分泌GPⅡb/Ⅲa抗体B细胞及血小板特异性抗体检测在特发性血小板减少性紫癜诊断中的意义  

Significance of detection of anti-GP Ⅱ b/Ⅲa antibody secreting B cells and platelet-specific antibody in patients with idiopathic thrombocytopenic purpura

作　　者：陈剑芳[1] 杨林花[1] 董春霞[1] 冯建军[1] 刘秀娥[1] 鹿育晋[1] 常丽贤[1] 刘俊庆[1] 

机构地区：[1]山西医科大学第二医院血液科,太原030001

出　　处：《中华血液学杂志》2010年第9期603-606,共4页Chinese Journal of Hematology

摘　　要：目的 检测特发性血小板减少性紫癜（ITP）患者及非免疫性血小板减少患者分泌GPⅡb/Ⅲa抗体B细胞、血小板特异性抗体的变化,评价其对诊断ITP及非免疫性血小板减少疾病的作用及临床意义.方法 应用酶联免疫斑点技术（ELISPOT）及改良血小板抗原单克隆抗体固相化检测技术（MAIPA）分别检测58例ITP患者、33例非免疫性血小板减少患者及31名正常对照者分泌GPⅡb/Ⅲa抗体B细胞频数、血小板特异性抗体（抗GPⅡb/Ⅲa抗体）表达的变化.结果 ITP患者分泌GPⅡb/Ⅲa抗体B细胞频数[（6.6±4.2）/105个外周血单个核细胞（PBMNC）]明显高于非免疫性血小板减少患者[（2.2±2.0）/105个PBMNC]（P＜0.05）及正常对照组[（1.3±0.5）/105个PBMNC]（P＜0.05）,而分泌GPⅡb/Ⅲa抗体B细胞频数在非免疫性血小板减少患者及正常对照组间的差异无统计学意义（P＞0.05）.通过ELISPOT法检测分泌GPⅡb/Ⅲa抗体B细胞对ITP诊断的敏感性为70.69%,特异性为90.91%,高于改良MAIPA法的敏感性（χ^2=7.03,P＜0.05）.根据ROC曲线,ELISPOT区分ITP患者和非免疫性血小板减少患者的鉴别效度为0.886.结论 通过检测分泌GPⅡ/bⅢa抗体B细胞及血小板特异性抗体能够较好地反映ITP的发病机制.应用ELISPOT方法检测ITP患者分泌GPⅡb/Ⅲa抗体B细胞具有较高敏感性及特异性,可提高ITP的实验窒诊断水平,对指导治疗有一定的临床意义.Objective To detect the frequencies of anti-GP Ⅱ b/Ⅲa antibody secreting B cells and platelet-specific antibody in patients with idiopathic thrombocytopenic purpura （ITP） and non-immune thrombocytopenia, and to evaluate their roles in the diagnosis of ITP and their clinical significance. Methods The frequencies of circulating B cells secreting anti-GP Ⅱ b/Ⅲ a antibody and platelet-specific antibody in 58 ITP patients, 33 non-ITP patients and 31 healthy controls were tested by Enzyme-linked Immunospot Assay （ELISPOT） and modified monoclonal antibody immobilization of platelet antigens assay （MAIPA） respectively. Results The frequencies of circulating B cells secreting anti-GP Ⅱ b/Ⅲ a antibody in ITP patients [（6.6 ±4.2）/105 PBMNC] were significantly increased （ P 〈 0.05 ） than that of the controls [（ 1.3 ±0.5 ）/10 5 PBMNC] and non-immune thrombocytopenic purpura patients [（2.2 ± 2.0）/10 5 PBMNC]. How ever there was no apparent difference between the latter two groups （P〉0.05）. ELISPOT had a sensitivity of 70.69%, a specificity of 90.91% for the diagnosis of ITP, the sensitivity being higher than that of modified MAIPA＇s （43.10%） （χ^2= 7.03, P 〈 0. 05 ）. The ROC curve showed the discriminative validity of cytometric bead array was 0.886. Conclusion The frequencies of circulating B cells secreting anti-GP Ⅱ b/Ⅲ a antibody may reflect the pathogenesis of ITP. ELISPOT assay have high sensitivity and specificity than modified MAIPA for the diagnosis of ITP and the guidance for clinical therapy.

关 键 词：酶联免疫斑点技术 血小板抗原单克隆抗体捕获技术 紫癜 血小板减少性 特发性 抗体 血小板 

分 类 号：R554.6[医药卫生—血液循环系统疾病]