【作者】 张宁；

【导师】 张华；

【作者基本信息】 大连医科大学 ， 老年医学， 2014， 硕士

【摘要】 目的：老年期人高发心肌梗死、脑卒中、慢性阻塞性肺疾病及恶性肿瘤等多种疾病高发，随着世界范围进入老龄化社会现象的加剧，预防和治疗老年期疾病已成为众多国内外学者的研究方向。大量研究表明多种老年期疾病患者体内存在血小板活化，且活化程度与疾病发生密切相关。血小板参数及其活化标志物在此类疾病中的检测逐渐得到重视，抗血小板活化的治疗方案也在不断完善。老年疾病的预防十分重要，针对老年人体内血小板活化的原因，有学者提出血小板活化与年龄增加相关。但又有研究发现血小板参数或活化标志物的变化与年龄增长并非完全一致，故对上述观点尚存在争议。本研究通过分析血小板参数及其活化标志物随年龄增加的变化，探讨血小板活化与增龄的相关性。恶性肿瘤始终是威胁老年人健康及寿命的主要疾病。血小板颗粒中储存有与肿瘤发生及转移相关的生长因子，血小板活化后可将其大量释放到细胞外，发挥促进或抑制血管生成作用。老年肿瘤患者体内是否存在更高的血小板活化比率，其释放的生长因子是否是促进肿瘤发生的原因之一，关于此类问题的临床研究报道较少。本研究通过比较健康老年人及老年肿瘤患者体内血小板活化标志物及血小板相关生长因子的水平，分析血小板活化与老年人肿瘤发生的相关性。方法：1.利用统计学分析方法比较2012年9月-12月在我院体检中心体检的健康年轻人（25-45岁）、老年人(≥60岁)及肿瘤科老年肿瘤患者血小板参数变化。2.用流式细胞仪细胞分析法分别检测健康年轻人、健康老年体检者及老年肿瘤患者外周血血小板活化标记物CD62P阳性率。3.用酶联免疫吸附法(ELISA)检测健康年轻、老年体检者及老年肿瘤患者血浆中血小板相关生长因子PF4、CTAP-Ⅲ水平。结果：1.健康年轻组、健康老年组、老年肿瘤组PLT以(±s)表示分别为：(236±51)×109/L、（214±54）×109/L、（258±92）×109/L，健康老年组较年轻组减低，老年肿瘤组升高,统计学差异显著（P＜0.01）；MPV分别为（10.45±0.78）fl、（10.41±0.79）fl、（10.13±1.02）fl，在健康年轻组、健康老年组、老年肿瘤组依次降低，但在健康两组差异无统计学意义(P＞0.05)。健康组年龄与PLT显示负相关（r=-0.19），与MPV无统计学相关性（r=0.01，P＞0.05）。2.健康年轻组、健康老年组、老年肿瘤组CD62P阳性率以(±s)表示分别为：（12.89±6.70）%、（20.37±9.52）%、（34.77±10.29）%，依次升高，各组间差异有统计学意义（P＜0.05）。3.血浆血小板因子-4（PF4）水平以(±s)表示分别为：（77.91±46.76）ug/ml、（62.93±34.73）ug/ml、（57.59±44.47）ug/ml，结缔组织激活肽-Ⅲ(CTAP-Ⅲ)水平分别为：（13.45±11.13）ng/ml、（15.13±13.03）ng/ml、（9.53±13.22）ng/ml，在老年肿瘤组均较健康老年组及健康年轻组降低，但差异无统计学意义（P＞0.05）。结论：1.随增龄外周血CD62P阳性率越高，血小板参数变化不明显。2.老年肿瘤患者CD62P阳性率均较健康组升高，血小板参数及血小板相关生长因子（PF4、CTAP-Ⅲ）与肿瘤发生相关性不显著。更多还原

【Abstract】 Objective: The aged are highly susceptible to various diseases, includingmyocardial infarction, stroke, chronic obstructive pulmonary disease, cancer, etc. As theworld is entering the aging society, both domestic and foreign scholars commit to theprevention and treatment of the senile diseases. Previous studies have demonstrated thatthe platelet activation in the aged is involved in multiple diseases, and it is closelyrelated to the senile diseases. Platelet parameters and activation markers in diseaseshave arisen more attention recently, and the antiplatelet therapy continues to improve. Itis of great importance to prevent the old-aged disease; some scholars believe that thereason for platelet activation in elderly people is aging. However, there are few reportsabout the association of the platelet activation and aging. The purpose of the study is todetect the relationship of the platelet parameters, activation markers and age, and toinvestigate the association between platelet activation and age.Malignant tumor is one of the main diseases that threaten the health of the elderly.Platelet granule stores the growth factors that related to tumor metastasis, and it can besecreted extracellular to promote or inhibit angiogenesis after activation of platelet.Whether elderly patients with cancer have higher platelet activation ratio and whetherthe secretion of growth factor is the cause of cancer remain unknown. This studycompared the levels of platelet activation markers and platelet related growth factorsbetween healthy elderly and aged tumor patients, and analyzed the correlation betweenplatelet activation and elderly cancer.Methods:1. We used statistics analysis method to compare the platelet parameters in thehealthy young adults (25-45years old), the aged (≥60years) examined in our hospitalmedical center and the aged tumor patients of the tumor department between theSeptember and December in2012.2. We examined the platelet activation marker CD62P positive rate in the blood ofhealthy young adults, the elderly and aged tumor patients using Flow Cytometry CellMethod.3. Plasma content of platelet factor4(PF4) and connective tissue activating peptideⅢ(CTAP-Ⅲ) in healthy young, elderly and aged tumor patients using enzyme linkedimmune sorbent assay(ELISA). Result:1. PLT in the healthy young adults group, the elderly group and aged tumor groupare expressed as (±s) and were（236±51）×109/L,（214±54）×109/L and（258±92）×109/L respectively. PLT in aged tumor group was significantly higher than healthyyoung adults group, while PLT in the healthy young group was significantly higher thanthe elderly group (P＜0.01). MPV in the three groups were （10.45±0.78） fl,（10.41±0.79）fl and （10.13±1.02）fl respectively. MPV in aged tumor group wassignificantly lower than the other groups, while there was no difference between healthyyoung adults and aged group (P＞0.05). Age and PLT were negatively correlated（r=-0.19）.2. The positive rate of CD62P increased gradually from healthy young adults group,the elderly group to aged tumor group, which were （12.89±6.70）%、（20.37±9.52）%and （34.77±10.29）%respectively, and the differences between each of them werestatistically significant (P＜0.05).3. Both the levels of PF4and CTAP-Ⅲ in plasma in aged tumor group weredecreased than in healthy young and aged group, but there were no statisticaldifferences (P＞0.05).Conclusion:1. CD62P positive rate in the blood was increased with aging, while the changes ofplatelet parameters were not significant.2. Both platelet parameters and CD62P positive rate in aged tumor patients wereincreased than healthy group, the platelet related growth factor was closely related to theoccurrence of tumor.更多还原