血栓性血小板减少性紫癜患者vWF裂解蛋白酶抗原和活性的检测及意义

目的研究血管性血友病因子裂解蛋白酶(ADAMTS13)抗原含量和活性在血栓性血小板减少性紫癜(TTP)患者及遗传性 TTP 家族突变携带者中变化的情况。方法用残余胶原结合实验(RCBA)检测13例 TTP 患者共28份血浆标本含血浆置换(PE)前后]及10例携带者的 ADAMTS13活性;用新近建立的三抗体夹心酶联免疫反应法检测标本的 ADAMTS13抗原含量。结果正常对照组 ADAMTS13含量为(600.93±145.36)mU/ml(设白种人混合血浆的 ADAMTS13抗原含量为1000mU/ml),活性为(74.79±11.81)%。遗传性 TTP 患者 ADAMTS13抗原含量和活性治疗前和发病间期均明显减低,PE 后恢复;其家族中携带者 ADAMTS13抗原含量为(331.40±109.85)mU/ml,活性为(66.79±12.82)%(与对照组比较,P 值分别<0.01和>0.05);原发性 TTP 患者 PE 前 ADAMTS13抗原含量为(98.7±82.08)mU/ml,活性为(22.23±19.07)%(与对照组比较,P 值均<0.01);PE 后ADAMTS13 抗原含量为(449.4±232.33)mU/ml,活性为(60.92±22.33)%(与对照组比较,P 值分别<0.01和>0.05);1例继发性 TTP 患者 PE 后 ADAMTS13抗原含量远高于正常,活性仅为6.00%结论治疗前的 TTP 患者 ADAMTS13抗原含量和活性均明显减低。大多数患者两指标变化趋势一致,也有个别患者两指标变化趋势相反,前者可能因为遗传因素或体内免疫系统的廓清作用,后者可能因为抗 ADAMTS13抗体仅抑制了 ADAMTS13的活性而未影响其抗原的含量或其他未知原因所致。

Determination of the ADAMTS13 antigen and its activity in TTP patients and carriers

OBJECTIVE: To investigate the antigen levels and activity of von Willebfrand factor cleaving protease ADAMTS13 in thrombotic thrombocytopenic purpura (TTP) patients and carriers. METHODS: 28 samples from 13 TTP patients and 10 samples from the carriers were examined. The activity of ADAMTS13 was measured by residue collagen binding assay, and antigen by a newly developed sandwich ELISA. RESULTS: The mean ADAMTS13 level in Chinese normal controls (CN) was (600.93 +/- 145.36) mU/ml (n = 26) comparable to the level (1000 mU/ml) in pooled normal Caucasian plasma, and the activity was (74.79 +/- 11.81)%. Both the antigen level and activity of ADAMTS13 in congenital TTP patients either before plasma exchange (pre-PE) or interval relapse were quite lower than those in normal control, but were increased after PE (post-PE). The antigen was (331.40 +/- 109.85) mU/ml (P < 0.01, n = 10), and activity was (66.79 +/- 12.82)% (P > 0.05). The ADAMTS13 levels pre-PE in idiopathic TTP was (98.7 +/- 82.08) mU/ml (n = 11, P < 0.01), and that post-PE was up to (449.4 +/- 232.33) mU/ml (P < 0.01, n = 10). The activity of ADAMTS13 in patients pre-PE and post-PE were (22.23 +/- 19.07)% (P < 0.01) and (60.92 +/- 22.33)% (P > 0.05) respectively. In a secondary TTP patient the ADAMTS13 antigen was much higher than that in CN, and the activity was 6.00%. CONCLUSION: The antigen and activity of ADAMTS13 in most TTP patients pre-PE are deficient, and these two indices in most TTP patients are paralleled. The reason for ADAMTS13 deficiency is congenital shortage or clearance by immune system, but it is unknown that why in some patients the ADAMTS13 antigen is extremely high but its activity is quite low.