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目的：本研究拟通过检测血浆中的几种血小板microRNAs来观察输血对先天性心脏病患儿血小板活性的影响，以进一步明确输血导致缺血性并发症的相关机制，为临床合理用血提供参考。方法2013年10月至2014年6月，选择本院100例拟行先天性心脏病矫治术的患儿作为研究对象，输血组和未输血组各50名。输血组将患儿静脉血1．8 ml与0．5 ml同型贮存红细胞悬液混合，30 min后检测各项指标。采用流式细胞仪检测血小板表面P－选择素的表达水平以及血小板微粒（PMP）的含量。光密度比浊法检测两组患儿ADP诱导下血小板的聚集功能。运用Taqman探针实时荧光定量聚合酶链反应（ RT－PCR）检测血浆血小板来源的miR－223、miR－24、miR－126、miR－191的水平。进一步比较未输血组患儿中，非紫绀型亚组与紫绀型亚组间血小板活性、聚集功能及上述几种microRNAs的表达有无差异。结果两组患儿输血前血红蛋白（ Hb）水平无组间差异（ P＞0．05），输血组加入0．5 ml贮存红细胞悬液后，Hb较之前升高（23±6）g／L。输血组较未输血组，血小板表面P－选择素的表达水平、PMP的含量以及血小板聚集功能均明显增高（ P＜0．05）。输血组血浆血小板来源的几种microRNAs含量较未输血组明显升高（ P＜0．05），以miR－223的差异性最为显著。未输血组中，紫绀型亚组血小板激活程度较非紫绀型亚组明显增高，血小板聚集功能明显降低，几种microRNAs的表达均较高（ P＜0．05）。结论输血可引起血浆中血小板来源的microRNAs表达增高，尤其是miR－223，可作为研究不同疾病状态下血小板活性的指标。为减少输血相关不良反应，临床输血应严格掌握用血指征。“,”Objective The aim of this study is to observe the impact of packed RBC transfusion on platelet activation and ag?gregation in vitro in pediatric patients with cardiac disease and to clarity whether circulating platelet microRNAs could be serve as a new indicator of platelet activation. Methods One hundred infant patients were randomly divided into 2 groups, transfusion group and non-transfusion group. Each group has 50 patients. In vitro transfusions were performed by the addition of RBC obtained from transfusion packs into fresh whole blood with a ratio about 1:4 (0.5 ml of RBC mixed with 1.8 ml of whole blood). After 30 min, the expression of P-selectin and the content of platelet microparticle (PMP) were tested by flow cytometry. Light transmission aggregometry was per?formed to determine the platelet aggregation. The expression levels of four kinds of circulation platelet microRNAs were detected by Taq?man quantitative real-time PCR. Results There were no significant difference in the baseline hemoglobin level between the two groups ( P>0. 05 ) . After RBC transfusion, the Hb level was elevated by 23 ± 6 g/L. Compared with non-transfusion group, platelet aggregation in transfusion group was significantly increased( P<0.05).Platelet activation was also increased by transfusion as confirmed by the elevation of P-selectin and PMP expressions induced by 20μM ADP. Similar results were found with the four kinds of circulat?ing platelet microRNAs ( P<0.05) . In the non-transfusion group, the levels of four kinds of microRNAs in the cyanotic subgroup were significantly elevated than the acyanotic subgroup( P<0.05) . Conclusion RBC transfusion increases in vitro platelet activation in pe?diatric patients with cardiac disease, providing a possible explanation for the increase in recurrent ischemic event and mortality reported after RBC transfusion in clinical practice. Circulation platelet microRNAs may serve as a new marker of platelet activation.