龙柴降血方对原发性血小板增多症患者凝血功能及血小板活化蛋白的影响  

Effects of Longchai decoction for regulating platelet on coagulation function and platelet activating protein in patients with essential thrombocythemia

作　　者：郑茂凤 李芋锦 杨二鹏 李雨蒙 孙妍 陈科 陈卓 吕妍[2] 王明镜[2] 胡晓梅[2,6] ZHENG Maofeng;LI Yujin;YANG Erpeng;LI Yumeng;SUN Yan;CHEN Ke;CHEN Zhuo;LYU Yan;WANG Mingjing;HU Xiaomei(Graduate School of Beijing University of Chinese Medicine,Beijing 100029,China;Xiyuan Hospital,China Academy of Chinese Medical Science,Beijing 100091,China;The First People’s Hospital of Yunnan Province,Kunming 650032,Yunnan,China;Tsinghua Changgeng Hospital,Tsinghua University,Beijing 102218,China;Graduate School of China Academy of Chinese Medical Science,Beijing 100700,China;Suzhou Hospital of Xiyuan Hospital of Chinese Academy of Chinese Medical Science,Suzhou Hospital of Traditional Chinese Medicine,Suzhou 215003,Jiangsu,China)

机构地区：[1]北京中医药大学研究生院,北京100029 [2]中国中医科学院西苑医院,北京100091 [3]云南省第一人民医院,云南昆明650032 [4]清华大学附属北京清华长庚医院,北京102218 [5]中国中医科学院研究生院,北京100700 [6]中国中医科学院西苑医院苏州医院(苏州市中医医院),江苏苏州215003

出　　处：《现代中西医结合杂志》2024年第15期2088-2093,共6页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：国家自然科学基金面上项目(82174360);国家自然科学基金青年科学基金项目(82304945,82004187);中国中医科学院科技创新工程重大攻关项目(CI2021A01702,CI2021A01707);中国中医科学院基本科研业务费新入职科研人员启动资金专项(ZZ16-XRZ-003)。

摘　　要：目的观察龙柴降血方对原发性血小板增多症(ET)患者凝血功能及血小板活化蛋白的影响。方法选取2020年1月—2021年10月中国中医科学院西苑医院收治的ET患者22例,给予龙柴降血方治疗4个月,观察治疗前后血栓弹力图指标[凝血时间(R)、凝血速率(K)、纤维蛋白功能(Angle)、血栓最大振幅(MA)、血栓最大振幅时间(TMA)、即时振幅(A)、30 min振幅(A30)、从血样开始检测到曲线分叉所需时间(SP)、血凝块溶解时间(CLT)]、高凝状态发生率和积分变化。选取其中15例ET患者,采用平行反应监测(PRM)技术检测患者治疗前后血小板活化蛋白[血小板膜糖蛋白Ibα(GPIbα)、糖蛋白VI(GPVI)、选择素-P(SELP)]表达水平,分析比较血小板聚集改善患者和血小板聚集增强患者上述各蛋白表达水平的差异;取5例健康者和10例ET患者治疗前后血清,采用Western blot法检测血清GPIbα表达情况;分析15例ET患者MA与血清GPIbα表达水平的相关性。结果与治疗前比较,龙柴降血方治疗后MA、CLT、高凝状态发生率、高凝状态积分和血清GPIbα、GPVI表达水平均明显降低(P均<0.05),血清SELP表达水平无明显变化(P>0.05)。治疗后血小板聚集改善患者血清GPIbα表达水平明显低于血小板聚集增强患者(P<0.05),GPVI表达水平无明显变化(P>0.05)。与健康人相比,10例ET患者治疗前血清GPIbα相对表达量明显增高(P<0.05);10例ET患者治疗后血清GPIbα相对表达量较治疗前明显降低(P<0.05)。龙柴降血方治疗后MA下降与GPIbα表达下调呈正相关(r=0.6986,P<0.05)。结论龙柴降血方能够抑制ET患者血小板聚集,改善高凝状态,其机制可能与抑制GPIbα蛋白介导的血小板活化信号通路有关。Objective It is to observe the effects of Longchai decoction for regulating platelet on coagulation function and platelet activating protein in patients with essential thrombocythemia(ET).Methods Twenty-two ET patients treated in Xiyuan Hospital of China Academy of Chinese Medical Science from January 2020 to October 2021 were selected and treated with Longchai decoction for regulating platelet for 4 months,the indexes of thromboela-stogram[reaction time(R),kinetics time(K),kinetics of clot development(Angle),maximal amplitude(MA),time to MA(TMA),amplitude(A),30 min amplitude(A30),SP,clot lysis time(CLT)],incidence and scores of hypercoagulable state before and after the treatment were observed.Fifteen of the ET patients were selected,and their expression levels of platelet activation proteins[glycoprotein Ibα(GPIbα),glycoprotein VI(GPVI),and selectin-P(SELP)]before and after treatment were detected by the parallel response monitoring(PRM)technique to analyze and compare the differences in the expression levels of the above proteins between the patients with improved platelet aggregation and the patients with enhanced platelet aggregation;the serum of 5 healthy patients and 10 ET patients were taken before and after treatment to detect the expression of serum GPIbαby Western blot method;the correlation between MA and the expression level of serum GPIbαin 15 ET patients was analyzed.Results Compared with before treatment,the MA,CLT,incidence and scores of hypercoagulable state,and expression levels of serum GPIbαand GPVI were significantly reduced after treatment with Longchai decoction for regulating platelet(all P<0.05),and there was no significant difference in the expression level of serum SELP(P>0.05).The expression level of serum GPIbαwas significantly lower in patients with improved platelet aggregation than that in patients with enhanced platelet aggregation after treatment(P<0.05),but there was no significant change in the expression level of GPVI(P>0.05).Compared with healthy people,the relative ex

关 键 词：原发性血小板增多症 龙柴降血方 血栓最大振幅 血小板聚集 血小板活化 血小板膜糖蛋白IBΑ 

分 类 号：R733.3[医药卫生—肿瘤]