丁胺卡那霉素对血小板聚集和凝血功能的抑制作用  

Inhibitory effects 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 [2]浙江省人民医院急诊科

出　　处：《浙江检验医学》2010年第2期3-8,共6页Zhejiang Journal of Laboratory Medicine

基　　金：浙江省医学重点学科基金(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,初步探讨其对凝血功能的影响及相关作用机制。方法方法 :将不同浓度(0mg/L组、30mg/L组、91mg/L组和910mg/L组)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。检测ADP诱导的血小板最大聚集率,活化血小板P-选择素,GPIIb/IIIa及纤维蛋白原受体(Fg-R)表达水平,PT,APTT,TT及纤维蛋白原(Fg)水平。以前述4种浓度丁胺卡那霉素以及62.5U/ml肝素钠和109mmol/L枸橼酸钠分别与新鲜全血作用,测定全血凝固时间(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30minADP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 30mg/L组血小板最大聚集、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0mg/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值均【0.001),而对3者的抑制率分别为25.2%、42.9%和59.4%,均有统计学意义(χ2值分别为6.71、9.11和10.34,P值均【0.01);30mg/L组APTT(80.5±6.8)s和CT(857±66)s明显高于0mg/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值均【0.001);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值均【0.05];30mg/L组,91mg/L组和910mg/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];除910mg/L组PT增加有统计学意义(P【0.001)外,各组GPIIb/IIIa、PT、TT、Fg以及血浆Ca2+浓度变化无统计学意义(P均】0.05)。丁胺卡那霉素治疗后患者血小板聚集率(51.6±10.1)%、P-选择素(6.8±1.8)%和Fg-R(20.1±5.8)%明显低于治疗前的(66.8±11.4)%、(10.9�Objective To observe the in vitro inhibitory effects of amikacin on platelet aggregation and blood coagulation tests,and to explore its effects on hemostasis and the related mechanisms.Methods Platelet rich plasma and platelet poor plasma from volunteers were mixed with different concentration of amikacin which was divided into four groups (0 mg/L of amikacin group,30 mg/L of amikacin group,91 mg/L of amikacin group and 910 mg/L of amikacin group). The maximal ratio of platelet aggregation induced by adenosine diphosphate(ADP) were measured with platelet aggregation analyzer. The expression levels of P-selectin,glycoprotein(GP)IIb/IIIa and fibrinogen receptor(Fg-R) were determined with flow cytometer. The prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT) and fibrinogen (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 added into and mixed with fresh whole blood,the blood clotting time(CT) and plasma calcium ions (Ca2+) were detected,respectively,with glass tube method and blood-gas analyzer. Blood samples were collected from 10 patients with acute lower respiratory tract infection before and 30 minutes after routine amikcin treatment. The maximial ratio of platelet aggregation,the expression levels of P-selectin,GPIIb/IIIa and Fg-R induced by ADP were measured; and PT,APTT,CT and plasma Ca2+ were determined,too.Results At 30 mg/L of amikacin group,the maximial 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( P<0.001),the inhibitory rates of the three indicators was 25.2%,42.9% and 59.4%,respectively(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

关 键 词：丁胺卡那霉素 血小板聚集 血液凝固 纤维蛋白原受体 内源凝血途径 出血 

分 类 号：R446.11[医药卫生—诊断学]