ITP血小板特异性自身抗体（GPⅡb/Ⅲa和GPIbα）与临床疗效（静脉丙种球蛋白和糖皮质激素）的关系
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摘要
目的:检测特发性血小板减少性紫癜(ITP)患者体内的抗血小板膜糖蛋白(GPⅡb/Ⅲa和GPIbα)特异性自身抗体,并探讨特异性自身抗体与静脉丙种球蛋白和糖皮质激素治疗的临床疗效是否存在针对性,以便得到更经济和个体化的治疗方案,为ITP提出新的分型依据。
方法:应用改良的单克隆抗体特异性俘获血小板抗原(MAIPA)法检测抗血小板膜糖蛋白(GPIIb/IIIa, GPIbα)特异性自身抗体,然后对ITP患者进行正规治疗(糖皮质激素、静脉丙种球蛋白),比较分别含有抗GPIIb/IIIa抗体和抗GPIbα抗体的ITP患者其采用静脉丙种球蛋白和糖皮质激素治疗临床疗效有无差异。
结果:ITP组(107例)其中23%(25/107)为单一抗GPIIb/IIIa抗体阳性, 18%(19/107)为单一抗GPIbα抗体阳性,34%(36/107)为双抗体阳性,25%(27/107)为双抗体阴性。ITP组经治疗后,双抗体阳性组(36例)22例治疗无效,单一抗GPIbα抗体阳性组(19例)9例治疗无效,二者比较,差异无显著性(χ~2=0.995,P>0.05);双抗体阳性组(36例)22例治疗无效,单一抗GPIIb/IIIa抗体阳性组(25例)2例治疗无效,二者比较,差异有显著性(χ~2=17.439,P<0.01)。单一抗GPIIb/IIIa抗体阳性组,糖皮质激素治疗(15例)0例治疗无效,糖皮质激素联合静脉丙种球蛋白治疗(10例)2例治疗无效,二者比较,差异无显著性(P=0.150>0.05);单一抗GPIbα抗体阳性组,糖皮质激素治疗(17例)9例治疗无效,糖皮质激素联合静脉丙种球蛋白治疗(2例)0例治疗无效,二者比较,差异无显著性(P=0.263>0.05);双抗体阳性组,糖皮质激素治疗(17例)11例治疗无效,糖皮质激素联合静脉丙种球蛋白治疗(19例)11例治疗无效,二者比较,差异无显著性(P=0.470>0.05);双抗体阴性组,糖皮质激素治疗(24例)3例治疗无效,糖皮质激素联合静脉丙种球蛋白治疗(3例)0例治疗无效,二者比较,差异无显著性(P=0.692>0.05)。
结论:血小板特异性自身抗体种类(GPⅡb/Ⅲa和GPIbα)及种类数目与ITP的临床疗效(糖皮质激素、静脉丙种球蛋白)有一定关系,对临床治疗方案的选择有一定意义。以抗血小板膜糖蛋白(GPⅡb/Ⅲa和GPIbα)特异性自身抗体为ITP进行新的分型依据尚不足,需扩大样本量进一步研究。
Objective To evaluate the clinical significance of the relationship between specific autoantibodies against platelet glycoprotein (GPⅡb/Ⅲa and GPIbα) and clinical therapeutic effect(IVIG and glucocorticosteroid) in idiopathic thrombocytopenic purpura .
Methods Specific autoantibodies against platelet glycoprotein were measured by a monoclonal antibody immobilization of platelet antigen assay(MAIPA).
Results We found that 23%(25/107) of patients had mono-specific antibodies to GPIIb/IIIa and 18%(19/107) had mono-specific antibodies to GPIbα. Another 34%(36/107)of the patients had antibodies to both antigens and 25%(27/107) of patients had no detectable antibody to either platelet antigen. We found that the frequency of catabatic cases in patients with antibodies to both antigens (14/36) was significantly lower than that in patients with mono-specific antibodies to GPIIb/IIIa (23/25) (χ~2=17.439,P<0.01) in ITP. No significant difference was observed between patients with antibodies to both antigens and patients had mono-specific antibodies to GPIbα.(χ~2=0.995,P>0.05)。The clinical therapeutic effect(IVIG and glucocorticosteroid) in patients with mono-specific antibodies to GPIIb/IIIa, antibodies to both antigens and no detectable antibody to either platelet antigen are not so different(P>0.05).
Conclusions The kinds of the specific autoantibodies against platelet glycoprotein might be related with clinical therapeutic effect in ITP. The autoantibodies would play a significant role in selecting effective treatment. Typing on the autoantibodies for ITP is insufficiency, need to expand the sample size for further study.
方法:应用改良的单克隆抗体特异性俘获血小板抗原(MAIPA)法检测抗血小板膜糖蛋白(GPIIb/IIIa, GPIbα)特异性自身抗体,然后对ITP患者进行正规治疗(糖皮质激素、静脉丙种球蛋白),比较分别含有抗GPIIb/IIIa抗体和抗GPIbα抗体的ITP患者其采用静脉丙种球蛋白和糖皮质激素治疗临床疗效有无差异。
结果:ITP组(107例)其中23%(25/107)为单一抗GPIIb/IIIa抗体阳性, 18%(19/107)为单一抗GPIbα抗体阳性,34%(36/107)为双抗体阳性,25%(27/107)为双抗体阴性。ITP组经治疗后,双抗体阳性组(36例)22例治疗无效,单一抗GPIbα抗体阳性组(19例)9例治疗无效,二者比较,差异无显著性(χ~2=0.995,P>0.05);双抗体阳性组(36例)22例治疗无效,单一抗GPIIb/IIIa抗体阳性组(25例)2例治疗无效,二者比较,差异有显著性(χ~2=17.439,P<0.01)。单一抗GPIIb/IIIa抗体阳性组,糖皮质激素治疗(15例)0例治疗无效,糖皮质激素联合静脉丙种球蛋白治疗(10例)2例治疗无效,二者比较,差异无显著性(P=0.150>0.05);单一抗GPIbα抗体阳性组,糖皮质激素治疗(17例)9例治疗无效,糖皮质激素联合静脉丙种球蛋白治疗(2例)0例治疗无效,二者比较,差异无显著性(P=0.263>0.05);双抗体阳性组,糖皮质激素治疗(17例)11例治疗无效,糖皮质激素联合静脉丙种球蛋白治疗(19例)11例治疗无效,二者比较,差异无显著性(P=0.470>0.05);双抗体阴性组,糖皮质激素治疗(24例)3例治疗无效,糖皮质激素联合静脉丙种球蛋白治疗(3例)0例治疗无效,二者比较,差异无显著性(P=0.692>0.05)。
结论:血小板特异性自身抗体种类(GPⅡb/Ⅲa和GPIbα)及种类数目与ITP的临床疗效(糖皮质激素、静脉丙种球蛋白)有一定关系,对临床治疗方案的选择有一定意义。以抗血小板膜糖蛋白(GPⅡb/Ⅲa和GPIbα)特异性自身抗体为ITP进行新的分型依据尚不足,需扩大样本量进一步研究。
Objective To evaluate the clinical significance of the relationship between specific autoantibodies against platelet glycoprotein (GPⅡb/Ⅲa and GPIbα) and clinical therapeutic effect(IVIG and glucocorticosteroid) in idiopathic thrombocytopenic purpura .
Methods Specific autoantibodies against platelet glycoprotein were measured by a monoclonal antibody immobilization of platelet antigen assay(MAIPA).
Results We found that 23%(25/107) of patients had mono-specific antibodies to GPIIb/IIIa and 18%(19/107) had mono-specific antibodies to GPIbα. Another 34%(36/107)of the patients had antibodies to both antigens and 25%(27/107) of patients had no detectable antibody to either platelet antigen. We found that the frequency of catabatic cases in patients with antibodies to both antigens (14/36) was significantly lower than that in patients with mono-specific antibodies to GPIIb/IIIa (23/25) (χ~2=17.439,P<0.01) in ITP. No significant difference was observed between patients with antibodies to both antigens and patients had mono-specific antibodies to GPIbα.(χ~2=0.995,P>0.05)。The clinical therapeutic effect(IVIG and glucocorticosteroid) in patients with mono-specific antibodies to GPIIb/IIIa, antibodies to both antigens and no detectable antibody to either platelet antigen are not so different(P>0.05).
Conclusions The kinds of the specific autoantibodies against platelet glycoprotein might be related with clinical therapeutic effect in ITP. The autoantibodies would play a significant role in selecting effective treatment. Typing on the autoantibodies for ITP is insufficiency, need to expand the sample size for further study.
引文
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