血小板相关抗体IgG初筛不能提高单克隆抗体特异性俘获血小板抗原对免疫性血小板减少性紫癜诊断的敏感性  

The screening assay of platelet-associated immunoglobulin G can not improve the sensitivity of monoclonal antibody immobilization of platelet antigens assay in immune thrombocytopenic purpura

作　　者：衣翠华[1] 侯明[2] 朱媛媛[3] 秦平[2] 

机构地区：[1]山东大学齐鲁医院化疗科,济南250012 [2]山东大学齐鲁医院血液内科,济南250012 [3]山东大学齐鲁医院血液病研究室,济南250012

出　　处：《中华检验医学杂志》2007年第3期269-272,共4页Chinese Journal of Laboratory Medicine

基　　金：国家自然科学基金(30300312;30470742;30570779);卫生部2004-2006年临床学科重点项目

摘　　要：目的评价血小板相关抗体 IgG(PAIgG)初筛能否提高单克隆抗体特异性俘获血小板抗原(MAIPA)技术对免疫性血小板减少性紫癜(ITP)诊断的敏感性。方法用酶联免疫吸附竞争法检测 PAIgG,改良 MAIPA 技术检测抗血小板 GPⅡb/Ⅲa、GPⅠb/Ⅸ特异性抗体;190例血小板减少症患者同时行 PAIgG 及 MAIPA 检测,其中132例为 ITP 患者;采用 Kappa 检验进行两种诊断试验的一致性分析。结果单做 PAIgG 及 PAIgG 与 MAIPA 并联诊断 ITP 的敏感度分别为85.6%和90.2%,较单做 MAIPA(53.0%)分别提高32.6%与37.2%;特异度分别为29.3%和24.1%,较单做MAIPA(81.0%)则分别下降51.7%与56.9%;PAIgG 与 MAIPA 串联诊断 ITP 的敏感度、特异度、阳性预测值、阴性预测值分别为48.5%、86.2%、88.9%和42.4%,均与单做 MAIPA 相当。ITP 与非免疫性血小板减少症患者 PAIgG 与 MAIPA 测定结果之间的 Kappa 值分别为0.129与0.012,即两种试验对 ITP 及非免疫性血小板减少症诊断的一致性均较差。结论 PAIgG 检测不能作为 MAIPA 的过筛试验。Objective To evaluate if the assay of platelet-associated immunoglobulin G （PAIgG） can improve the sensitivity of monoclonal antibody immobilization of platelet antigens assay （MAIPA） in immune thrombocytopenic purpura （ITP）. Methods Anti-GP Ⅱ b/Ⅲ a and anti-GP Ⅰb/IX autoantibodies were detected by a modified MAIPA; PAIgG was detected by competitive ELISA. MAIPA and PAIgG were done simultaneously in 190 patients with thrombocytopenia, in which 132 were diagnosed as ITP according to the diagnostic criteria. Kappa test was used to analyze the concordance between MAIPA and PAIgG. Results The sensitivities of PAIgG alone or in parallel with MAIPA to ITP were 32. 6% and 37. 2% higher than MAIPA alone respectively, while their specificities were 51.7% and 56. 9% lower respectively. The sensitivity, specificity, positive predictive value, negative predictive value of PAIgG in series with MAIPA were all not superior to MAIPA alone. The kappa values between MAIPA and PAIgG in ITP and non-immune thrombocytopenia were 0. 129 and 0. 012 respectively, which meant the concordance between them was poor. Conclusion The detection of PAIgG should not be used as screening before MAIPA in distinguishing immune from non-immune thrombocytopenia.

关 键 词：紫癜 血小板减少性 特发性 抗体 诊断 筛查 

分 类 号：R446.6[医药卫生—诊断学]