儿童特发性血小板减少性紫癜抗核抗体、血小板生成素特征与治疗方案

Serum ANA and TPO in idiopathic thrombocytopenic purpura(ITP) children and treatment methods comparison

目的:探讨特发性血小板减少性紫癜(ITP)患儿的抗核抗体(ANA)阳性率、血小板生成素(TPO)水平以及对激素与激素+IVIG治疗效果的分析,为临床提供辅助诊断依据及指导治疗。方法:采用全自动血细胞分析仪进行血小板计数,骨髓细胞彩色图文分析系统对巨核细胞进行人工分类计数,ELISA法检测TPO水平,采用金标免疫斑点试剂盒对ANA进行定性检测。结果:急慢性ITP儿童抗核抗体阳性率高于正常对照组,抗核抗体阳性与阴性的ITP患儿治疗前后PLT、TPO无显著性差异;与正常对照组比较,急慢性ITP儿童PLT水平低于正常,巨核细胞数量高于正常,TPO水平无显著性差异;在治疗方面,激素与激素+IVIG两种方法治疗后PLT水平有显著性差异。结论:急慢性ITP儿童由抗核抗体阳性与阴性治疗前后PLT、TPO水平无变化推测抗核搞体阳性与阳性治疗前后PLT、TPO水平无变化推测抗核抗体阳性仅仅是一种伴随现象。TPO水平受到血小板和巨核细胞数量的双重调控。在治疗方面,激素+IVIG优于单用激素。

Objective： To study the positive incidence of ANA and the level of TPO in ITP children and assay the therapeutic efficacy of steroid and combining steroid with IVIG for assisting clinical diagnosis and treatment. Methods： Platelet counts were performed with automated complete blood counter. Megakaryocytes in bone marrow were counted manually. The serum TPO levels were measured by ELISA. ANA was then detected with gold labeling immunodotting assay, Results： Acute and chronic ITP children have higher positive incidence than the normal control. There was no significant difference amount of platelet and TPO between before and ＇after therapy in ITP children of positive and negative ANA. Compared with normal control, acute and chronic ITP children have lower level of platelet, higher amaount of megakaryocyte, but similar level of TPO. After therapy of steroid and combining steroid with IVIG, there was dramatic difference of platelet levels. Conclusions： Positive ANA is just incidental in acute and chronic ITP children. ITP level is regulated by amounts of platelet and megakaryocyte. Treatment of combining steroid and IVIG is more effective than steroid alone.