ITP血小板特异性自身抗体(GPⅡb/Ⅲa和GPIbα)与糖皮质激素和静脉丙种球蛋白临床疗效的关系  

Relationship Between Specific Autoantibodies Against Platelet Glycoprotein(GPⅡb/VⅢa and GPIbα) and Clinical Therapeutic Effect(glucocorticosteroid and IVIG) in Idiopathic Thrombocytopenic Purpura

作　　者：陶莉莉[1] 鲍静[1] 缪华伟[1] 杨明珍[1] 夏瑞祥[1] 倪合宇[2] 曾庆曙[1] 

机构地区：[1]安徽医科大学第一附属医院血液内科,安徽合肥230022 [2]加拿大多伦多大学实验医学与病理生物学系

出　　处：《中国微循环》2009年第3期193-196,共4页Journal of Chinese Microcirculation

基　　金：安徽省科技厅重点科研计划项目(07020303076)

摘　　要：目的检测特发性血小板减少性紫癜(ITP)患者体内的抗血小板膜糖蛋白(GPⅡb/Ⅲa和GPIbα)特异性自身抗体,并探讨特异性自身抗体与糖皮质激素和静脉丙种球蛋白(静丙)治疗的临床疗效是否存在针对性,以便得到更经济和个体化的治疗方案,为ITP提出新的分型依据。方法应用改良的单克隆抗体特异性俘获血小板抗原(MAIPA)法检测抗GPⅡb/ⅡIa,GPIbα特异性自身抗体。结果双抗体阳性组与单一抗GPIbα抗体阳性组总疗效比较,差异无显著性(χ2=0.995,P>0.05)双抗体阳性组与单一抗GPⅡb/ⅡIa抗体阳性组总疗效比较,差异有显著性(χ2=17.439,P<0.01),后者优于前者;单一抗GPⅡb/ⅡIa抗体阳性组,双抗体阳性组,双抗体阴性组,糖皮质激素治疗与糖皮质激素联合静丙治疗比较,差异无显著性(P>0.05)。结论血小板特异性自身抗体种类(GPⅡb/Ⅲa和GPIbα)及种类数目与ITP的临床疗效(糖皮质激素、静丙)有一定关系,对临床治疗方案的选择有一定意义。以抗血小板膜糖蛋白(GPⅡb/Ⅲa和GPIbα)特异性自身抗体为ITP进行新的分型依据尚不足,需扩大样本量进一步研究。Objective To evaluate the clinical significance of the relationship between specific autoantibodies against platelet glycoprotein（GPⅡb/Ⅲa and GPIbα） and clinical therapeutic effect（ glucocorticosteroid and IVIG） in idiopathic thrombocytopenie purpura（ITP）. To find the more economical, individualized treatment and the basis for the new clinical classification of ITP. Methods Specific autoantibodies against platelet glycoprotein were measured by a monoclonal antibody immobilization of platelet antigen assay（ MAI- PA）. Results The frequency of eatabatie cases in patients with mono-specifie antibodies to GPIIblIIa was significantly higher than that in patients with antibodies to both antigens（ X^2 = 17. 439, P 〈 0.01）. No significant difference was observed between patients with antibodies to both antigens and patients who had mono-specific antibodies to GPIboα（ X^2 = 0.995, P 〉 0.05）. The clinical therapeutic effects（ IVIG and glucocorticosteroid） in patients with mono-specific antibodies to GPIIbllla, antibodies to both antigens and no detectable antibody to either platelet antigen are not so different（ P 〉 0.05）. Conclusion The kinds of the specific autoantibodies against platelet glycoprotein might be related to clinical therapeutic effect in ITP. The autoantibodies would play a significant role in selecting effective treatment. Typing of autoantibodies for ITP is insufficient, the sample size should be expanded for further study.

关 键 词：紫癜 特发性 抗体 血小板糖蛋白 

分 类 号：R554.6[医药卫生—血液循环系统疾病]