血小板相关抗体检测与骨髓形态学在特发性血小板减少性紫癜诊断中的应用价值

THE APPLICATION VALUE OF DETECTING PLATELET ASSOCIATED ANTD30DY AND BONE MARROW MORPHOLOGY IN THE DIAGNOSIS FOR IDIOPATHIC THROMBOCYTOPENIC PURPURA

目的探讨血小板相关抗体(platelet-associated antibody,PAIg)与骨髓形态学在特发性血小板减少性紫癜(idiopathic thrombocytopenic purpura,ITP)诊断中的临床价值,以及PAIg与血小板计数的关系。方法应用流式细胞仪检测30例ITP患者PAIg,同时对血象、骨髓形态学进行观察。结果血小板抗体阳性率80.0%(24/30),其中IgG79.0%,IgA33.0%,IgM62.0%。3项同时阳性者3例(12.5%),2项同时阳性者12例(50.0%),1项阳性率9例(37.5%)。骨髓象显示巨核细胞增多,以成熟受阻为主要表现,有少数患者巨核细胞正常或减少。结论 3种血小板抗体IgG、IgA、IgM含量差异无统计学意义(P>0.05),但存在以下趋势,即血小板计数越低,血小板抗体水平越高。PAIg检测是诊断ITP的有效指标,也可了解ITP的发展程度,还可以用于治疗ITP预后的疗效观察。

Objective To investigate the value of platelet- associated antibody （PAIg） and bone marrow morphology in the diagnosis of idiopathic thrombocytopenic purpura （ITP） and the correlation between the platelet relative antibody and number of platelet count. Methods The platelet associated IgG （PAIgG） in peripheral blood of the 30 patients with ITP were detected by flow cytometry （ FCM）, meanwhile the hemogram bone marrow morphology were observed. Results In the 30 patients, there were 24 cases whose platelet antibody was positive, the positive rate was 80.0%, of which IgG 79.0%, IgA 33.0%, IgM 62. 0%, among them there were 3 cases whose three platelet antibo.：lies simultaneous positive （12.5%）, 12 cases whose two antibodies positive （50.0%）, and 9 cases whose one positive （37.5 % ）, The Bone marrow examination of most ITP patients revealed that the numbers of the megalokaryocyte（MK） were increased and its main manifestation was the maturation arrest of MK. R^t in a few ITP patients the numbers of the MK were normal or decreased. Conclusion There is a tendency in the levels of PAIgG, PAIgA, PAIgM, The lower expression of platelet count, the higher expression of platelet antibodies. Therefore the PAIgG can be used as an effective indicator in the diagnosis, clinicaltreatment and prognostic evaluation of ITP.