血小板相关抗体及淋巴细胞亚群检测在儿童原发免疫性血小板减少症早期治疗效果评估中的作用  

The effect of platelet-associated antibodies and lymphocyte subsets levels on early treatment evaluation in primary immune thrombocytopenia children

作　　者：张雪[1] 陈振萍[1] 巩文玉[1] 

机构地区：[1]首都医科大学附属北京儿童医院血液肿瘤中心,儿童血液病与肿瘤分子分型北京市重点实验室,儿科学国家重点学科,100045

出　　处：《检验医学与临床》2015年第20期2981-2983,共3页Laboratory Medicine and Clinic

基　　金：国家自然科学基金资助项目(81200351);北京市自然科学基金资助项目(7152053);北京市医院管理局临床医学发展专项经费资助(ZY201404)

摘　　要：目的研究血小板相关抗体(PA-Ig)水平及淋巴细胞亚群检测在原发免疫性血小板减少症(ITP)患儿早期临床治疗效果评估中的作用。方法采用流式细胞术检测111例ITP患儿和27例健康儿童(对照组)的PA-IgG、PA-IgM、PA-IgA水平及淋巴细胞亚群,同时对患儿早期治疗效果进行评估。结果根据早期治疗效果,将ITP患儿分为完全反应组、有效组、无效组。ITP患儿各组PA-IgG、PA-IgM水平较对照组均有明显升高(P<0.05),无效组PA-IgA水平显著高于对照组(P<0.05),完全反应组和有效组PA-IgA水平与对照组差异无统计学意义(P>0.05)。完全反应组PA-IgG、PA-IgM水平明显低于有效组和无效组(P<0.05),有效组PA-IgG、PA-IgM水平明显低于无效组(P<0.05)。无效组PA-IgA水平最高。完全反应组、有效组及无效组CD3+、CD3+/CD4+、CD3+/CD8+及CD19+表达水平与对照组比较,差异均有统计学意义(P<0.05),但ITP患儿各组CD16+/CD56+表达水平与对照组差异无统计学意义(P>0.05)。结论 ITP患儿血液中PA-Ig高水平表达及多种抗体混合高表达提示早期治疗效果欠佳,淋巴细胞亚群结果提示ITP患儿存在细胞及体液免疫功能异常,这将为调整治疗方案提供重要的实验室依据。Objective To study the effect of platelet-associated antibodies（PA-Ig）and lymphocyte subsets levels on early treatment evaluation in children with primary immune thrombocytopenia（ITP）.Methods Flow cytometry was used to detect the levels of PA-IgG,PA-IgM,PA-IgA and lymphocyte subsets molecule expression in111 cases of newly diagnosed children ITP and 27 healthy children（control group）.In addition,the effect of early treatment in children ITP was assessed.Results The ITP children were divided into complete response（CR）group,partial response（PR）group and no response（NR）group,according to the early treatment effect.The levels of PAIgG and PA-IgM in CR group,PR group and NR group were significantly higher than those in the control group（P〈0.05）.Compared to the control group,PA-IgA level in NR group was significant higher（P〈0.05）,however,there was no statistical difference of PA-IgA levels observed in CR group and PR group（P〉0.05）.The levels of PA-IgG and PA-IgM in CR group were statistical lower than those in PR group and NR group（P〈0.05）.The levels of PA-IgG and PA-IgM in PR group were significantly lower than NP group（P〈0.05）.The PA-IgA level of NP group was the highest.Compared with control group,there were significant difference of CD3＋,CD3＋/CD4＋,CD3＋/CD8＋and CD19＋in CR group,PR group and NR group（P〈0.05）.However,there was no significant difference of CD16＋/CD56＋between each ITP subgroups and control group（P〉0.05）.Conclusion Higher PA-Ig levels and a mixed high expression of PA-Ig in ITP children often predict poor outcome of early treatment,and lymphocyte subsets indicate cellular and humoral immune dysfunction in ITP children,which would provide an important laboratory basis for the follow-up treatment and adjustment solution.

关 键 词：血小板相关抗体 淋巴细胞亚群 原发免疫性血小板减少症 儿童 

分 类 号：R558.2[医药卫生—血液循环系统疾病]