肾综合征出血热患者血小板的超微结构与功能的关系

目的　探讨肾综合征出血热 (HFRS)患者早期循环中血小板超微结构与功能变化的关系。方法　动态检测 5 0例HFRS患者的血小板计数 (BPC ,直接试管法 )、血小板黏附率 (PAdT ,玻珠柱法 )、血小板聚集率 (PAgT ,比浊法 ) ,并运用透射电镜技术对 8例早期患者循环中血小板的超微结构进行观察。结果　HFRS患者早期即有大量血小板变性、空泡化、膜裂解、颗粒物质减少 ,在异常的血小板内可见到特征性的汉坦病毒颗粒 ;此外 ,HFRS病程各期血小板的数量和功能均有规律性的改变 ;自发热期 ,HFRS患者BPC、PAdT、PAgT逐渐降低 ,至低血压休克、少尿期 ,以上改变达顶峰 ,从多尿期开始逐渐恢复 ,至恢复期接近正常。对不同病型的患者 ,以上各指标有显著差异 (P <0 .0 1)。结论　HFRS早期病毒侵入与血小板超微结构、功能改变有其相关性。

The relationship between ultrastructure and function of the circulating platelets in HFRS patients

Objective To study the relationship between ultrastructure and function of the circulating platelets in patients with hemorrhagic fever with renal syndrome (HFRS). Methods Blood platelet count (BPC, direct method), platelet adhesion test (PAdT, glass bead cylinder method) and platelet aggregation test (PAgT, turbidimetry) were determined in 50 cases of HFRS. The ultrastructure of circulating platelets were also studied in 8 early-stage HFRS patients by using the routine transmission electron microscope (TEM). Results Characteristic Hantaviruses were found in the platelets, and degeneration, vacuolation, membrane lysis and decrease of α-granule and dense granule of the platelets were also seen in the 8 patients. BPC, PAdT and PAgT began to decrease early from febrile, and they decreased most in hypotensive or iliguric stage, and they began to rise from diuretic stage. Moreover, these changes were notable in patients of severe type (P< 0.01). Conclusion A positive correlation exists between the invasion of Hantavirus and ultrastructure and dysfunction of the circulating platelets in earlier HFRS patients.