摘要
第一部分维持血液透析患者血小板凝血酶受体的表达
目的：观察维持血液透析患者血小板蛋白酶激活受体1(PAR1)、蛋白酶激活受体4(PAR4)和膜糖蛋白Iba (GPIba)的表达与正常人之间的差异。
方法：采用流式细胞术检测PAR1,PAR4和GPIba的表达,采用比浊法检测其血小板最大聚集率(MAR)。
结果：维持透析患者血小板表面GPIba表达略低于对照组,PAR1表达升高(P<0.05),血小板最大聚集率降低(P<0.05)；相关性分析显示PAR1的表达和血液透析频率之间存在明显正相关(r=0.601,P<0.05)。
结论：PAR1作为具有高亲和力的凝血酶受体,在维持透析患者体内的过度表达,导致血小板聚集功能增强,可能是该类患者心脑血管事件频发的主要原因之一。
第二部分参芎葡萄糖注射液对肾病终末期维持血液透析患者血小板凝血酶受体1和受体4的影响
目的：观察肾病终末期维持血液透析患者使用参芎葡萄糖注射液对血小板凝血酶受体1(PAR1)和受体4(PAR4)表达的影响。
方法：选取肾病终末期长期透析患者86例,使用参芎葡萄糖注射液,7天为一个疗程,连续使用2个疗程。其他治疗方案不变。使用流式细胞仪检测治疗前后PAR1和PAR4的表达,采用比浊法检测其血小板最大聚集率(MAR),同时检测肾功能。并与正常对照组比较。
结果：治疗前肾病终末期长期透析患者PAR1、PAR4表达和血小板最大聚集率明显高于对照组(P=0.001,P=0.006,P=0.008)；参芎葡萄糖注射液治疗后,除了PAR4(P=0.067),以上指标较治疗前均明显下降(P=0.036,P=0.046),虽仍高于对照组,但无明显统计学意义。
结论：(1)血小板PAR1在肾病终末期长期透析患者体内的过度表达,从而导致血小板聚集功能增强,这可能是肾病终末期长期透析患者存在血栓风险的原因之一；(2)参芎葡萄糖注射液可降低患者PAR1、PAR4的表达,有效改善血小板功能,调节血小板活性。
Part one Levels of main platelet thrombin receptors in chronic haemodialysis patients
Objective:To investigate the expression of platelet membrane receptors proteinase activated receptor-1(PARl), proteinase activated receptor-4(PAR4) and glycoprotein Iba (GPIba) in patients on chronic haemodialysis (HD).
Methods:Flow cytomery was used to assess the expression of PARl, PAR4and GPIba levels on the platelet surface. Platelet reactivity was assessed by ADP-stimulated aggregation. The results were expressed as the maximal platelet aggregation rate (MAR).
Results:The expression of GPIba was a little lower, the PARl percentage was higher (P<0.05) and the platelet MAR(%) in the chronic haemodialysis group was obviously lower than in the control subjects (P <0.05). There was a positive relationship between PARl levels and the months of HD(r=0.601,P<0.05).
Conclusion:The presence of a high PARl level and more cardiovascular and cerebrovascular events in the HD group may indicate that the increase of platelet PARl level is a risk marker in HD patients.
Part two Effects of Salvia Miltiorrhiza Liguspyragine Hydrochlorid and Glucose Injection on the levels of main platelet thrombin receptors in chronic haemodialysis patients
Objective:To investigate the effects of Salvia Miltiorrhiza Liguspyragine Hydrochlorid and Glucose Injection(参芎葡萄糖注射液,SLGI) on the expression of platelet membrane receptors proteinase activated receptor-1(PARl) and proteinase activated receptor-4(PAR4) in end-stage renal disease (ESRD) patients on chronic haemodialysis (HD).
Methods:Eighty-six patients in ESRD with HD were treated with SLGI,7days as one therapeutic course, for2successive courses. The previous therapies remained unchanged. Flow cytometry was used to detect the expression of platelet PARl and PAR4in patients, and turbidity method was used to determine the platelet maximum aggregation rate (MAR), meanwhile the renal function was measured. The final data were compared with those before the treatment, and with those in the normal control group (54healthy subjects).
Results:Compared with the normal control group, expressions of PARl and PAR4, and platelet MAR in ESRD patients on HD were significantly higher (P=0.001, P=0.006, P=0.008) before the treatment; after the treatment with SLGI, the above indexes in patients were remarkably decreased (P-0.036, P=0.046), except PAR4(P=0.067), but still higher than those in the normal control group, however, it was not statistically significant.
Conclusion:(1) The overexpressions of PAR1and PAR4lead to platelet aggregation increased and this might be one of the reasons for the thrombic events in ESRD patients on HD.(2) SLGI was able to down-regulate expressions of PAR1and PAR4in ESRD patients on HD, improve platelet function and regulate platelet activation.
引文
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