GPⅡb/Ⅲa在免疫性血小板减少症中的诊疗意义

Clinical Significance of Platelet Membrane Glycoprotein GPIIb/IIIa in Diagnosis and Treatment of Immune Thrombocytopenia

目的:采用流式细胞术(FCM)联合酶联免疫吸附法(ELISA)分析血小板膜糖蛋白(GPⅡb/Ⅲa)在免疫性血小板减少症中的表达情况及识别作用,探讨其对ITP的诊疗意义。方法:选择2014年10月-2018年10月期间本院血液科收治的免疫性血小板减少症患者52例作为ITP组,同时选取体检中心的30例健康人作为对照组,通过FCM测定血小板膜糖蛋白阳性表达率以及全自动分析仪检测外周血小板计数,ELISA检测血浆膜糖蛋白水平;比较免疫性血小板减少症患者治疗前、后血小板膜糖蛋白水平;分析免疫性血小板减少症患者血小板膜糖蛋白阳性表达率和血浆膜糖蛋白水平与血小板数的相关性。结果:免疫性血小板减少症患者GPⅡb/Ⅲa+(即CD41+/CD61+)表达率以及血浆GPⅡb/Ⅲa水平显著低于对照组(P<0.001);免疫性血小板减少症患者在接受治疗后,血小板GPⅡb/Ⅲa+表达率较治疗前明显升高(P<0.001);血小板GPⅡb/Ⅲa+表达率、GPⅡb/Ⅲa水平均与其血小板计数呈正相关(r=0.772,r=0.966)。血小板GPⅡb/Ⅲa水平联合血小板数诊断免疫性血小板减少症灵敏度为90.38%,特异度为93.33%,阳性似然比为13.57,阳性预测值为95.92%。结论:在临床上运用血小板膜糖蛋白作为免疫性血小板减少症初步筛查方式简单方便,灵敏快捷,具有临床意义,可考虑作为临床诊断的新方法。

Objective:To explore the clinical significance of platelet membrane glycoprotein(GPⅡb/Ⅲa)detection by flow cytometry(FCM)combined with enzyme-linked immunosorbent assay(ELISA)in diagnosis and treatment of immune thrombocytopenia(ITP).Methods:Fifty-two patients with immunological thrombocytopenia admitted to the Department of Hematology in our hospital during October 2014-October 2018 were enrolled in ITP group.Thirty healthy people from the physical examination center were enrolled in control group.The positive expression rate of platelet membrane glycoprotein was measured by FCM,and the peripheral platelet count was detected by automatic analyzer,and the plasma membrane glycoprotein level was measured by ELISA.The difference between the two groups was compared.The platelet membrane glycoprotein levels in ITP patients before and after treatment were compared.Results:The positive expression rate of GPⅡb/Ⅲa(i,e CD41+/CD61+)and plasma GPⅡb/Ⅲa levels in ITP patients were significantly lower than those in the healthy controls.The increased expression of platelet GPⅡb/Ⅲa was associated with the response to therapy.The positive expression rate and level of GPⅡb/Ⅲa postively correlated with its platelet count.The sensitivity of platelet GPⅡb/Ⅲa combined with platelet count for diagnosis of ITP was 90.38%,the specificity was 93.33%,the positive likelihood ratio was 13.57,and the positive predictive value was 95.92%.Conclusion:The platelet membrane glycoprotein detection as a preliminary screening method used for diagnosis of immune thrombocytopenia is simple,convenient,sensitive and rapid,thus may be considered as a new method for clinical diagnosis.