血小板特异性抗体对特发性血小板减少性紫癜诊断价值的研究

Study on diagnostic value of platelet glycoprotein-specific autoantibody detection in idiopathic thrombocytopenic purpura

目的:检测特发性血小板减少性紫癜及非免疫性血小板减少症患者抗血小板特异性抗体与血小板相关抗体,评价其在特发性血小板减少性紫癜中的诊断价值。方法:用流式细胞仪检测血小板相关抗体PAIgG,PAIgA,PAIgM;用改良单克隆抗体特异性俘获血小板抗原技术检测抗血小板膜糖蛋白(GPⅡb/Ⅲa,GPⅠb/Ⅸ)特异性自身抗体。结果:血小板相关抗体在特发性血小板减少性紫癜组敏感度为80%,在非免疫性血小板减少症组为63.3%。改良单克隆抗体特异性俘获血小板抗原法检测抗GPⅡb/Ⅲa和GPⅠb/Ⅸ抗体,在特发性血小板减少性紫癜组中的敏感度分别为53.3%和30%;在非免疫性血小板减少症组中除1例GPⅠb/Ⅸ阳性外,其余均为阴性;2组检出率比较差异有统计学意义(P<0.05)。结论:血小板相关抗体敏感度较高,但特异度较低;抗血小板特异性抗体敏感度虽较低,但特异性较高,可鉴别特发性血小板减少性紫癜和非免疫性血小板减少症。可作为特发性血小板减少性紫癜的特异性诊断指标。

The PAIgG, PAIgA and PAIgM were determined with FCM and GP Ⅱ b/Ⅲ a and GPⅠb/Ⅸ were determined with the technique of modified monoclonal antibody immobilization of platelet antigen. Results The sensitivity of PAIg was 80% in idiopathic thrombocytopenic purpura group and 63.3% in non-immune thrombocytopenia group. In idiopathic thrombocytopenic purpura group the sensitivities of GP Ⅰ b/Ⅸ and GP Ⅱ b/Ⅲ a were respectively 30 % and 53.3 %. Only one patient in nonimmune thrombocytopenia group showed positive GP Ⅰ b/Ⅸ. There was a statistic difference between two groups. Conclusion The sensitivity of PAIg is very high but its specificity is low. Modified MAIPA can differentiate immune thrombocytopenia and non-immune thrombocytopenia, and can be a specific index in diagnosing idiopathic thrombocytopenic purpura.