急性白血病患者血小板免疫状态的变化

Changes of platelet immune condition in patients with acute leukemia

目的 :探讨急性白血病患者出血与血小板相关抗体 (PAIgG)和抗血小板糖蛋白Ⅱb/Ⅲa (抗GPⅡb/Ⅲa)自身抗体的关系。方法 :用酶联免疫吸附法测定 60例急性白血病 (AL)患者和 2 0例正常对照的PAIgG和抗GPⅡb/Ⅲa自身抗体。其中抗GPⅡb/Ⅲa自身抗体用SZ 2 1 (针对GPⅢa)和SZ 2 2 (针对GPⅡb)两种单抗同时测定。并同时测定了血小板计数 (BPC)和血小板聚集功能 (PagT)等。结果 :AL组PAIgG值 ((1 54 .30± 2 5 .71 )fg/plt)显著高于正常对照组 ((2 .0 8± 1 .72 )fg/plt) ,P <0 .0 1。 60例AL中 40例在正常参考值 (5 .8fg/plt)以上。其中 2 4例外周血血小板减少 ,且PAIgG值与血小板数呈负相关 (P <0 .0 0 1 ,r=- 0 .395) ;1 6例血小板数正常。 60例AL中抗GPⅡb/Ⅲa自身抗体阳性率 40 % (2 4 / 60 ) ,其中 1 4例单独SZ 2 1阳性 ,1 0例SZ 2 2阳性。 2 4例阳性患者均呈现ADP诱导的聚集功能减低 ,用 5μlADP诱聚时 ,最大聚集率 (5 .58± 4 .76) %。 结论

Aim:To investigate the relations between bleeding and platelet associated immunoglobulin G(PAIgG) and anti platelet glycoprotein Ⅱb/Ⅲ a (GP Ⅱb/Ⅲa) autoantibodies in patients with acute leukemia (AL).Methods:A total of 60 patients with AL (AL group) and 20 normal controls (normal group) were chosen.PAIgG and anti GPⅡb/Ⅲ a autoantibodies were measured by enzyme linked immunosorbent assay (ELISA) . SZ 21 (aiming GPⅢ a) and SZ 22 (aiming GPⅡ b) were used to measure anti GPⅡb/Ⅲa autoantibodies.Blood platelet count (BPC) and platelet agglutination test (PagT) were performed at the same time.Results:In AL group PAIgG ((154.30±25.71) fg/plt) were higher than that of normal group ((2.08±1.72) fg/plt), P <0.01;40 out of 60 patients with AL were above 5.8 fg/plt, among whom,24 had peripheral blood platelets decrease,and PAIgG and BPC were negatively related ( P <0.001, r =-0.395) .BPC for the rest 16 were normal.Out of 60 patients with AL, 24 had positive anti GPⅡb/Ⅲa autoantibodies,14 out of the 24 were SZ 21 positive and the other 10 were SZ 22 positive.All the 24 patients presented a decrease in PagT.The maximum agglutination rate induced by 5μl ADP was (5.58±4.76)%.Conclusion:There are immune platelet drop in quantity and abnormality in quality caused by platelet immune abnormity in part of the patients with AL.