Kim Hyun Jung, Choi Eun Hye, Lim Yeon Jung, Kil Hong Ryang
Department of Pediatrics, Eulji University School of Medicine, Daejeon, Korea.
Eulji Medi-Bio Research Institute, Eulji University School of Medicine, Daejeon, Korea.
J Korean Med Sci. 2017 Jul;32(7):1147-1153. doi: 10.3346/jkms.2017.32.7.1147.
Little is known about platelet dynamics and the effect of antiplatelet therapy in Kawasaki disease (KD). This study sought to define platelet activation dynamics in KD patients by assaying platelet-derived microparticles (PDMPs). We measured plasma PDMPs levels in 46 patients with KD using an enzyme-linked immunosorbent assay (ELISA). Blood samples were collected before, at 2-5 days, and 9-15 days after intravenous immunoglobulin (IVIG) infusion, 2 months and 4-5 months after the onset of KD. We measured PDMP levels in 23 febrile and 10 afebrile control patients. In the acute phase of KD patients, PDMP levels increased significantly after IVIG treatment (12.04 ± 5.58 nmol before IVIG infusion vs. 19.81 ± 13.21 nmol at 2-5 days after IVIG infusion, P = 0.006). PDMP levels were negatively correlated with age and positively correlated with procalcitonin levels in the acute phase of KD. No significant difference was found in PDMP levels between KD patients with and without coronary artery lesion (CAL). Elevated PDMP levels after IVIG therapy significantly decreased below the pre-IVIG level in subacute phase (19.81 ± 13.21 nmol at 2-5 days after IVIG infusion vs. 8.33 ± 2.02 nmol at 9-15 days after IVIG infusion, P < 0.001), and PDMP levels stayed below the pre-IVIG level in the convalescent phase, during which antiplatelet therapy was given. However, PDMP levels rebounded after discontinuing aspirin in 17 patients. In conclusion, enhanced platelet activation was noted before treatment of KD and peaked immediately after IVIG treatment. Recurrent rising of PDMP levels was observed after discontinuing aspirin, although there were no significant differences between the PDMP levels at 2 months after the onset of KD and those at 4-5 months after the onset of the disease.
关于川崎病（KD）中血小板动力学及抗血小板治疗的效果，目前所知甚少。本研究旨在通过检测血小板衍生微粒（PDMPs）来明确KD患者的血小板激活动力学。我们采用酶联免疫吸附测定（ELISA）法测量了46例KD患者的血浆PDMPs水平。在静脉注射免疫球蛋白（IVIG）前、注射后2 - 5天和9 - 15天、KD发病后2个月和4 - 5个月采集血样。我们还测量了23例发热对照患者和10例无热对照患者的PDMP水平。在KD患者的急性期，IVIG治疗后PDMP水平显著升高（IVIG注射前为12.04±5.58 nmol，IVIG注射后2 - 5天为19.81±13.21 nmol，P = 0.006）。在KD急性期，PDMP水平与年龄呈负相关，与降钙素原水平呈正相关。有无冠状动脉病变（CAL）的KD患者之间，PDMP水平未发现显著差异。IVIG治疗后升高的PDMP水平在亚急性期显著降至IVIG注射前水平以下（IVIG注射后2 - 5天为19.81±13.21 nmol，IVIG注射后9 - 15天为8.33±2.02 nmol，P < 0.
