ITP及风湿免疫性疾病血小板及粒细胞相关抗体临床意义探讨

Clinical Significance of Platelet Antibody Expression in ITP and Rheumatoid Autoimmune Disease

目的对免疫性血小板减少性紫癜(ITP)患者、健康人群以及伴有血小板减少的风湿免疫性疾病患者(系统性红斑狼疮,类风湿关节炎,干燥综合征)体内血小板相关免疫球蛋白(PAIg)及粒细胞相关免疫球蛋白(Ig)水平的阳性率进行比较,探讨其在免疫性血小板减少性疾病发病中的作用和意义。方法用Beckman Coulter公司XL流式细胞仪对205例ITP患者、133例健康人及64例伴有血小板减少的风湿免疫性疾病患者的血小板及粒细胞表面相关免疫球蛋白水平检测并进行比较。结果 PAIg G在ITP患者及伴有血小板减少的风湿免疫性疾病患者中均升高,与健康人对照组存在差异;PAIg A的增高仅出现在ITP患者中,与健康人对照组存在差异;而伴有血小板减少的风湿免疫性疾病患者中不增高,与健康人对照组无显著差异。PAIg M的增高仅出现在伴有血小板减少的风湿免疫性疾病患者中,与健康人对照组存在差异,而ITP患者与健康人群对照组无显著差异。三种粒细胞相关抗体则均出现于ITP患者及伴有血小板减少的风湿免疫性疾病患者,与健康人群对照组存在差异。结论 ITP虽然定义为器官特异性免疫性疾病,但受累靶细胞决不仅限于血小板,至少还包括白细胞。免疫性血小板减少疾病发病中普遍存在粒细胞相关抗体的出现。PAIg G并非仅出现在ITP患者,结合PAIg A的增高在临床上可能更支持ITP的诊断;而伴有血小板减少的风湿免疫性疾病患者出现的血小板下降可能主要由PAIg M所介导。

Objective To investigate the role and significance of platelet and leukocyte surface associated antibody（ PAIg） in the pathogenesis of autoimmune thrombocytopenic diseases. Methods The platelet and leukocyte associated antibody levels in 205 cases of ITP patients, 64 patients with rheumatic disease accompanied by thrombocytopenia and 133 healthy people were detected and compared. Results The PAIg G levels in ITP patients and patients with rheumatic autoimmune diseases were increased compared with healthy controls. The PAIg A levels increase occurred only in ITP patients,while the patients of rheumatic autoimmune diseases and healthy controls was normal. The increase of PAIg M levels occurred only in patients with rheumatoid immune disease,but there was no significant difference between ITP patients and healthy controls.All three kinds of granulocyte associated antibodies were seen in patients with ITP and rheumatic disease.Conclusion Although ITP is defined as organ specific autoimmune diseases,the involvement of target cells not only focuses on platelet,at least also include white blood cell. PAIg G is not only present in ITP patients; the increase of PAIg A may more support the clinical diagnosis of ITP. The number of platelets reduction in patients with autoimmune thrombocytopenic diseases may be mainly mediated by PAIg M.