血小板抗体和T细胞亚群检测在诊断原发免疫性血小板减少症中的意义

Significance of detection of platelet antibody and T cell subsets in diagnosis of primary immune thrombocytopenia

目的探讨血小板抗体和T细胞亚群检测在诊断原发免疫性血小板减少症(ITP)中的意义。方法回顾性分析2017年3月至2018年5月广元市第二人民医院收治的143例免疫性血小板减少症患者的临床资料,其中ITP患者93例(ITP组),继发免疫性血小板减少症(sITP)患者50例(sITP组)。选取同期在该院体检的健康志愿者50例为对照组。采用流式细胞仪检测患者血小板抗体(PAIgG、PAIgM、PAIgA)和T细胞亚群(CD3^+、CD4^+、CD8^+、CD4^+/CD8^+)水平。采用受试者工作特征曲线(ROC曲线)评价血小板抗体和T细胞亚群诊断ITP的作用。结果 ITP组患者PAIgG、PAIgM、PAIgA均明显高于sITP组和对照组,差异有统计学意义(P<0.05);CD3^+、CD4^+、CD4^+/CD8^+水平明显低于sITP组和对照组,差异有统计学意义(P<0.05),而CD8^+水平明显高于sITP组和对照组,差异有统计学意义(P<0.05)。ITP组患者PAIgG、PAIgM、PAIgA异常率均明显高于sITP组和对照组,差异有统计学意义(P<0.05);CD3^+、CD4^+、CD8^+、CD4^+/CD8^+异常率均明显高于sITP组和对照组,差异有统计学意义(P<0.05)。血小板抗体联合T细胞亚群诊断ITP的ROC曲线下面积为0.932,灵敏度为86.5%,特异度为87.5%。结论 ITP患者存在血小板抗体升高和T细胞亚群紊乱的现象,联合检测血小板抗体和T细胞亚群能够更加准确地反映患者病情,提高诊断效能,为疾病的临床治疗提供更好的支持。

Objective To investigate the significance of detection of platelet antibody and T cell subsets in diagnosis of primary immune thrombocytopenia(ITP).Methods The clinical data of 143 immune thrombocytopenia patients admitted to a hospital from March 2017 to May 2018 were retrospectively analyzed,including93 patients with ITP(ITP group)and 50 patients with secondary immune thrombocytopenia(sITP)group.50 healthy volunteers in a hospital during the same period were selected as control group.The levels of platelet antibodies(PAIgG,PAIgM,PAIgA)and T cell subsets(CD3^+,CD4^+,CD8^+,CD4^+/CD8^+)were detected by flow cytometry.Receiver operating curve(ROC)was used to evaluate the role of platelet antibodies and T cell subsets in the diagnosis of ITP.Results The PAIgG,PAIgM and PAIgA in ITP group were significantly higher than those in the sITP group and control group,the difference was statistically significant(P<0.05);The levels of CD3^+,CD4^+ and CD4^+/CD8^+ were significantly lower than those in the sITP group and control group,the difference was statistically significant(P<0.05),while the CD8^+ level was significantly higher than that of the control group and the control group,the difference was statistically significant(P<0.05).The abnormal rates of PAIgG,PAIgM and PAIgA in the ITP group were significantly higher than those in the sITP group and control group,the difference was statistically significant(P<0.05),and the abnormal rates of CD3^+,CD4^+,CD8^+ and CD4^+/CD8^+ were significantly higher than those in the sITP group and control group,the difference was statistically significant(P<0.05).The area under the ROC curve(AUC)of platelet antibody combined with T cell subsets in diagnosing ITP was 0.932,sensitivity 86.5% and specificity 87.5%.Conclusion ITP patients have the phenomenon of platelet antibody increase and T cell subgroup disorder.Combined detection of platelet antibody and T cell subsets can more accurately reflect the patient′s condition,improving the diagnostic efficiency,and provide better support for the clinical treatment of disease.