血小板抗体检测在新生儿血小板减少症诊治中的应用

The application of platelet antibody tests in the diagnosis and treatment of neonatal thrombocytopenia

目的探讨血小板抗体检测在新生儿血小板减少症(NT)诊治中的应用。方法采用固相凝集法(MASPAT)对2014年5月-2016年10月本院新生儿科收治的110名NT患儿和其中18名患儿的母亲做血小板抗体检测,根据检测结果将其分为血小板抗体阳性组(观察组)和阴性组(对照组),比较2组患儿发病时间、颅内出血情况,分析组间差异,对比2组随机输注患儿的24 h血小板纠正计数增加值(24 h CCI)。结果本组患儿血小板抗体阳性率20.91%(23/110)。观察组与对照组NT发病时间:≤72 h者分别为82.61%(19/23)vs 49.43%(43/87),>72 h者分别为17.39%(4/23)vs 50.57%(44/87)(P<0.05);颅内出血:60.87%(14/23)vs 31.03%(27/87)(P<0.05);对34名Plt<50×109/L需输注血小板的重症NT患儿采取随机输注,24 h CCI(×109/L)组间比较:≥7.5者分别为100%(7/7)vs 85.19%(23/27)(P>0.05)。结论免疫性NT患儿多为重症,发病时间急,伴有严重的颅内出血;免疫因素所致NT患儿可不做配型随机输注血小板,亦能达到预期疗效。对围生期血小板减少孕妇做免疫性血小板抗体监测有助于降低NT发病率。

Objective To evaluate the application of platelet antibody tests in the diagnosis and treatment of neonatal thrombocytopenia.Methods The monoclonal antibody solid phase platelet antibody test（ MASPAT） was applied to detect platelet antibodies in samples acquired from 18 mothers and 110 infants suffering from thrombocytopenia who received treatment in our hospital during May 2014 to October 2016. According the test results,samples were divided into the platelet antibody-positive group（ observation group） and the platelet antibody negative group（ control group）. We compared the condition occurrence time line and the intracranial hemorrhage status between the two groups. The 24 h corrected count increment（ CCI） was also compared. Results The positive rate of platelet antibody presence in the observation group was 20. 91%（ 23/110）. The rates of thrombocytopenia occurrence time points ≤72 h in the observation group and the control group were82. 61%（ 19/23） vs 49. 43%（ 43/87）（ P〈0. 05） while the rates of an occurrence time point beyond 72 hours were 17. 39%（ 4/23）） vs 50. 57（ 44/87）（ P〈0. 05）; The intracranial hemorrhage rates were 60. 87%（ 14/23） vs 31. 03%（ 27/87）（ P〈0. 05）. 34 severe thrombocytopenia cases with platelet count50 × 10^9/L were processed with random transfusion followed by 24 h CCI measurement,which yielded no statistically significant difference between the two groups（ P〉0. 05）. Rates of cases with CCI≥7. 5 in the two groups were 100%（ 7/7） vs 85. 19%（ 23/27）,respectively. Conclusion Most infants with autoimmune NT（ neonate thrombocytopenia） mostly suffer from acute onset of symptoms and severe intracranial hemorrhage.Infants with a low platelet count due to immune issues can receive random transfusion and the results lived to our expectations. For pregnant women,immune platelet antibody monitoring during pregnancy could help reducing the occurrence of neonatal thrombocytopenia.