Zdrojewski Z, Raszeja-Specht A, Kustosz J, Skibowska A, Rutkowski B
Z Kliniki Chorób Nerek Akademii Medycznej w Gdańsku.
Przegl Lek. 1996;53(5):434-8.
Platelets (PLT) play an important role in hemostasis, modulation of immunological and inflammatory processes. There is also evidence that PLT takes part in the development of atherosclerosis and glomerulosclerosis. The aim of presented study was to determine morphological and functional changes of platelets and their relation to the lipid, protein and coagulation factors disturbances in patients with chronic glomerulonephritis (CGN). The studies were carried out in 60 patients with CGN diagnosed by renal biopsy: 30 patients without nephrotic syndrome (NS)-CGN and 30 patients with NS-CGN+NS. Protein and lipid disturbances, coagulation factors were estimated using routine laboratory methods. Platelet count (PLT), mean platelet volume (MPV) and modal platelet volume (PLT-Mode) were measured using Technicon H1 hematological autoanalyser. Platelet function was assessed by aggregometry using turbidimetric method (inductors: ADP 1-3 microM, collagen 50g/ml, epinephrine 0.25-5 microM). Spontaneous platelet aggregation (SPA) was measured in platelet rich plasma (PRP) without inductors for 15 min, in 1-2 hours after venesection. SPA was observed in 9 of 30 patients with CGN and in 19 of 30 patients with CGN+NS. MPV and PLT Mode were significantly higher in patient showing SPA compared with those without. Significant correlations between SPA and the concentration of plasma albumin (r = -0,70; p < 0.02) TG and CH-LDL (r = 0,61; p < 0.05) were found in CGN+NS patients. APTT was significantly shorter in patients showing SPA compared with those without and negative significant correlation between SPA and APTT was found. Platelet aggregation to inductors in CGN and CGN+NS patients was diminished compared with control group. Lack of second phase aggregation in response to aggregation inducers was observed in patients with SPA. Conclusions. 1. Platelet hyperaggregation play an important role in hypercoagulation state in CGN patients. 2. SPA in vitro was observed in majority of CGN+NS patients and in some without NS. 3. Pathomechanism of SPA is probably multifactorial (hypoalbuminemia, dyslipidemia, changes in concentration of coagulation parameters).
血小板（PLT）在止血、免疫和炎症过程的调节中发挥着重要作用。也有证据表明血小板参与动脉粥样硬化和肾小球硬化的发展。本研究的目的是确定慢性肾小球肾炎（CGN）患者血小板的形态和功能变化及其与脂质、蛋白质和凝血因子紊乱的关系。对60例经肾活检确诊为CGN的患者进行了研究：30例无肾病综合征（NS）的CGN患者和30例有NS的CGN+NS患者。使用常规实验室方法评估蛋白质和脂质紊乱、凝血因子。使用Technicon H1血液学自动分析仪测量血小板计数（PLT）、平均血小板体积（MPV）和众数血小板体积（PLT-Mode）。采用比浊法通过凝集测定评估血小板功能（诱导剂：ADP 1-3 microM、胶原50g/ml、肾上腺素0.25-5 microM）。在采血后1-2小时，在无诱导剂的富血小板血浆（PRP）中测量15分钟的自发血小板聚集（SPA）。在30例CGN患者中有9例观察到SPA，在30例CGN+NS患者中有19例观察到SPA。与未出现SPA的患者相比，出现SPA的患者MPV和PLT Mode显著更高。在CGN+NS患者中发现SPA与血浆白蛋白浓度（r = -0.70；p < 0.02）、甘油三酯和胆固醇低密度脂蛋白（r = 0.61；p < 0.05）之间存在显著相关性。与未出现SPA的患者相比，出现SPA的患者活化部分凝血活酶时间（APTT）显著缩短，并且发现SPA与APTT之间存在显著负相关。与对照组相比，CGN和CGN+NS患者对诱导剂的血小板聚集减少。在出现SPA的患者中观察到对聚集诱导剂缺乏第二阶段聚集。结论。1. 血小板高聚集在CGN患者的高凝状态中起重要作用。2. 在大多数CGN+NS患者和一些无NS的患者中观察到体外SPA。3. SPA的发病机制可能是多因素的（低白蛋白血症、血脂异常、凝血参数浓度变化）。
