联合检测PAIg与CD41+淋巴样小巨核对ITP及MDS鉴别诊断的意义

Detection of Platelet-associated Antibody (PAIg) and CD41+ Lymphoid Megakaryocyte in Differential Diagnosis of Idiopathic Thrombocytopenic Purpura and Myelodysplastic Syndrome

目的:探讨血小板相关抗体(PAIg)及CD41+淋巴样小巨核在特发性血小板减少性紫癜(ITP)中的诊断价值,以及对ITP与骨髓增生异常综合征(MDS)的鉴别诊断价值。方法:研究血小板相关抗体的样本取自两组患者。一组为ITP患者,另一组为MDS患者。在CD41患者检测中,ITP患者组与MDS患者组进行了比较。ELISA方法用来检测血小板相关抗体的表达,包括PAIgA、PAIgM和PAIgG。CD41阳性淋巴样小巨核的检测采用生物素酶连亲和-碱性磷酸酶标法。抗CD41抗体是单克隆抗体。数据统计分析使用卡方检验。结果:血小板相关抗体检测中,ITP组49例患者的PAIg检出阳性率为81.6%,MDS组9例患者PAIg阳性率为33.3%,二者比较有显著差异,结果具有统计学意义。酶联免疫细胞化学检测ITP组和MDS组淋巴样小巨核CD41阳性表达显示,ITP组阳性率为5%(1/20),而MDS组阳性率为58.3%(21/36)。结论:血小板相关抗体(PAIg)及CD41+淋巴样小巨核的表达可作为一项有价值的指标帮助诊断和鉴别诊断ITP患者;同时对判断ITP患者的效果及预后,以及提高ITP的诊断率具有重要的价值。并且CD41+淋巴样小巨核可作为ITP与MDS的鉴别诊断依据。

Objects：The purpose of present study is to investigate the importance of platelet associated antibodies （PAIg） and CD41＋ lymph kind of small giant nuclear cells in diagnoses of idiopathic thrombocytopenic purpura （ITP）.In addition, the identification effects on distinguishing ITP and myelodysplastic syndrome （MDS） are studied.Methods：Samples were collected from two group patients for PAIg studies.One group was ITP patients; the other one was MDS patients.For CD41 detection, ITP group was compared with MDS patient group.We used ELISA to testify the positive expression of PAIg （including PAIgA, PAIgM and PAIgG） under the same condition; while immunocytochemical reaction （VECTASTAIN ABC-AP Kits） was applied to detect CD41 on lymph kind of small nuclear cells.The antibody to CD41 was monoclonal.Data were analyzed by Qatari side test （p）.Results：In the results of PAIg measurements, 81.6% out of 49 ITP patients were positive, however, 33.3% out of 9 MDS patients were positive.The difference was significant The immunocytochemical determination of CD41＋ lymph kind of small giant nuclear cells in IPT group indicated 5% （1/20） positive, but 50% positive in MDS group （21/36）.Conclusions：Based on the results, the expression of PAIg and CD41＋ lymph kind of small giant nuclear cells could be a valuable indicator for the accurate diagnosis of ITP patients.PAIg could also help evaluate the efficiency of the ITP patient treatments and their prognosis.CD41 positive expression on lymph kind of small giant nuclear cells could improve the differential diagnosis between ITP and MDS patients.