CAJ | 학술논문

目的研究血小板膜糖蛋白GPⅡb/Ⅲa、GP Ⅰ b/Ⅸ、GPⅠa/Ⅱa特异性抗体(抗GPⅡb/Ⅲa、GP Ⅰ b/Ⅸ 、GP Ⅰ a/Ⅱa抗体)在原发免疫性血小板减少症(ITP)患者的分布,评价抗GPⅡb/Ⅲa、GP Ⅰ b/Ⅸ、GPⅠ a/Ⅱa抗体与疗效的关系.方法 2010年12月至2012年11月442例ITP患者纳入研究,分为新诊断ITP组(132例)、持续性ITP组(152例)、慢性ITP组(158例).应用酶联免疫吸附法(ELISA)检测各组患者抗血小板GP Ⅱb/Ⅲa、GP Ⅰ b/Ⅸ、GPⅠa/Ⅱa抗体.新诊断ITP患者给予静脉丙种球蛋白(IVIG)联合糖皮质激素治疗,分析抗体分布与疗效的关系.结果新诊断ITP组、持续性ITP组、慢性ITP组患者血小板膜糖蛋白抗体的阳性率分别为59.09％、26.97％、37.35％,差异有统计学意义(P＜0.05)；新诊断ITP组单一抗GPⅡb/Ⅲa抗体阳性率为38.64％,抗GPⅡb/Ⅲa与抗GPⅠa/Ⅱa双抗体阳性率为15.91％,与持续性ITP组、慢性ITP组比较,差异均有统计学意义(P值均＜0.05)；抗GPⅡb/Ⅲa抗体阳性的新诊断ITP组患者,IVIG联合糖皮质激素方案的完全反应率(80.39％)高于三种抗体均阴性患者(57.41％),差异有统计学意义(P＜0.05).结论与持续性ITP组和慢性ITP组比较,新诊断ITP患者单一抗GPⅡb/Ⅲa抗体、抗GPⅡb/Ⅲa与抗GPⅠa/Ⅱa双抗体阳性呈高表达.抗GPⅡb/Ⅲa抗体阳性患者对IVIG联合糖皮质激素的标准治疗方案有良好的治疗反应.
목적 연구혈소판막당단백GPⅡb/Ⅲa、GP Ⅰ b/Ⅸ、GPⅠa/Ⅱa특이성항체(항GPⅡb/Ⅲa、GP Ⅰ b/Ⅸ 、GP Ⅰ a/Ⅱa항체)재원발면역성혈소판감소증(ITP)환자적분포,평개항GPⅡb/Ⅲa、GP Ⅰ b/Ⅸ、GPⅠ a/Ⅱa항체여료효적관계.방법 2010년12월지2012년11월442례ITP환자납입연구,분위신진단ITP조(132례)、지속성ITP조(152례)、만성ITP조(158례).응용매련면역흡부법(ELISA)검측각조환자항혈소판GP Ⅱb/Ⅲa、GP Ⅰ b/Ⅸ、GPⅠa/Ⅱa항체.신진단ITP환자급여정맥병충구단백(IVIG)연합당피질격소치료,분석항체분포여료효적관계.결과 신진단ITP조、지속성ITP조、만성ITP조환자혈소판막당단백항체적양성솔분별위59.09％、26.97％、37.35％,차이유통계학의의(P＜0.05)；신진단ITP조단일항GPⅡb/Ⅲa항체양성솔위38.64％,항GPⅡb/Ⅲa여항GPⅠa/Ⅱa쌍항체양성솔위15.91％,여지속성ITP조、만성ITP조비교,차이균유통계학의의(P치균＜0.05)；항GPⅡb/Ⅲa항체양성적신진단ITP조환자,IVIG연합당피질격소방안적완전반응솔(80.39％)고우삼충항체균음성환자(57.41％),차이유통계학의의(P＜0.05).결론 여지속성ITP조화만성ITP조비교,신진단ITP환자단일항GPⅡb/Ⅲa항체、항GPⅡb/Ⅲa여항GPⅠa/Ⅱa쌍항체양성정고표체.항GPⅡb/Ⅲa항체양성환자대IVIG연합당피질격소적표준치료방안유량호적치료반응.
Objective To study the expression of specific anti-platelet glycoprotein autoantibodies GP Ⅱ b/Ⅲ a,GP Ⅰ b/Ⅸ and GP Ⅰ a/Ⅱ a in primary immune thrombocytopenia (ITP),and to evaluate the relationship between the therapeutic effect and the expression of specific anti-platelet glycoprotein antibodies GP Ⅱ b/Ⅲ a,GP Ⅰ b/Ⅸ and GP Ⅰ a/Ⅱ a.Methods Anti-GP Ⅱ b/Ⅲ a,GP Ⅰ b/Ⅸ and GP Ⅰ a/Ⅱ a antibodies were assayed by ELISA for patients with ITP.Total 442 patients in our hospital,who were retrospectively investigated from December 2010 to November 2012,were divided into newly diagnosed ITP,persistent and chronic ITP.The expression of specific anti-platelet glycoprotein antibody in each group was measured separately.The newly diagnosed ITP patients were treated with intravenous IgG (IVIG) and corticosteroids.The relationship between the expression of specific antiplatelet glycoprotein antibodies GP Ⅱ b/Ⅲa,GP Ⅰ b/Ⅸ and GP Ⅰ a/Ⅱ a and the complete response(CR) was studied.Results Positive rates of anti-platelet glycoprotein antibodies were 59.09％,26.97％ and 37.35％ respectively in newly diagnosed ITP,persistent and chronic ITP,the difference was statistical significant (P＜0.05).In newly diagnosed ITP,positive rate of antibody against GP Ⅱ b/Ⅲ a was 38.64％,double positive rate of antibodies against both GP Ⅱ b/Ⅲ a and GP Ⅰ a/Ⅱ a was 15.91％,there was statistical significance (P＜0.05) compared with that of persistent and chronic ITP.The complete response (CR) rate in newly diagnosed ITP patients with positive antibody against GP Ⅱ b/Ⅲ a was 80.39％ after treatment with IVIG and corticosteroids.There was statistical significance compared with that in patients having no antibodies (P＜0.05).Conclusion The expression of antibodies against GP Ⅱ b/Ⅲ a and double positive for both GP Ⅱ b/Ⅲ a and GP Ⅰ a/ Ⅱ a autoantibodies increased in newly diagnosed ITP patients.Patients with anti-GP Ⅱ b/Ⅲ a autoantibody had good response to medication with IVIG and corticosteroids.