a Department of Internal Medicine , Radboud University Medical Center , Nijmegen , The Netherlands.
b Radboud Center for Infectious Diseases , Radboud University Nijmegen Medical Center , Nijmegen , The Netherlands.
Platelets. 2017 Sep;28(6):595-601. doi: 10.1080/09537104.2016.1252837. Epub 2016 Dec 29.
Platelets may play a role in the high risk for vascular complications in Gram-positive sepsis. We compared the platelet reactivity of 15 patients with Gram-positive sepsis, 17 with Gram-negative sepsis and 20 healthy controls using a whole blood flow cytometry-based assay. Patients with Gram-positive sepsis had the highest median fluorescence intensity (MFI) of the platelet membrane expression of P-selectin upon stimulation with high dose adenosine diphosphate (ADP; P = 0.002 vs. Gram-negative and P = 0.005 vs. control groups) and cross-linked collagen-related peptide (CRP-XL; P = 0.02 vs. Gram-negative and P = 0.0001 vs. control groups). The Gram-positive group also demonstrated significantly higher ADP-induced fibrinogen binding (P = 0.001), as wll as platelet-monocyte complex formation (P = 0.02), compared to the Gram-negative group and had the highest plasma levels of platelet factor 4, β-thromboglobulin and soluble P-selectin. In contrast, thrombin-antithrombin complex and C-reactive protein levels were comparable in both patient groups. In conclusion, common Gram-positive pathogens induce platelet hyperreactivity, which may contribute to a higher risk for vascular complications.
血小板可能在革兰氏阳性菌脓毒症的高血管并发症风险中发挥作用。我们使用全血流式细胞术检测比较了 15 例革兰氏阳性菌脓毒症患者、17 例革兰氏阴性菌脓毒症患者和 20 例健康对照者的血小板反应性。高剂量二磷酸腺苷（ADP）刺激后，革兰氏阳性菌脓毒症患者血小板膜 P-选择素表达的中位荧光强度（MFI）最高（P=0.002 与革兰氏阴性菌比较，P=0.005 与对照组比较），交联胶原相关肽（CRP-XL）也最高（P=0.02 与革兰氏阴性菌比较，P=0.0001 与对照组比较）。与革兰氏阴性菌组相比，革兰氏阳性组 ADP 诱导的纤维蛋白原结合（P=0.001）和血小板-单核细胞复合物形成（P=0.02）也显著更高，且血小板因子 4、β-血栓球蛋白和可溶性 P-选择素的血浆水平也最高。相比之下，凝血酶-抗凝血酶复合物和 C 反应蛋白水平在两组患者中相似。总之，常见的革兰氏阳性病原体可诱导血小板高反应性，这可能导致更高的血管并发症风险。
