持续性和慢性免疫性血小板减少症患儿免疫抗体表达的意义  

Expression of immune autoantibodies in children with persistent/chronic immune thrombocytopenia

作　　者：李珊珊[1] 蒋慧[1] 夏敏[2] 

机构地区：[1]上海交通大学附属儿童医院,上海市儿童医院血液肿瘤科,200040 [2]上海交通大学附属儿童医院,上海市儿童医院检验科,200040

出　　处：《中华实用儿科临床杂志》2015年第7期517-520,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：上海市科委重大项目子课题（12411952406）;适宜技术联合开发推广应用项目（SHDCl2012221）

摘　　要：目的 探讨免疫抗体在儿童持续性和慢性免疫性血小板减少症（pITP/cITP）中的表达及临床意义.方法 2013年12月至2014年8月上海市儿童医院血液肿瘤科确诊为pITP/cITP的34例患儿为研究组,其中男20例,女14例;中位年龄5岁（9个月-12岁）.其中pITP 14例,cITP 20例,选取同期上海市儿童医院性别、年龄匹配的健康体检儿童20例（健康对照组）和新诊断ITP患儿24例（新诊断ITP组）作为对照.流式细胞术测定血小板相关免疫球蛋白（PAIg）和流式微球法检测血小板特异性自身抗体.结果 cITP组中血小板表面的PAIgA、PAIgM、PAIgD和血小板膜糖蛋白（GP）Ⅲa、GPⅡb特异性自身抗体均明显高于健康对照组（P＜0.05）,pITP组血小板表面GPIb、GPⅢa、GPⅡb、血小板颗粒膜蛋白140 （GMP140）特异性自身抗体明显高于健康对照组（P＜0.05）,cITP组GPⅨ、GPⅢa、GMP140及pITP组GPⅡb特异性自身抗体低于新诊断ITP组（P＜0.05）,且pITP组GPIⅨ、GP Ⅰb、GPⅡb、GMP140特异性自身抗体高于 cITP组;cITP组中PAIgM与血小板计数呈负相关（P ＜0.05）;GPⅢa的受试者工作特征（ROC）曲线下面积（AUC）高于其他血小板自身抗体.结论 血小板自身抗体在儿童pITP/cITP病情迁延中可能发挥重要作用,其中,特异性自身抗体水平虽呈下降趋势,但高于正常水平,可能为其重要机制;GPⅢa特异性自身抗体对pITP/cITP诊断价值优于其他抗体.Objective To investigate the expression and clinical significance of platelet autoantibodies in children with persistent/chronic immune thrombocytopenia （pITP/cITP）.Methods Total of 34 children diagnosed with pITP/cITP（14 cases and 20 cases,respectively）in the Department of Hematology and Oncology,Shanghai Children＇s Hospital from December 2013 to August 2014 were enrolled as the study group,including 20 male and 14 female,the median age of 5 years old.The study also included 20 healthy children （the healthy control group） matched with gender and age,and 24 cases of newly diagnosed ITP （newly diagnosed ITP group） serving as the control groups.Platelet-associated immunoglobulin （PAIg） and platelet-specific autoantibodies on surface of platelets were mea-sured by flow cytometry or flow cytometric bead.Results Significant elevation of PAIgA,PAIgM,PAIgD and specific autoantibodies against glucoprotein（GP） Ⅲa,and GP Ⅱb were demonstrated in children with cITP,as well as specific autoantibodies against GP Ⅰ b,GP Ⅲ a,GP Ⅱ b,and granule membrane protein 140 （GMP140） in children with pITP,compared with the healthy control group（P 〈 0.05）;the levels of GPⅨ,GP Ⅲ a,GMP140 in cITP group and GP Ⅱ b in pITP showed significant declination,compared with the newly diagnosed ITP group（P 〈 0.05）;between piTP group and cITP group,autoantibodies GPⅨ,GP Ⅰ b,GP Ⅱ b,and GMP140 in the latter were much lower（P 〈 0.05）.Significant negative relation between PAIgM and platelet count was found in cITP group （P 〈 0.05）.Receiver operating characte-ristic （ROC） curve analysis showed that the area under ROC curve （AUC） of GP Ⅲ a autoantibodies was larger than that of other platelet-autoantibodies in pITP/ciTP diagnosis.Conclusions Platelet autoantibodies play a significant role in pITP/ciTP,especially platelet-specific autoantibodies,which show a declining tendency in the course and may be the main mechanism.The detection of GPⅢa specific autoantibody is more ad

关 键 词：持续性/慢性免疫性血小板减少症 血小板抗体 表达 临床意义 

分 类 号：R725.5[医药卫生—儿科]