联合MAIPA、网织血小板与PAIgG检测对特发性血小板减少性紫癜诊断的意义

Significance of simultaneous measurement of MAIPA,reticulated platelets and PAIgG in the diagnosis of idiopathic thrombocytopenic purpura.

目的探讨血小板特异性抗体与网织血小板(RP)、血小板相关抗体(PAIgG)在特发性血小板减少性紫癜(ITP)诊断中的价值。方法通过改良的单克隆抗体特异性捕获血小板抗原试验(MAIPA)测定ITP(86例)与非免疫性血小板减少(30例)患者血浆中血小板膜糖蛋白(GP)Ib、GPⅡb-Ⅲa以及P-选择素自身抗体,同时以流式细胞术(FCM)检测相应的RP%及PAIgG。结果ITP组MAIPA、RP%和PAIgG检测阳性率分别为62·79%、80·23%和70·93%;非免疫性血小板减少组分别为6·67%、23·33%和36·67%;两组间差异显著(P<0·01)。三种方法检测ITP结果具有相关性(P<0·05)。结论MAIPA是ITP的特异性诊断指标,多种抗体应用可以提高其敏感度。MAI-PA联合PAIgG及RP测定有益于ITP的正确诊断。

Objective To investigate the diagnosis value of platelet glycoprotein-specific autoantibody, reticulated platelet（RP） and platelet-associated immunoglobulin（PAIgG） in the patients with idiopathic thrombocytopenic purpura（ITP）. Methods By a monoelonal antibody immobilization of platelet antigen assay（MAIPA）, antiplatelet autoantibodies were detected using monoelonal anti- bodies specific for glycoproteins（GP） Ⅰ b,Ⅱb/Ⅲa and P-selectin in patients with ITP and nonimmune thrombocytopenia. Meanwhile, RP% and PAIgG were measured in the same samples with flow- cytometry（FCM）. Results The positive rates of MAIPA, RP% and PAIgG were 62. 79%, 80. 23% and 70. 93 % respectively in patients with ITP, which were markedly higher than those in patients with nonimmune thrombocytopenia （NITP） （6. 67 %, 23. 33 % and 36. 67 %, respectively） （ P〈0. 01）. Significant correlations existed among MAIPA,RP% and PAIgG assays（P〈0.05）. Conclusion MAIPA is a specific method for the diagnosis of ITP. The sensitivity of MAIPA can be increased by application of many kinds of antibodies. A correct diagnosis of ITP may achieved by combined measurement of MAIPA with RP and PAIgG.