| Objective:Perihip fractures include femoral neck and intertrochanteric fractures.The elderly are more likely to have perihip fractures under the damage of low energy due to the decrease of body function,poor limb muscle strength and osteoporosis.After that,the body is in a state of hypercoagulable due to various factors such as bleeding,limb braking,release of inflammatory factors and the increased metabolism of various substances in the body.This study discussed the microparticles(MPs)in the role of the state of hypercoagulable in patients with perihip fracture by comparing the different types of MPs levels and activated clotting time(ACT)in the peripheral blood of perihip fracture patients and non-fracture population.The effect of MPs on classic coagulation function also be detection.The mechanism of MPs in hypercoagulability in patients with peripheral hip fractures were preliminarily discussed and the change of the ACT after MPs removed by Lactadherin protein aimed to provide a theoretical basis for the new treatment of hypercoagulable state in patients with perihip fracture.Methods:(1)Perihip fracture patients admitted to the orthopedic emergency department of our hospital from December 2018 to September 2019 who met the inclusion criteria were collected as the fracture group.At the same time,the health examination center collected the non-fracture people who met the inclusion criteria as the control group.2ml venous blood was collected from superficial vein in forearm in the morning from these research objects;(2)The nanoparticle tracking analyzer and transmission electron microscope were used to observe the purified particles.(3)Flow cytometry was used to determine the level of MPs expressing phosphatidylserine(PS)and platelet-drived microparticles(PMPs)in the peripheral blood of the objects.(4)The application of blood coagulation and platelet function analyzer was developed for the determination of fracture group and control group ACT,and detect the change of the ACT after MPs removed by Lactadherin protein;(5)The automatic coagulation analyzer was applied to measure the blood coagulation function of each sample CFP before and after MPs filtration and removal;Results:(1)The morphology of MPs has a complete double-layer membrane structure.The size is within 100-1000nm and the morphology is uneven.The size of MPs in peripheral blood of group with perihip fracture was(245.4±3.6)nm.The size of MPs in peripheral blood of control group was(236.5±2.7)nm,and there was no significant difference in MPs diameter between the two groups(P>0.05);(2)The counts of AV~+MPs in perihip fracture group was(564.3±171.0)/ul,PMPs:(326.0±103.8)/ul,the counts of AV~+MPs in control group was(251.9±81.5)/ul,PMPs:(192.1±40.6)/ul,there was a statistical difference between the two(P<0.01).The level of ACT in peripheral blood of group with perihip fracture was(323.8±93.9)s,the control group ACT was(535.5±76.2)s,the difference between the two was statistically significant(P<0.01);(3)According to shapiro-wilk test,the distribution is normal and there are no outliers.There was a linear relationship between AV~+MPs count and ACT value in peripheral blood samples of the perihip fracture group,and Pearson correlation analysis showed a highly negative correlation between AV~+MPs count and ACT value(r=-0.827,P<0.001).However,there is no linear relationship between PMPs count and ACT value,and there is no correlation between them(P>0.05).;(4)The results of CFP were PT:(10.8±0.46)s,APTT:(30.6±1.56)s and Fib:(3.08±0.36)g/L,INR:(0.98±0.04),TT:(19.3±0.62)s;After MPs were filtered from CFP,PT:(10.8±0.52)s,APTT:(32.4±3.0)s,Fib:(2.90±0.33)g/L,INR:(0.99±0.05)s and TT:(19.9±0.63)s were detected.There was no significant difference(P>0.05);(5)The ACT in perihip fracture was(340.4±38.51)s.The ACT in the protein group that add Lactadherin protein was(898.4±35.7)s,The negative control group that add PBS was(331.1±41.19)s,there was a statistically significant difference between the three groups(F=1001.41p<0.01).There was a statistically significant difference between the fracture group and the protein group,the negative control group and the protein group(p<0.001),there was no statistically significant difference between the fracture group and the negative control group(p>0.05).Conclusion The levels of AV~+MPs and PMPs in perihip fracture group were higher than those in control group.MPs had no significant effect on the coagulation function.Lactadherin protein have the function of the correct hypercoagulable state in vitro. |
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