血小板特异性抗体、血小板相关抗体、网织血小板联合检测对血小板减少的鉴别诊断

目的探讨血小板相关抗体（PAlgG）、网织血小板（RP）及血小板特异性抗体（抗GPⅡb／Ⅲa、抗GPIb、抗P-选择素）检测对区别免疫性与非免疫性血小板减少性紫癜的诊断。方法本院75例血小板减少性紫癜患者，其中35例是特发性血小板减少性紫癜（ITP），40例为非免疫性血小板减少性紫癜，同时以PAlgG、RP及抗GPⅡb／Ⅲa、抗GPIb、抗P-选择素进行检测，其中血小板特异性抗体用改良单克隆抗体免疫固相法（MAIPA）检测，PAlgG、RP用流式细胞术测定。结果35例ITP患者有22例血小板特异性抗体检测至少一项阳性，占61．5％，非免疫性血小板减少患者均为阴性反应；ITP患者RP平均值30．5±5．5，非免疫性血小板减少患者为26.5±5.0（P〉0.05）；ITP患者PAIgG均值为38．5±6．0，非免疫性血小板减少患者为36．6±6．2（P〉0．05）。结论免疫性和非免疫性血小板减少性紫癜患者RP和PAlgG结果均显示增高，但差异无显著性；血小板特异性抗体检测是特异性较强的一项指标，对提高ITP确诊率及鉴别免疫性和非免疫性血小板性紫癜有意义。

The Differential Diagnosis of the Detection of Platelet Glycoprotein Specific Autoantibody, Platelet Assosiated lgG and Reticulater Platelets in Thrombocytopenic Purpura

Objective To study platelet associated lgG （PAlgG） , platelet glycoprotein specific au-toantibody and reticulated platelets （RP） measurement in the differential diagnosis between autoimmune thrombocytopenia and nonimmune thrombocytopenias. Methods A total of 75 cases patients with thrombocytopenia ,idiopdthic thrombocytopenic purpura（ITP） 35 cases,and nonimmune thrombocytopenia 40 cases. An- ti- GP Ⅱb/Ⅲa,anti- GP I b and anti- P- seletion autoantibodies were detected by a modified monoclonal anti- body inlmobilization of platelet antigens assay （ modified MAIPA） , PAlgG and RP were measured by flow cytometry （FCM）. Results The total positive rate of antibodies against platelet GP Ⅱb/Ⅲa, GP I b and Pseletion were 61.5% in ITP , and there was no positive finding in the nonimmune thrombocytopenias. The aver- age count of RP in ITP and nonimmune thrombocytopenias were 30.5 ±5.5 and 26.5±5.0 respectively,there was not significant difference.. The average count of PAlgG in ITP and nonimmune thrombocytopenias were respectively 41.8 6.0 and 39.5 6.2, there was not significant difference too. Conclusion The average count of RP and PAlgG were high in ITP and nonimmune thrombocytopenias , but there was not significant difference. The platelet GP specific autoantibody detection is considerably better in discriminating immune from nonimmune thrombocytopenia.