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  • Title: [Predictive Effect of Platelet Activation Index Expression before and after Adenosine Bisphosphate Activation on Bleeding Risk in ITP Patients].
    Author: Qiu HC, Liu Q, Kong R, Wu PF, Zhang XL, Wu DH, Wang Y.
    Journal: Zhongguo Shi Yan Xue Ye Xue Za Zhi; 2019 Aug; 27(4):1236-1240. PubMed ID: 31418386.
    Abstract:
    OBJECTIVE: To investigate the predictive effect of platelet activation index expression before and after adenosine bisphosphate activation on bleeding risk in patients with primary immune thrombocytopenia (ITP). METHODS: Eighty-nine patients with ITP admitted in our hospital from January 2017 to October 2018 were selected and inrolled in ITP group, the bleeding scoreing and grading were performed by using the ITP-BAT for ITP patients, then 89 ITP patients were divided into 4 subgroups: nothing bleeding symptom group, mild bleeding symprom group, mode rate bleeding symptom group and severe bleeding symptom group according to bleeding scores and grades obtained from ITP-BAT detection. At the same time, 22 persons underwent the health physical examination were selected and enrolled in control group. The adenosine diphosphate (ADP) was used as activator for all patients and controls. The flow cytonetry was used to analyze the expression of platelet membranc glyco protein (GPⅠb, GPⅡb /Ⅲ a) and P-selectin before and after ADP activation, the multiple linear person's correlation analysis was used to analyze the correlation of bleeding degree of ITP patients before and after ADP acbivation with the expression levels of GPⅠb, GPⅡb/Ⅲa and P-selectin. RESULTS: After the ADP activation, the expression level of GPⅠb significantly decreased, while the expression levels of GPⅠb, GPⅡb/Ⅲ a and P-selectin significantly increased in control group, nothing bleeding symptom group and mild bleeding symptom group; but the expression level of GPⅠb significantly increased, while the expression level of GPⅡb/Ⅲ a significantly decreased in moderate and severe bleeding symptom group, the both differences were statistically significant (P＜0.05). however, the expression level of P-selectin in moderate and severe bleeding symptom groups before and after ADP activation was not statistivally significant (P＞0.05). Before ADP activation, the expression level of GPⅠb in ITP subgroups was lower than that in control group, the expression level of GPⅡb/Ⅲ a in ITP subgroups was higher than that in control group, the expression level of P-selectin in moderate and severe bleeding symptom groups was higher than that in control group (P＜0.05). After ADP activation, the expression levels of GPⅠb and P-selectin in ITP subgroups both were lower than those in control group, the expression level of GPⅡb/Ⅲa in ITP subgroups was higher than that in control group (P＜0.05). The comparison among ITP subgroups showed that before ADP activation, the expression level of GPⅠb in moderate and severe bleeding symptom groups was lower than that in nothing bleeding symotom and mild bleeding symptom groups, while the expression levels of GPⅡb/Ⅲa and P-selectin were higher than those in nothing bleeding symptom and mild bleeding symptom groups (P＜0.05), however, after ADP activation, the expression level of GPⅠb in moderate and severe bleeding symptom groups was higher than that in nothing bleeding symptom and mild bleeding symptom groups, while the expression levels of GPⅡb/Ⅲ a and P-selection in moderate and severe bleeding symptom groups were lower than those in nothing and mild bleeding symptom groups (P＜0.05). The correlation analysis showed that before ADP activation, the expression levels of GPⅠb and GPⅡb/Ⅲa positivdy correlated with the bleeding risk (r=0.483, 0.504), and the P-selectin not correlated with the bleeding risk (r=0.000); however, after ADP activation, the expression level of GPⅠb and GPⅡb/Ⅲ a negatively correlated with the bleeding risk (r=-0.627, -0.406, -0.108). CONCLUSION: The expression level of platelet activation indicators before and after ADP activation is of certain value for prevention of bleeding risk in ITP patients and can be used as a reference indicator for the treatment and efficacy evaluation. 题目: ITP患者二磷酸腺苷激活前后血小板活化指标表达对患者出血风险的预测作用研究. 目的: 研究原发免疫性血小板减少症（ITP）患者二磷酸腺苷激活前后血小板活化指标表达对患者出血风险的预测作用. 方法: 选择我院2017年1月- 2018年10月住院治疗的ITP患者89例为ITP组，采用ITP 特异性出血评价工具（ITP-BAT）进行出血评分及出血程度分级。根据出血程度分为4个亚组：无出血症状组（19例），轻度出血组（32例），中度出血组（27例），大量及严重出血组（11例）。选择同期健康体检者22例为对照组，所有受检者均以二磷酸腺苷（ADP）为激活剂，应用流式细胞术检测激活前后血小板膜糖蛋白（GP）Ⅰb、Ⅱb/Ⅲa 和P选择素表达，分析GPⅠb、GPⅡb/Ⅲa、P选择素表达。采用Pearson多重线性相关性分析ADP激活前后ITP患者出血程度与GPⅠb、GPⅡb/Ⅲa、P 选择素表达水平的相关性. 结果: 对照组、无症状组、轻度症状组ADP激活后GPⅠb表达水平显著下降，GPⅡb/Ⅲa、P 选择素表达水平显著升高；中度症状组、重度症状组ADP激活后GPⅠb表达水平显著升高，GPⅡb/Ⅲa表达水平显著降低，差异均有统计学意义（P＜0.05）。中度症状组、重度症状组ADP激活前后P选择素表达水平差异无统计学意义（P＞0.05）。ADP激活前ITP各亚组GPⅠb表达水平低于对照组，GPⅡb/Ⅲa表达水平高于对照组，中度症状组、重度症状组P 选择素表达水平高于对照组，差异均有统计学意义（P＜0.05）。ADP激活后ITP各亚组GPⅠb 、P选择素表达水平均低于对照组，GPⅡb/Ⅲa表达水平高于对照组，差异均有统计学意义（P＜0.05）。ITP各亚组比较显示，ADP激活前中度症状组、重度症状组GPⅠb表达水平低于无症状组、轻度症状组；GPⅡb/Ⅲa、P 选择素表达水平高于无症状组、轻度症状组，差异均有统计学意义（P＜0.05）。ADP激活后中度症状组、重度症状组GPⅠb表达水平高于无症状组、轻度症状组； GPⅡb/Ⅲa、P 选择素表达水平低于无症状组、轻度症状组，差异均有统计学意义（P＜0.05）。相关分析显示，ADP激活前GPⅠb、GPⅡb/Ⅲa表达水平与出血风险呈正相关（r=0.483，0.504）；P-选择素与出血风险不相关（r=0.000）；ADP激活后GPⅠb、GPⅡb/Ⅲa和P-选择素表达水平与出血风险呈负相关（r=-0.627， -0.406，-0.108）. 结论: ADP激活前后血小板活化指标表达水平对预防ITP患者出血风险有一定的价值，可以作为治疗和疗效观察的参考指标.
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