中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2010年
9期
765-768
,共4页
陈剑芳%杨林花%冯建军%常丽贤%刘秀娥%鹿育晋
陳劍芳%楊林花%馮建軍%常麗賢%劉秀娥%鹿育晉
진검방%양림화%풍건군%상려현%류수아%록육진
紫癜,血小板减少性%特发性%血小板生成素%T淋巴细胞亚群%酶联免疫斑点技术%血小板特异性抗体%网织血小板
紫癜,血小闆減少性%特髮性%血小闆生成素%T淋巴細胞亞群%酶聯免疫斑點技術%血小闆特異性抗體%網織血小闆
자전,혈소판감소성%특발성%혈소판생성소%T림파세포아군%매련면역반점기술%혈소판특이성항체%망직혈소판
Purpura,thrombocytopenic,idiopathic%Thrombopoietin%T-lymphocyte subsets%Enzyme-linked immunospot assay%Ptatelet-specific antibody%Reticulated platelet
目的 检测特发性血小板减少性紫癜(ITP)患者免疫相关指标的变化,探讨其在ITP发病机制中的作用及其临床意义.方法 应用酶联免疫斑点技术(ELISPOT)、改良血小板抗原单克隆抗体固相化检测技术(MAIPA)、流式细胞术及夹心法ELISA分别检测64例1TP患者及31例正常对照者分泌GPⅡb/Ⅲa抗体B细胞、血小板特异性抗体(抗GPⅡb/Ⅲa抗体、抗GP I b/Ⅸ抗体)、T淋巴细胞亚群、网织血小板(RP)及血小板生成素(TPO)的变化.结果 ITP患者分泌GPⅡb/Ⅲa抗体B细胞频数[急性ITP组患者为7.6±4.6/105个外周血单个核细胞(PBMC),慢性ITP组患者为5.3±3.0/105个PBMC]、血小板特异性抗体(抗GPⅡb/Ⅲa抗体、抗GPI b/Ⅸ抗体)的吸光度值(急性ITP组患者为0.51±0.11、0.48±0.06,慢性ITP组患者为0.49±0.10、0.46±0.09)、CD8+T淋巴细胞百分比[(27.09±9.86)%]、RP百分比[巨核细胞增多组为(24.85±19.18)%,巨核细胞正常组为(23.89±18.90)%]明显高于正常对照组[1.3±0.5/105个PBMC,0.33±0.06,0.41±0.03,(22.08±4 54)%,(8.19±2.46)%,P值均＜0.05],其中急性ITP患者分泌GPⅡb/Ⅲa抗体B细胞高于慢性ITP患者(P＜0.05).ITP组CD3+T淋巴细胞百分比、CD4+T淋巴细胞百分比及CD4+/CD8+比值[(60.88±14.59)%、(28.41±10.55)%、1.18±0.59]均低于正常对照组[(69.89±6.43)%、(35.38±5.05)%、1.64±0.29,P值均＜0.05].ITP患者巨核细胞增多组TPO水平(72.09±41.64)明显低于ITP患者巨核细胞正常组(118.60±70.72,P＜0.05),与正常对照组(75.37±26.32)之间差异无统计学意义(P＞0.05).结论 分泌GPⅡb/Ⅲa抗体B细胞、血小板特异性抗体、T淋巴细胞亚群、RP%及TPO在ITP诊断及指导定向干预治疗中有一定的意义.
目的 檢測特髮性血小闆減少性紫癜(ITP)患者免疫相關指標的變化,探討其在ITP髮病機製中的作用及其臨床意義.方法 應用酶聯免疫斑點技術(ELISPOT)、改良血小闆抗原單剋隆抗體固相化檢測技術(MAIPA)、流式細胞術及夾心法ELISA分彆檢測64例1TP患者及31例正常對照者分泌GPⅡb/Ⅲa抗體B細胞、血小闆特異性抗體(抗GPⅡb/Ⅲa抗體、抗GP I b/Ⅸ抗體)、T淋巴細胞亞群、網織血小闆(RP)及血小闆生成素(TPO)的變化.結果 ITP患者分泌GPⅡb/Ⅲa抗體B細胞頻數[急性ITP組患者為7.6±4.6/105箇外週血單箇覈細胞(PBMC),慢性ITP組患者為5.3±3.0/105箇PBMC]、血小闆特異性抗體(抗GPⅡb/Ⅲa抗體、抗GPI b/Ⅸ抗體)的吸光度值(急性ITP組患者為0.51±0.11、0.48±0.06,慢性ITP組患者為0.49±0.10、0.46±0.09)、CD8+T淋巴細胞百分比[(27.09±9.86)%]、RP百分比[巨覈細胞增多組為(24.85±19.18)%,巨覈細胞正常組為(23.89±18.90)%]明顯高于正常對照組[1.3±0.5/105箇PBMC,0.33±0.06,0.41±0.03,(22.08±4 54)%,(8.19±2.46)%,P值均＜0.05],其中急性ITP患者分泌GPⅡb/Ⅲa抗體B細胞高于慢性ITP患者(P＜0.05).ITP組CD3+T淋巴細胞百分比、CD4+T淋巴細胞百分比及CD4+/CD8+比值[(60.88±14.59)%、(28.41±10.55)%、1.18±0.59]均低于正常對照組[(69.89±6.43)%、(35.38±5.05)%、1.64±0.29,P值均＜0.05].ITP患者巨覈細胞增多組TPO水平(72.09±41.64)明顯低于ITP患者巨覈細胞正常組(118.60±70.72,P＜0.05),與正常對照組(75.37±26.32)之間差異無統計學意義(P＞0.05).結論 分泌GPⅡb/Ⅲa抗體B細胞、血小闆特異性抗體、T淋巴細胞亞群、RP%及TPO在ITP診斷及指導定嚮榦預治療中有一定的意義.
목적 검측특발성혈소판감소성자전(ITP)환자면역상관지표적변화,탐토기재ITP발병궤제중적작용급기림상의의.방법 응용매련면역반점기술(ELISPOT)、개량혈소판항원단극륭항체고상화검측기술(MAIPA)、류식세포술급협심법ELISA분별검측64례1TP환자급31례정상대조자분비GPⅡb/Ⅲa항체B세포、혈소판특이성항체(항GPⅡb/Ⅲa항체、항GP I b/Ⅸ항체)、T림파세포아군、망직혈소판(RP)급혈소판생성소(TPO)적변화.결과 ITP환자분비GPⅡb/Ⅲa항체B세포빈수[급성ITP조환자위7.6±4.6/105개외주혈단개핵세포(PBMC),만성ITP조환자위5.3±3.0/105개PBMC]、혈소판특이성항체(항GPⅡb/Ⅲa항체、항GPI b/Ⅸ항체)적흡광도치(급성ITP조환자위0.51±0.11、0.48±0.06,만성ITP조환자위0.49±0.10、0.46±0.09)、CD8+T림파세포백분비[(27.09±9.86)%]、RP백분비[거핵세포증다조위(24.85±19.18)%,거핵세포정상조위(23.89±18.90)%]명현고우정상대조조[1.3±0.5/105개PBMC,0.33±0.06,0.41±0.03,(22.08±4 54)%,(8.19±2.46)%,P치균＜0.05],기중급성ITP환자분비GPⅡb/Ⅲa항체B세포고우만성ITP환자(P＜0.05).ITP조CD3+T림파세포백분비、CD4+T림파세포백분비급CD4+/CD8+비치[(60.88±14.59)%、(28.41±10.55)%、1.18±0.59]균저우정상대조조[(69.89±6.43)%、(35.38±5.05)%、1.64±0.29,P치균＜0.05].ITP환자거핵세포증다조TPO수평(72.09±41.64)명현저우ITP환자거핵세포정상조(118.60±70.72,P＜0.05),여정상대조조(75.37±26.32)지간차이무통계학의의(P＞0.05).결론 분비GPⅡb/Ⅲa항체B세포、혈소판특이성항체、T림파세포아군、RP%급TPO재ITP진단급지도정향간예치료중유일정적의의.
Objective To assess the clinical significance of detecting the immune markers in idiopathic thrombocytopenic purpura (ITP). Methods The frequencies of circulating B cells secreting platelet-specific antibody, platelet-specific antibody, the percentage of T lymphocyte subsets, the percentage of reticulated platelet and the level of thrombopoietin in 64 ITP patients and 31 healthy controls were measured with enzyme-linked immunospot assay (ELISPOT),modified monoclonal antibody immunobilization of platelet antigens assay (MAIPA), flow cytometry and sandwich enzyme-linked innnunosorbent assay respectively. Results Compared with the controls[1.3 ± 0. 5/105 peripheral blood mononuclear cell (PBMC), (0.33±0.06,0.41±0.03), (22.08±4.54)% and (8.19±2.46)%], the frequencies of circulating B cells secreting platelet-specific antibody (7.6±4.6/105 PBMC in acute ITP group, 5.3±3.0/105 PBMC in chronic ITP group), platelet-specific antibody (including the anti-GP Ⅱ b/Ⅲa antibody, anti-GP Ⅰ b/X antibody) (0.51 ±0.11, 0.48±0.06 in acute ITP group; 0.49±0.10,0.46±0.09 in chronic ITP group), the percentage of CD8+ T Lymphocyte (27.09±9.86 ) %, the percentage of reticulated platelet in ITP patients[the megakaryocyte cytosis group (24. 85 ± 19. 18)%, the normal megakaryocyte group (23.89±18.90)%]were significantly increased ( all P＜0.05).The frequencies of circulating B cells secreting platelet-specific antibody in acute ITP patients were notably increased (P＜0.05) compared to the chronic ITP patients. In T lymphocyte subsets, the percentage of CD3+T lymphocyte and CD4+ T lymphocyte and the ratio of CD4+/CD8+ in the patients with ITP[(60.88±14.59)%, (28.41±10.55)%, 1.18±0.59]were notably decreased than those in the healthy controls [(69.89±6.43)%, (35.38±5.05) %, 1.64±0.29, P＜0.05]. There was no apparent difference of the level of thrombopoietin between ITP patients with megakaryocyte cytosis (72. 09 ± 41.64 ) and health controls (75.37± 26. 32, P ＞ 0. 05 ), however, the level of thrombopoietin of ITP patients with normal megakaryocyte apparently increased (118.60±70.72, P＜0.05). Conclusion Detecting the frequencies of circulating B cells secreting platelet-specific antibody, platelet-specific antibody, the percentage of T lymphocyte subsets, the percentage of reticulated platelet and the level of thrombepoietin in the patients with ITP may improve the diagnosis and guide clinical therapy.
