抗凝剂对ITP血小板特异性自身抗体检测的影响及抗体种类与糖皮质激素疗效的相关性  

Influence of Anticoagulants on Detection of ITP Platelet-Specific Autoantibodies and Relationship of Autoantibody Types with Glucocorticoid Efficacy

作　　者：陈洋[1] 葛健[2] 阮敏[2] 朱凌燕[2] 曾庆曙[2] 夏瑞祥[2] 倪合宇[3] 

机构地区：[1]南京市江宁医院血液科,江苏南京211101 [2]安徽医科大学第一附属医院血液科,安徽合肥230022 [3]加拿大多伦多大学实验医学与病理生物学系

出　　处：《中国实验血液学杂志》2015年第5期1380-1385,共6页Journal of Experimental Hematology

摘　　要：目的:探讨改良单克隆抗体俘获血小板抗原(MAIPA)法中EDTA(二价阳离子熬合剂)和肝素钠抗凝剂对检测免疫性血小板减少性紫癜(immune thrombocytopenia,ITP)患者血小板特异性自身抗体检测的影响,并研究ITP患者血小板特异性自身抗体种类与糖皮质激素治疗效果差异。方法:分别留取EDTA和肝素钠抗凝的ITP患者标本140份,采用改良MAIPA法分别检测血小板特异性自身抗体(GPIIb/IIIa和GPIbα),比较两种抗凝剂的检测结果的差异。结果:140例患者EDTA抗凝组检出GPIIb/IIIa抗体阳性55例,肝素抗凝组检出GPIIb/IIIa阳性76例,两者阳性重复42例;其中EDTA组阳性而肝素组阴性者13例,肝素组阳性而EDTA组阴性者34例,两者比较差异有统计学意义(x2=9.38,P<0.05)。140例患者EDTA抗凝组检出抗GPIbα抗体阳性62例,肝素抗凝组阳性51例,两者重复42例;其中EDTA组阳性而肝素组阴性者20例,而肝素组阳性EDTA组阴性者9例,两者比较差异无统计学意义(x2=3.44,P>0.05)。320例患者采用标准糖皮质激素治疗,抗GPIbα抗体阳性143例,有效率39.9%,抗GPIbα抗体阴性177例,有效率79.7%,两者比较差异有显著性(x2=53.115,P<0.05)。结论:EDTA抗凝剂对改良MAIPA法检测ITP患者血小板特异性自身抗体(GPIIb/IIIa)有影响;抗GPIbα抗体阳性可能是ITP患者糖皮质激素治疗不敏感的重要影响因素之一。Objective : To investigate the influence of divalent cation chelator EDTA and heparin sodium on the detection of ITP platelet-specific autoantibodies by the modified monoclonal antibody immobilization of platelet antigen assay( MAIPA) and to explore the relationship between types of platelet specific autoantibodies and glucocorticoid efficacy. Methods: The samples were obtained from EDTA-and heparin-anticoagulant ITP patients,respectively,so as to detect the platelet-specific autoantibodies( GPIIb /IIIa and GPIbα) in 140 ITP samples by modified MAIPA,then the differences between these two methods were compared. Results: Out of 140 cases in EDTA group,55 cases were positive for GPIIb /IIIa,while 76 cases in heparin group were positive for GPIIb /IIIa,42 cases in both group were repeatable; among them 13 cases were positive in EDTA group and negative in heparin group,while 34 cases were positive in heparin group and negative in EDTA group,there was significant difference between them( x2 = 9. 38,P < 0.05),62 cases in 140 cases of EDTA group were positive for GPIba,while 51 cases in heparin group were positive for GPIba,42 cases in both group were repeatabe; among them 20 cases were positive in EDTA group and negative in heparin group,while 9 cases were positive in heparin group and negative in EDTA group,there was no significant difference between them( x2 = 3. 44,P > 0. 05). A total of 320 cases received a standard glucocorticoid treatment,out of them 143 cases were possitive for GPIbα with effective rate 39. 9%,177 cases were negative for GPIbα with effective rate 79. 7%,there was statisticalty significant difference between them( x2 = 53. 115,P < 0. 05). Conclusion: EDTA anticoagulant( a divalent cation chelator) has a significant influence on detection of ITP platelet-specific autoantibodies( GPIIb /IIIa) by a modified MAIPA method and the GPIbα antibody positive may be one of the important factors that results in unsensitivity of ITP patients to glucocorticoid treatment.

关 键 词：MAIPA 抗凝剂 EDTA 血小板 特异性自身抗体 糖皮质激素 

分 类 号：R554.6[医药卫生—血液循环系统疾病]