血小板膜糖蛋白特异性抗体在ITP患儿中的表达及其与疗效、出血程度的关系分析  

Analysis of platelet glycoprotein-specific antibodies expression in children with ITP and its relationship with curative effect and bleeding degree

作　　者：张晴[1] 李旭[1] 高长俊[1] 任蓉[1] 韩静[1] ZHANG Qing;LI Xu;GAO Changjun;REN Rong;HAN Jing(Department of Pediatric Hematology,Tangshan Maternal and Child Health Hospital,Hebei Tangshan 063003,China)

机构地区：[1]唐山市妇幼保健院小儿血液科,河北唐山063000

出　　处：《中国妇幼健康研究》2023年第9期13-18,共6页Chinese Journal of Woman and Child Health Research

基　　金：2019年度河北省医学科学研究课题计划(20191548)。

摘　　要：目的分析血小板膜糖蛋白(GP)特异性抗体在免疫性血小板减少症(ITP)患儿中的表达情况及其与疗效、出血程度的关系。方法选取2018年2月至2020年12月于唐山市妇幼保健院儿科就诊的102例ITP患儿为研究对象,并将其纳入病例组,另选取同期同院进行体检的110例健康儿童纳入健康组。病例组患儿均接受糖皮质激素冲击疗法,以4周为1个疗程,共治疗5个疗程,并随访3个月。检测并比较两组GP特异性抗体表达情况,统计ITP患儿出血部位并分析不同GP特异性抗体出血程度、疗效及预后。结果病例组抗GPⅠb/Ⅸ抗体、抗GPⅡb/Ⅲa抗体表达水平高于健康组,差异有统计学意义(t值分别为16.521、51.718,P<0.05);102例ITP患儿抗GPⅠb/Ⅸ抗体阳性、抗GPⅡb/Ⅲa抗体阳性、双抗体阳性、双抗体阴性检出率分别为15.69%、4.90%、30.39%、49.02%,0级、1级、2级出血率分别为16.67%、50.00%、33.33%;且0级出血以双抗体阳性占比(0)最低,1级出血以抗GPⅡb/Ⅲa抗体阳性占比(80.00%)最高,2级出血以抗GPⅠb/Ⅸ抗体阳性、双抗体阳性占比(62.50%、48.39%)较高,差异有统计学意义(H=38.237,P<0.05);102例ITP患儿治疗5个疗程后有效率为78.43%,随访3个月后完全缓解率为68.63%;双抗体阴性ITP患儿有效率、完全缓解率均高于抗GPⅠb/Ⅸ抗体阳性、抗GPⅡb/Ⅲa抗体阳性、双抗体阳性ITP患儿,差异有统计学意义(χ^(2)值分别为19.866、27.709,P<0.05)。结论ITP患儿抗GPⅠb/Ⅸ抗体、抗GPⅡb/Ⅲa抗体表达水平较高,且其不同表达水平与患儿出血程度、疗效及预后均有密切关系,临床可通过监测GP特异性抗体来对ITP患儿进行早期诊断,并对其出血程度、疗效、预后等进行预测。Objective To analyze the expression of platelet membrane glycoprotein(GP)-specific antibodies in children with immune thrombocytopenia(ITP)and its relationship with curative effect and bleeding degree.Methods 102 children with ITP who were treated in the pediatric department of Tangshan Maternal and Child Health Hospital from February 2018 to December 2020 were selected as the research object and included in the case group,and another 110 healthy children who underwent physical examination in the same hospital in the same period were selected and included in the healthy group.All the children in the case group received glucocorticoid pulse therapy,with 4 weeks as a course of treatment,with a total of 5 courses of treatment,and were followed up for 3 months.The expression of GP-specific antibodies between the two groups was detected and compared.The bleeding sites of children with ITP were counted,and the bleeding degree,curative effect and prognosis of different GP-specific antibodies were analyzed.Results The expression levels of anti-GPIb/IX antibody and anti-GPIIb/Ila antibody in the case group were higher than those in the healthy group,and the differences were statistically significant(t=16.521 and 51.718,respectively,P<0.05).The positive anti-GPIb/IX antibody,positive anti-GPIb/la antibody,positive double antibody,and negative double antibody detection rates of 102 children with ITP were 15.69%,4.90%,30.39%,and 49.02%,respectively,and the rates of grade 0,1,and 2 bleeding were 16.67%,50.00%,and 33.33%,respectively.In addition,the proportion of grade 0 bleeding was the lowest with double antibody positivity(0.00%),the proportion of grade 1 bleeding was the highest with anti-GPb/lla antibody positivity(80.00%),and the proportion of grade 2 bleeding was higher with anti-GPIb/IX antibody positivity and double antibody positivity(62.50%and 48.39%),and the difference was statistically significant(H=38.237,P<0.05).The effective rate of 102 children with ITP was 78.43%after 5 courses of treatment,and the complete r

关 键 词：免疫性血小板减少症 血小板膜糖蛋白 特异性抗体 疗效 出血程度 预后 

分 类 号：R179[医药卫生—妇幼卫生保健]