改良MAIPA与网织血小板检测对免疫性血小板减少症的诊断价值  

Significance of simultaneous measurement of platelet specific autoantibody and reticulated platelet in the diagnosis of immune thrombocytopenia

作　　者：单哲[1] 杨春燕[2] 方美云[1] 

机构地区：[1]大连医科大学附属第一医院血液科,辽宁大连116011 [2]济宁医学院附属医院血液科

出　　处：《临床血液学杂志》2010年第6期644-648,共5页Journal of Clinical Hematology

基　　金：卫生行业科研专项项目(No:200802031)

摘　　要：目的:探讨血小板膜特异性抗体及网织血小板(RP)检测在免疫性血小板减少症(ITP)诊断中的意义及2者的相关性。方法:通过改良的单克隆抗体特异性俘获血小板抗原实验(MAIPA)检测90例ITP患者与20例非免疫性血小板减少患者(NITP)血浆中抗血小板膜糖蛋白(GP)Ⅱb/Ⅲa和Ⅰb/Ⅸ的特异性抗体;应用流式细胞术(FCM)检测以上患者RP%值。结果:①ITP患者抗GPⅡb/Ⅲa、抗GPⅠb/Ⅸ抗体共阳性率为33.30%,单一抗GPⅡb/Ⅲa抗体为8.89%,抗GPⅠb/Ⅸ抗体为12.22%;ITP初发患者血小板膜特异性抗体阳性率为58.73%,复发患者为44.44%,2者差异无统计学意义(P>0.05);糖皮质激素应用前的MAIPA实验阳性率为58.46%,高于用药后的阳性率44.00%;PLT≤30×109/L的ITP患者MAIPA的阳性率58.18%高于PLT>30×109/L患者的阳性率48.75%,但2者差异无统计学意义(P>0.05)。②ITP患者的RP%(5.45±5.78)与正常人(0.81±0.41)比较差异有统计学意义(P<0.05),NITP患者RP%(0.89±0.06)与正常人比较差异无统计学意义(P>0.05);应用糖皮质激素前92.30%ITP患者高于对照,用药后为72.00%,用药前后RP%比较差异有统计学意义(P<0.05)。结论:检测血小板膜特异性抗体的MAIPA实验对ITP的诊断特异性高,单一抗体检测阳性率低,通过2种特异性抗体联合检测可以提高MAIPA的敏感性。糖皮质激素的应用对抗GPⅡb/Ⅲa、抗GPⅠb/Ⅸ抗体的阳性率有影响。RP的检测对于ITP的诊断具有重要意义,该实验也可用于协助激素治疗效果的判断。Objective：To investigate the diagnosis value of platelet glycoprotein specific autoantibody and reticulated platelet（RP） in the patients with immune thrombocytopenia（ITP）,and then analysis the relevance of them.Method：Platelet glycoprotein specific autoantibodies were detected by modified monoclonal antibody immobilization of platelet antigens assay（modified MAIPA） .We used monoclonal antibodies specific to glycoproteins（GP） Ⅱb/Ⅲa andⅠb/Ⅸin 90 patients with ITP and 20 patients with nonimmune thrombocytopenia（NITP） ;RP% were measured by flow cytometry（FCM） .Result：①In 90 patients with ITP,the positive rate of anti-GPⅡ b/Ⅲa was 8.89%,anti-GPⅠb/Ⅸwas 12.22%,anti-GPⅡb/Ⅲa andⅠb/Ⅸwas 33.33%,the total positive rate of antiplatelet membrane glycoprotein autoantibody was 54.44%.The positive rate in new-onset patients was 58.73%,and in recurrent patients was 44.44%,before glucocorticoid treatment was 58.46%,after treatment was 44.00%;the positive rate was 58.18% in patients with PLT≤30×109/L,and 48.57% in patients with PLT 30×10 9 /L.②There was 86.67% patients had high levels of RP%.Compared with the normal group,there was a significant difference（P0.05） .There was 92.30% patients with ITP had high levels of RP%before glucocorticoid treatment,72.00% after glucocorticoid treatment（P0.05） .There was no significant difference between the NITP group and the normal group（P0.05） .Conclusion：Detection of platelet-specific autoantibodies by MAIPA had high specificity for ITP diagnosis.The sensitivity could be increased when combined two specific autoantibodies.The positive rate of anti-GPⅡb/Ⅲa and anti-GPⅠb/Ⅸcould be affected by glucocorticoid.Detection of reticulated platelets had sensitivity for ITP diagnosis.

关 键 词：免疫性血小板减少症 血小板特异性抗体 网织血小板 

分 类 号：R558[医药卫生—血液循环系统疾病]