改良Coombs试验对诊断自身免疫性溶血性贫血的价值

Improvement of Coombs Tests for the Diagnosis of Autoimmune Hemolyic Anemia

目的 :比较经典Coombs试验、改良Coombs试验、单抗Coombs分型试验 ,寻找更灵敏的方法诊断自身免疫性溶血性贫血 (AIHA)。方法 :对 45例临床怀疑为AIHA病人依次进行经典Coombs试验、改良Coombs试验、单抗Coombs分型试验。结果 :5例经过临床观察及相关检查发现为其它疾病 ;30例经典Coombs试验 (+) ;36例改良Coombs试验IgG(+) ;40例单抗Coombs分型试验 (+) :IgG1(+)患者最多 (2 7例 ,为总数 ,下同 ) ,IgG3(+)其次 (2 0例 ) ,IgG2 (+)较少 (14例 ) ,IgG4(+)最少 (9例 ) ,1例未检出任何亚型。还发现经典Coombs试验灵敏度为 75 .5 % ,改良Coombs试验灵敏度为 90 .0 % ,单抗Coombs分型试验灵敏度为 97.5 %。结论 :温抗体IgG 4种亚型主要为IgG1,某些病例可见IgG3,IgG2少见 ,IgG4罕见 ;单抗Coombs分型试验比经典Coombs试验及改良Coombs试验敏感。

Objective: To compare the effects of classical Coombs test, modified Coombs test and modified Coombs test with monoclonal antibodies in the diagnosis of autoimmune hemolytic anemia(AIHA).Methods: Classical Coombs test,modified Coombs test and modified Coombs test with monoclonal antibodies were used in 45 patients with suspected autoimmune hemolytic anemia (AIHA). Results: 30,36 and 40 patients were positive,in Classical Coombs test,modified Coombs test and modified Coombs test with monoclonal antibodies respectivly.Five patients was diagnosed as non AIHA.Typing of IgG incomplete warm autoantibody identified IgG1 in 27patients, IgG3 in 20,IgG2 in 14 and IgG4 in 9. No any subclass was detected in one patient.The sensitivity of classical Coombs test,modified Coombs test and modified Coombs test with monoclonal antibodies were 75.5%,90.0% and 97.5%.respectively. Conclusion: Among the 4 subclasses of IgG detected,IgG1 was the most common one,followed by IgG3 and IgG2,and IgG4 was the least .Modified Coombs test with monoclonal antibodies was the most sensitive method in this study.