血小板膜表面自身抗体表达与大剂量地塞米松治疗ITP疗效的关系  

The impact of platelet membrane autoantibodies on high-dose dexamethasone therapy in patients with idiopathic thrombocytopenic purpura

作　　者：王蕊[1] 秦平[1] 冀学斌[1] 侯明[1] 

机构地区：[1]山东大学齐鲁医院肿瘤中心血液科,济南250012

出　　处：《中华血液学杂志》2009年第9期619-621,共3页Chinese Journal of Hematology

基　　金：国家自然科学基金（30600259;30770922;30800491;30801258）;卫生部临床学科重点项目（2007-2009）;国家973资助项目（2006CB503800）;教育部全国优秀博士论文专项基金（200561）;山东省优秀中青年科学家科研奖励基金（2008BSB03009）;国家卫生行业公益性科研专项（200802031）;泰山学者岗位基金;教育部新世纪优秀人才支持计划（NCET-07-0514）

摘　　要：目的评价特发性血小板减少性紫癜（ITP）患者血小板膜糖蛋白（GP）特异性自身抗体对大剂量地塞米松冲击治疗效果的影响。方法应用改良直接单克隆抗体俘获血小板抗原（MAIPA）技术检测血小板膜GPⅡb／Ⅲa、GPⅠb特异性自身抗体的表达。所有患者均接受口服地塞米松40mg，每日1次，共4d。结果大剂量地塞米松治疗后，GPⅡb／Ⅲa、GPⅠb自身抗体阴性患者疗效（64．2％）明显优于自身抗体阳性患者（42．1％）（P〈0．05），GPⅡb／Ⅲa自身抗体阳性（36．4％）与阴性（63．8％）患者的疗效差异有统计学意义（P〈0．05），GPⅠb自身抗体对疗效没有明显影响（P〉0．05）。结论血小板膜GPⅡb／Ⅲa特异性自身抗体检测可作为ITP患者口服大剂量地塞米松疗效预测的潜在指标。Objective To evaluate the impact of platelet membrane glycoprotein （GP）-specific autoantibodies on high-dose dexamethasone therapy in patients with idiopathic thrombocytopenic purpura （ITP）. Methods Modified direct monoclonal antibody immobilization of platelet antigen assay （MAIPA） was used to detect platelet GP Ⅱ b/Ⅲ a and/or GPⅠ b specific autoantibodies. All patients received oral dexamethasone 40 mg/d for 4 days. Results The response rate of high-dose dexamethasone in GP Ⅱ b/Ⅲ a and/or GP Ⅰ b specific autoantibody-negative patients was significantly different from that of antibody-positive patients （P 〈 0.05 ）. The response rate of GP Ⅱ b/Ⅲ a specific autoantibody-positive patients was lower than that of antibody-negative patients （ P 〈 0.05 ）. GP Ⅰ b specific autoantibody had no significant impact on the efficacy of high-dose dexamethasone （P 〉 0.05 ）. Conclusion Platelet membrane GP Ⅱ b/Ⅲ a-specific autoantibody can be a potential negative indicator for ITP patients＇ response to high-dose oral dexamethasone.

关 键 词：紫癜 血小板减少性 特发性 抗体特异性 直接单克隆抗体俘获血小板抗原 血小板计数 

分 类 号：R686[医药卫生—骨科学]