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目的:探讨特发性血小板减少性紫癜(ITP)与血小板相关抗体之间的相互关系,为临床诊断和治疗提供帮助。方法:回顾性分析了2000年1月～2007年4月应用流式细胞术检测140例临床确诊的ITP患者初诊时及治疗前后不同血小板相关抗体——血小板膜糖蛋白抗体(PAIg)的表达。结果:ITP患者初诊时PAIgG、PAIgA及PAIgM抗体表达水平均高于正常对照组;PAIgG、PAIgM、PAIgA表达水平与血小板数之间均呈负相关,相关系数分别为γ=-0.72、γ=-0.83和γ=-0.67。在确诊ITP后予激素等免疫治疗无效转变为慢性ITP的患者时,PAIgM抗体水平要明显高于激素治疗有效的急性ITP患者,并且PAIgM异常增高或联合PAIgG增高的比例要显著多于急性ITP患者(均P<0.05)。35例PAIgG和PAIgM同时升高的ITP患者,经治疗血小板升至正常后,PAIgG、PAIgM抗体表达水平均有显著下降。结论:ITP的发生与血小板抗体密切相关,初诊ITP患者PAIgM单独或联合PAIgG异常增高常提示预后不良,易转变为慢性ITP。
Objective: To investigate the relationship between idiopathic thrombocytopenic purpura (ITP) and platelet-associated antibodies and to provide assistance in clinical diagnosis and treatment. Methods: From January 2000 to April 2007, flow cytometry was used to detect the expression of platelet-associated glycoprotein antibody (PAIg) in 140 clinically diagnosed ITP patients before and after treatment. Results: The expression levels of PAIgG, PAIgA and PAIgM were significantly higher in ITP patients than those in normal control group. The expressions of PAIgG, PAIgM and PAIgA were negatively correlated with platelet count (r = -0.72, γ = 0.83 and γ = -0.67. PAIgM antibody levels were significantly higher in patients with ITP refractory to immunosuppression such as hormones after the diagnosis of ITP than in patients with acute ITP treated with steroid therapy and the proportion of patients with abnormal or elevated PAIgM was significantly higher than those with acute ITP (All P <0.05). In 35 ITP patients with elevated PAIgG and PAIgM, the expression levels of PAIgG and PAIgM were significantly decreased after the platelets were treated. Conclusions: The occurrence of ITP is closely related to platelet antibody. The abnormal increase of PAIgM alone or in combination with PAIgG in newly diagnosed ITP patients suggests that the prognosis is poor, and it is easy to change to chronic ITP.