父母血小板血型不合引起新生儿同种免疫性血小板减少症的初步研究

The Preliminary Study of Neonatal Alloimmune Thrombocytopenia Caused by Parent Platelet Antigen Incompatibility

目的探讨由于父母血小板血型不合产生血小板抗体,诱导新生儿发生同种免疫性血小板减少症的相关性。方法收集22例临床上确诊为新生儿免疫性血小板减少症(NIT)的患儿为研究对象,采用ELISA方法检测患儿及其父母的血小板相关抗体,应用PCR-SSP法对患儿及父母进行HLA及HPA基因分型,根据相应的抗原进行抗体特异性分析。结果 22例NIT患儿中,14例是由于同种免疫性因素引起的,其中27.3%(6例)由HLA抗体引起,13.6%(3例)由HPA抗体引起,22.7%(5例)由HLA+HPA抗体引起;9.1%(2例)由于被动免疫性因素引起;27.3%(6例)由自身抗体引起。其中,同种免疫性抗体以抗HLA-A2、19,抗-B40及抗HPA-3a多见。结论在新生儿免疫性血小板减少症中,主要以父母血小板血型不合引起新生儿同种免疫性血小板减少症为主,临床产前诊断预防和产后治疗具有重要意义。

Objective To investigate the correlation between platelet GP specific antibodies/HLA antibodies and the neonatal alloimmune thrombocytopenia. Methods 22 patients with neonatal immune thrombocytopenia were selected for this study. The patients were genotyped for HLA-A/B as well as HPA systems by standard PCR-SSP assays.The platelet GP specific antibodies and HLA antibodies in serum and platelet elution were tested with a solid phase ELISA. Then the specificity of antibodies was analyzed according to the corresponding antigens. Results Among the 22 NAIT patients, 14 patients were caused by alloimmune, of which 6 patients（27.3%） were caused by HLA antibodies, 3 pateints （13.6%） were caused by HPA antibodies, 5 patients （22.7%） were caused by both HLA and HPA antibodies. Apart from alloimmune, 2 patients （9.1%） were caused by passive immunity factors and 6 patients （27.3%） were caused by auto- antibodies.The common allo-immune antibodies were anti-HLA-A2, anti-HLA-19, anti-B40 and anti-HPA-3a. Conclusions The main cause of neonatal immune thrombocytopenia was parent platelet antigen incompatibility.It is of great significance in the prevention of clinical prenatal diagnosis and postnatal treatment.