登革热患者血小板减少与血小板膜糖蛋白特异性抗体相关  

Thrombocytopenia in Dengue Fever was Correlated with Specific Antibody against Platelet Membrane Glycoprotein

作　　者：杨方集[1] 吴元凯[1] 陈淑如[1] 谢茜[2] 李新华[1] 朱昌浩 谢冬英[1] 崇雨田[1] 

机构地区：[1]中山大学附属第三医院感染科//热带病防治研究教育部重点实验室,广东广州510630 [2]南方医科大学公共卫生与热带医学学院三级生物安全实验室//广东省热带病研究重点实验室,广东广州510515

出　　处：《中山大学学报（医学科学版）》2016年第3期326-332,共7页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省科技计划项目(2013A020229001;2013A020229002)

摘　　要：【目的】了解登革热患者血小板膜糖蛋白特异性抗体(抗GPIIb/IIIa和抗GPIb/IX)的表达,探讨登革热患者血小板减少是否与血小板膜糖蛋白特异性抗体相关。【方法】用改良的血小板抗原单抗特异性固相化法(MAIPA法)检测51例登革病毒1型(DENV-1)登革热患者和50例健康者血清的抗GPIIb/IIIa和抗GPIb/IX特异性抗体,分析血小板膜糖蛋白特异性抗体水平和血小板计数的相关性。【结果】51例DENV-1登革热患者血清中血小板膜糖蛋白特异性抗体抗GPIIb/IIIa、抗GPIb/IX和双抗体总体阳性率分别为35.3%(18/51)、37.3%(19/51)和43.1%(22/51);与50例健康者的阳性率8.0%(4/50),6.0%(3/50)和10.0%(5/50)相比,差异有统计学意义(P<0.001)。重度血小板减少登革热患者(PLT<50×109/L)血清中,抗GPIIb/IIIa和抗GPIb/IX抗体检出率为100%(6/6)和83.3%(5/6),血小板计数无减少登革热患者血清中抗体阳性率为14.8%(4/27)和29.6%(8/27),差异有统计学意义(P=0.0001,P=0.015)。在登革热血小板计数减少患者血清中,抗GPIIb/IIIa和抗GPIb/IX抗体水平与血小板计数呈负相关(r=-0.58,P<0.001;r=-0.44,P<0.05)。【结论】登革热患者血小板减少与血小板膜糖蛋白特异性抗体抗GPIIb/IIIa和抗GPIb/IX相关;免疫因素参与登革热患者血小板减少的破坏过程。[Objective] To investigate the expression of platelet membrane glycoprotein specific antibodies （anti-GPIIb/IIIa and anti-GPIb/IX） in the patients with dengue fever, it was explored that whether thromboeytopenia in dengue fever was correlated with specific antibody against platelet membrane glycoprotein. [ Methods ] A modified monoclonal antibody specific immobilization of platelet antigens （MAIPA） method was used to detect the anti-GPIIb/IIIa and anti-GPIb/IX in the sera of 51 DENV-1 dengue fever patients and 50 healthy volunteers. The correlation between the antibody and platelet count was analyzed. [ Results ] The positive rate of anti-GPIIb/IIIa, anti-GPIb/IX and general positive rate were 35.3% （18/51）, 37.3% （19/51） and 43.1% （22/51） respectively in 51 DENV-I dengue fever patients. Compared with the antibody positive rate of 50 healthy volunteers [8.0% （4/50）, 6.0% （3/50） and 10.0% （5/50） respectively], the differences were statistically significant （P〈0.001）. The positive rate of anti-GPIIb/IIIa and anti-GPIb/IX in dengue fever patients with severe thrombocytopenia （PLT 〈 50 × 109/L） were 100% （6/6） and 83.3% （5/6）. Compared with the antibody positive rate of dengue fever patients without thrombocytopenia [ 14.8% （4/27） and 29.6% （8/27）], the differences were statistically significant （P = 0.0001; P = 0.015）. The anti-GPIIb/IIIa and anti-GPIb/IX antibody levels were negatively correlated with platelet count in dengue fever patients with thrombocytopenia （r = -0.58, P 〈 0.001 ; r = -0.44, P 〈 0.05）. [ Conclusion ] Thrombocytopenia in dengue fever was correlated with specific antibody against platelet membrane glycoprotein. Immune thrombocytopenia was involved in the destruction of platelet of dengue fever patients.

关 键 词：登革热 登革病毒1型 血小板减少 血小板膜糖蛋白 血小板抗体 

分 类 号：R512.99[医药卫生—内科学]