ml/10g of normal saline by gavage,and those in other groups were given 0.1 ml/10g by gavage.All groups were given drugs once a day for 8 days.The changes in corresponding indexes were observed by evaluating the degree of bleeding,detecting platelet counts with automatic blood analyzer,detecting serum platelet activating factor(PAF),calcium(Ca^(2+)),protein kinase C(PKC),and platelet granule membrane protein(GMP-140)in the mouse model by enzyme-linked immunosorbent assay(ELISA).Results(1)In terms of bleeding degree,as compared with the model group on the 8th day after administration,the bleeding degree of the prednisone group,Jianpi Yiqi Shexue group,and Guipi Decoction group had statistical significance(P<0.01).(2)In terms of platelet counts,there was significant difference among the prednisone group,Jianpi Yiqi Shexue group,Guipi Decoction group,and non-spleen treatment group before and on the 4th day of treatment(P>0.05),and the platelet count on the 8th day of treatment was significantly higher than that before and on the 4th day of treatment(P<0.01).(3)In terms of indexes related to platelet activation,as compared with the normal group,the expression of PAF,Ca^(2+),and PKC in the model group was decreased,and that of GMP-140 was increased slightly.As compared with the model group,the expression of PAF,Ca^(2+),PKC,and GMP-140 was increased in other intervention groups(P<0.05 or P<0.01),except in the non-s

关 键 词：免疫性血小板减少症 从脾论治 止血机制 血小板活化 

分 类 号：R285.5[医药卫生—中药学]