【作者】 孙激扬；

【导师】 季伟；

【作者基本信息】 苏州大学 ， 儿科学， 2008， 硕士

【摘要】 目的1.探讨外周血血小板计数是否可以作为早期判断儿童肺炎病情轻重的指标。2.探讨血小板活化及其炎症因子在儿童喘息性肺炎中的作用。方法1.对102例支气管肺炎伴有血小板增多的患儿(A组)与107例支气管肺炎血小板计数正常的患儿(B组)的临床特点、实验室指标(肝功能、心肌酶谱、白细胞计数、C反应蛋白)、潮气通气肺功能、免疫功能、血小板膜表面CD62P以及血浆肿瘤坏死因子-α(TNF-α)和白细胞介素(IL-6)浓度等进行比较。2.测定21例喘息性肺炎儿童(喘息组)、12例非喘息性肺炎儿童(非喘息组)组和10例健康儿童(健康组)血小板膜表面CD62P的表达、血浆P-选择素和转化生长因子-β(TGF-β)浓度。将三组儿童的富血小板血浆用胶原进行刺激,测定刺激后的血浆TGF-β和P选择素的含量。结果1.A组患儿临床症状比B组患儿重,表现为A组发生呼吸困难和喘息的比例高,住院时间长,白细胞计数高,代表小气道阻塞的肺功能指标呼气达峰时间(tPTEF)、达峰时间比(呼气达峰时间/呼气时间、tPTEF/tE)、剩余25%潮气量时的呼气流速(TEF25)、剩余25%潮气量时的呼气流速/呼气峰流速(TEF25/PTEF%)降低,IgA、IgG水平降低, CD3+细胞比例下降,两组相比有显著性差异(P<0.05)。A组患儿CD3-CD19+和CD19+CD23+细胞比例增高,血小板膜表面CD62P表达增高,血浆TNF-α、IL-6增高,与B组比较差异有显著性(P<0.05)。肺炎伴血小板增多大都发生在小年龄组(P<0.05)。2.喘息组患儿的CD62P比健康组高,两组比较差异有显著性(P<0.05)。三组患儿的富血小板血浆给予胶原刺激,刺激后三组血浆P-选择素和TGF-β浓度均比刺激前增加,有显著性差异(P<0.05)。刺激后喘息组血浆P选择素浓度比非喘息组和健康组高,均有显著性差异(P<0.05)。刺激后喘息组TGF-β浓度最高,非喘息组其次,健康组最低,三组之间两两比较,均有显著性差异(P<0.05)。结论1.外周血血小板计数可作为评判肺炎轻重并指导治疗的实用指标,年龄越小,实用价值越大。2.喘息性肺炎患儿存在血小板活化增强,潜在的血小板内炎症因子高表达。3.血小板及其炎症因子在喘息性肺炎中起促进炎症反应作用。更多还原

【Abstract】 Objective:1. To analyze the clinical significance and prognostic value of platelet count in pneumonia in pediatric patients . 2.To investigate the roles of platelets’activation and platelet released inflammatory factor in pneumonia children with wheezing.Methods:1.The study included 102 patients with thrombocytosis in pneumonia (group A)and 107 patients with normal platelet counts in pneumonia(group B).We compared clinical data, laboratory data(Hepatic function, cardiac enzyme, and C-reactive protein),tidal breathing lung function, immunologic function ,the expression of CD62P on platelets and plasma tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6) concentrations between the two groups. 2.We determined the expression of CD62P on platelets and plasma transforming growth factor-βand P-selectin levels among children in pneumonia with wheezing(wheezing group) , without wheezing(no wheezing group) and normal subjects(normal group).We isolated platelet-rich plasma from these children’s blood . Then stimulated the platelet-rich plasma with collagen for 30 minutes . Plasma transforming growth factor-β(TGF-β) and P-selectin levels were measured after stimulation.Results:1. Compared with group B, group A had a more severe clinical conditions:presence higher percentage of dyspnea and wheezing and longer hospitalization, white blood count increased ,lung faction parameter including tPTEF、tPTEF/tE、TEF25 and TEF25/PTEF %decreased ,the levels of IgA、IgG in serum declined,the ratio of CD3+leukomonocyte’s declined,CD3-CD19+ and CD19+CD23+ leukomonocyte percentage increased, the expression of CD62P on platelets and plasma TNF-αand IL-6 concentrations raised .The difference between the two groups was statistically significant (P<0.05). Patientes in group A were younger than patients in group B, The difference between the two groups was statistically significant (P<0.05).2.The expression of CD62P on platelet in wheezing group was higher than that of normal group, the difference between the two groups was statistically significant (P<0.05). After stimulated the platelet-rich plasma with collagen for 30 minutes , plasma transforming growth factor-β(TGF-β)and P-selectin levels were higher than before stimulation, the difference was statistically significant (P<0.05). The plasma P-selectin concentration of wheezing group after stimulation is higher than that of no wheezing group and normal group,and the difference between them was statistically significant (P<0.05). After stimulation , the plasma TGF-βconcentration of wheezing group after stimulation is higher than that of no wheezing group and normal group, while the plasma TGF-βconcentration of no wheezing group is higher than that of normal group, the difference between them were statistically significant (P<0.05).Conclusions:The severity of pneumonia in chidren is associated with platelet count . Platelet count is a useful clinical marker in judging the severity of pneumonia and guiding therapy, especially in low ages such as infants. The platelet of patients with wheezing had enhanced activity and had much more inflammatory factors . After stimulation,the platelet of patients with wheezing actived and released much more inflammatory factors such as TGF-βand P-selectin and promoted inflammation and induced wheezing .更多还原