血小板特异性自身抗体和淋巴细胞亚群检测在免疫性血小板减少症中的临床价值

目的检测血小板特异性自身抗体和外周血淋巴细胞亚群在免疫性血小板减少症(ITP)患者中的水平,并探讨两者之间的联系以及自身抗体与ITP病情间的关系,评价其在ITP中的临床价值。方法应用改良的单克隆抗体俘获血小板抗原(MAIPA)法检测40例ITP患者血小板膜糖蛋白(GPⅡbⅢa、GPIbα)特异性自身抗体;利用流式细胞术(FCM)检测ITP患者外周血淋巴细胞亚群(CD3+、CD3+CD4+、CD3+CD8+、CD19+、CD19+CD5+)水平。结果 ITP组抗GPⅡbⅢa抗体阳性30例,抗GPIbα抗体阳性26例,其中25%患者仅为单一抗GPⅡbⅢa抗体阳性,15%患者仅为单一抗GPIbα抗体阳性,50%患者为双抗体阳性,10%患者为双抗体阴性。非免疫性血小板减少组与对照组均为阴性。单抗体阳性组采血时血小板计数平均值明显低于双抗体阴性组(P<0.05);双抗体阳性组血小板计数平均值亦明显低于单抗体阳性组和双抗体阴性组(P<0.05)。ITP组与正常对照组相比较,CD3+T淋巴细胞、CD3+CD4+T淋巴细胞百分率以及CD3+CD4+/CD3+CD8+比例减低,CD3+CD8+T淋巴细胞、CD19+B淋巴细胞、CD19+CD5+B淋巴细胞百分率均明显高于对照组(P<0.05)。双抗体阳性组CD19+B淋巴细胞、CD19+CD5+B淋巴细胞百分率明显高于单抗体阳性组(P<0.05)。结论血小板特异性自身抗体检测对鉴别ITP和非免疫性血小板减少症有一定价值,自身抗体与ITP的病情有一定关系;血小板特异性自身抗体和T、B淋巴细胞可能共同参与了ITP的发病过程,并在其中起重要作用。

Clinical value of specific autoantibodies against platelet glycoprotein and lymphocyte subpopulations in immune thrombocytopenia

Objective To evaluate the clinical value of specific autoantibodies against platelet glycoprotein and lymphocyte subpopulations in immune thrombocytopenia(ITP).Methods Specific autoantibodies against platelet glycoprotein in 40 ITP patients were measured by a monoclonal antibody immobilization of platelet antigen assay(MAIPA).Lymphocyte subpopulations were measured by flow cytometry(FCM).Results We found that 75% and 65% patients had specific antibodies to GPⅡbⅢa and GPIbα.25% of patients had mono-specific antibodies to GPⅡbⅢa and 15% had mono-specific antibodies to GPIbα.50% of patients had double antibodies positive,10% of patients had double antibody negative.Average value of platelet count in patients with double antibodies were less than that in patients with mono-specific antibodies(P<0.05).CD3+,CD3+CD4+ and CD3+CD4+/ CD3+CD8+ in ITP were less,CD3+CD8+,CD19+CD5+ and CD19+ in ITP were more than that of the controls(P<0.05).CD19+CD5+ and CD19+ in patients with double antibodies were more than that in patients with mono-specific antibodies(P<0.05).Conclusion The specific autoantibodies against platelet glycoprotein and lymphocyte subpopulations may play a significant role in ITP.Severity in ITP patients are related with specific autoantibodies against platelet glycoprotein.