影响获得性血栓性血小板减少性紫癜首次缓解期内复发的相关指标研究  

Study on correlation indexes with recurrence of acquired thrombotic thrombocytopenic purpura during the first remission

作　　者：鲁旭娟 李笑峰[1] 陈满强 谢晓园[3] 

机构地区：[1]西安市中心医院检验科,710003 [2]陕西省渭南市富平县医院内科,711700 [3]延安大学附属医院干部病房,陕西延安716000

出　　处：《国际输血及血液学杂志》2016年第5期374-379,共6页International Journal of Blood Transfusion and Hematology

摘　　要：目的探讨血管性血友病因子裂解蛋白酶（ADAMTS）13活性和抗ADAMTS13抗体表达水平，与获得性血栓性血小板减少性紫癜（TTP）于首次缓解期内复发的关系。方法选择2008年3月至2014年6月于陕西延安大学附属医院和陕西省渭南市富平县医院诊治的37例获得性TTP患者为研究对象，按照其在首次缓解随访期内是否复发，分为研究组（n=15）和对照组（n=22）。分别采用残余胶原结合试验、ELISA、免疫印迹等方法，检测两组患者的ADAMTS13活性，ADAMTS13抗原水平，抗ADAMTS13抗体，ADAMTS13抑制物，血管性血友病因子（vWF）抗原和超大分子量vWF（ULVWF）多聚体等指标，并且进行统计学分析；采用多因素非条件logistic回归分析法，评估获得性TTP患者于首次缓解期内复发的独立影响因素。本研究遵循的程序符合病例收集医院人体试验委员会所制定的伦理学标准，得到该伦理会批准，分组征得受试对象本人的知情同意，并与之签订临床研究知情同意书。结果①研究组患者的中位ADAMTS13活性为11％（7％～124％），低于对照组的53％（7％～151％），差异有统计学意义（u=4．018，P〈0．05）。研究组与对照组患者的ADAMTS13活性显著降低率分别为53．3％（8／15）和22．7％（5／22），二者比较，差异有统计学意义（P=0．049）。②37例获得性TTP患者的血浆ADAMTS13活性和ADAMTS13抗原水平呈正相关关系（rs=0．810，P=0．001）。研究组患者的中位ADAMTS13抗原水平为33％（3％～99％），低于对照组的59％（3％～128％），差异有统计学意义（u=4．121，P〈0．05）。研究组与对照组ADAMTS13抗原水平显著降低率分别为13．3％（2／15）和9．1％（2／22），二者比较，差异有统计学意义（P=0．008）。③研究组患者的抗ADAMTS13抗体检出率为66．7％（10／15），高于对照组的36．4％（8／22），差异有统计学意义Objective To study the relationship between recurrence of acquired thrombotic thrombocytopenic purpura （TTP） patients in their first remission period and expression levels of a disintegrin and metallopeptidase with thrombospondin motif （ADAMTS）13 and anti-ADAMTS13 antibody. Methods From March 2008 to June 2014, a total of 37 patients with acquired TTP who were treated in Affiliated Hospital of Yan＇an University and Fuping County Hospital of Weinan City in Shaanxi Province were included in this study. According to whether relapse at the first time in follow-up period, they were divided into study group （n= 15） and control group （n= 22）. Residual collagen binding assays, ELISA, Western blotting method were used to detect the ADAMTS13 activity, levels of ADAMTS13 antigen, anti- ADAMTS13 antibody, ADAMTS13 inhibitor, von Willebrand factor （vWF） antigen and ultralarge von Willebrand factor （ULVWF）, respectively. The above indexes between two groups were compared by statistical methods. Multivariate unconditional logistic regression analysis was used to evaluate the independent influencing factors of recurrence in acquired TTP patients during their first remission. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of hospitals above. Informed consent was obtained from all participants. Results （1） The median plasma ADAMTS13 activity of study group was 11% （7%-124%）, which was lower than that of 53%（7%-151%） in control group, and there as significance difference between two groups （u=4. 018, P〈0.05）. Plasma ADAMTS13 activity remarkably reduced percentage was 53.3% （8/15） in study group, which was higher than that of 22.7% （5/22） in control group, the differences was statistically significant （P = 0. 049）. （2） Plasma ADAMTS13 activity level of all 37 patients with acquired TTP was positively correlated with plasma ADAMTS13 antigen level （rs= 0. 810, P= 0. 001）. The median plasma ADAMTS13 antigen level of s

关 键 词：紫癜 血栓性血小板减少性 ADAMTS13蛋白 人类 von WILLEBRAND因子 复发 

分 类 号：R554.6[医药卫生—血液循环系统疾病]