中华血液学杂志
中華血液學雜誌
중화혈액학잡지
Chinese Journal of Hematology
2015年
3期
202-205
,共4页
陈洋%葛健%阮敏%朱凌燕%谢研研%夏瑞祥%倪合宇%曾庆曙
陳洋%葛健%阮敏%硃凌燕%謝研研%夏瑞祥%倪閤宇%曾慶曙
진양%갈건%원민%주릉연%사연연%하서상%예합우%증경서
血小板减少%自身抗体%免疫球蛋白G%免疫球蛋白M%地塞米松
血小闆減少%自身抗體%免疫毬蛋白G%免疫毬蛋白M%地塞米鬆
혈소판감소%자신항체%면역구단백G%면역구단백M%지새미송
Thrombocylopenia%Autoantibodies%Immunoglobulin G%Immunoglobulin M%Dexamethasone
目的 探讨成人原发免疫性血小板减少症(ITP)患者血小板特异性自身抗体种类(GPⅡb/Ⅲa、GPⅠbα)及类型(IgG、IgM)对地塞米松疗效的影响.方法 185例ITP患者纳入研究,男61例,女124例,中位年龄42(18～83)岁.其中新诊断ITP 117例,持续性ITP 35例,慢性ITP 33例.入组患者接受地塞米松(40 mg/d×4 d)治疗,稳定后逐渐减量至5～10 mg/d维持3～4周.采用改良单克隆抗体俘获血小板抗原(MAIPA)法检测患者特异性自身抗体种类及类型,分析抗体种类及类型与地塞米松疗效的相关性.结果 ①按抗体类型分组:IgG组:单一抗GPⅡb/Ⅲa抗体阳性、单一抗GP Ⅰ bα抗体阳性、双抗体阳性、双抗体阴性患者治疗有效率分别为87.5％、50.0％、68.0％、72.3％,四组间抗体种类比较差异有统计学意义(x2=11.489,P=0.009).IgM组:单一抗GPⅡb/Ⅲa抗体阳性、单一抗GPIbα抗体阳性、双抗体阳性、双抗体阴性患者有效率分别为82.1％、71.4％、61.9％、68.9％,四组间抗体种类比较差异无统计学意义(x2=2.719,P=0.437).②按抗体种类分组:抗GP Ⅰ bα组:单一IgG抗体阳性、单一IgM抗体阳性、IgG+IgM双抗体阳性、IgG+IgM双抗体阴性患者有效率分别为52.4％、59.1％、76.5％、77.9％,抗体类型在四组间比较差异有统计学意义(x2=10.811,P=0.013).抗GPⅡb/Ⅲa组:单一IgG抗体阳性、单一IgM抗体阳性、IgG+IgM双抗体阳性、IgG+IgM双抗体阴性患者治疗有效率分别为73.3％、71.0％、61.9％、68.9％,四组间抗体类型比较差异无统计学意义(x2=1.374,P=0.719).结论 血小板特异性自身抗体为GP Ⅰ bα-IgG型的成人ITP患者对大剂量地塞米松冲击治疗的治疗反应较差.
目的 探討成人原髮免疫性血小闆減少癥(ITP)患者血小闆特異性自身抗體種類(GPⅡb/Ⅲa、GPⅠbα)及類型(IgG、IgM)對地塞米鬆療效的影響.方法 185例ITP患者納入研究,男61例,女124例,中位年齡42(18～83)歲.其中新診斷ITP 117例,持續性ITP 35例,慢性ITP 33例.入組患者接受地塞米鬆(40 mg/d×4 d)治療,穩定後逐漸減量至5～10 mg/d維持3～4週.採用改良單剋隆抗體俘穫血小闆抗原(MAIPA)法檢測患者特異性自身抗體種類及類型,分析抗體種類及類型與地塞米鬆療效的相關性.結果 ①按抗體類型分組:IgG組:單一抗GPⅡb/Ⅲa抗體暘性、單一抗GP Ⅰ bα抗體暘性、雙抗體暘性、雙抗體陰性患者治療有效率分彆為87.5％、50.0％、68.0％、72.3％,四組間抗體種類比較差異有統計學意義(x2=11.489,P=0.009).IgM組:單一抗GPⅡb/Ⅲa抗體暘性、單一抗GPIbα抗體暘性、雙抗體暘性、雙抗體陰性患者有效率分彆為82.1％、71.4％、61.9％、68.9％,四組間抗體種類比較差異無統計學意義(x2=2.719,P=0.437).②按抗體種類分組:抗GP Ⅰ bα組:單一IgG抗體暘性、單一IgM抗體暘性、IgG+IgM雙抗體暘性、IgG+IgM雙抗體陰性患者有效率分彆為52.4％、59.1％、76.5％、77.9％,抗體類型在四組間比較差異有統計學意義(x2=10.811,P=0.013).抗GPⅡb/Ⅲa組:單一IgG抗體暘性、單一IgM抗體暘性、IgG+IgM雙抗體暘性、IgG+IgM雙抗體陰性患者治療有效率分彆為73.3％、71.0％、61.9％、68.9％,四組間抗體類型比較差異無統計學意義(x2=1.374,P=0.719).結論 血小闆特異性自身抗體為GP Ⅰ bα-IgG型的成人ITP患者對大劑量地塞米鬆遲擊治療的治療反應較差.
목적 탐토성인원발면역성혈소판감소증(ITP)환자혈소판특이성자신항체충류(GPⅡb/Ⅲa、GPⅠbα)급류형(IgG、IgM)대지새미송료효적영향.방법 185례ITP환자납입연구,남61례,녀124례,중위년령42(18～83)세.기중신진단ITP 117례,지속성ITP 35례,만성ITP 33례.입조환자접수지새미송(40 mg/d×4 d)치료,은정후축점감량지5～10 mg/d유지3～4주.채용개량단극륭항체부획혈소판항원(MAIPA)법검측환자특이성자신항체충류급류형,분석항체충류급류형여지새미송료효적상관성.결과 ①안항체류형분조:IgG조:단일항GPⅡb/Ⅲa항체양성、단일항GP Ⅰ bα항체양성、쌍항체양성、쌍항체음성환자치료유효솔분별위87.5％、50.0％、68.0％、72.3％,사조간항체충류비교차이유통계학의의(x2=11.489,P=0.009).IgM조:단일항GPⅡb/Ⅲa항체양성、단일항GPIbα항체양성、쌍항체양성、쌍항체음성환자유효솔분별위82.1％、71.4％、61.9％、68.9％,사조간항체충류비교차이무통계학의의(x2=2.719,P=0.437).②안항체충류분조:항GP Ⅰ bα조:단일IgG항체양성、단일IgM항체양성、IgG+IgM쌍항체양성、IgG+IgM쌍항체음성환자유효솔분별위52.4％、59.1％、76.5％、77.9％,항체류형재사조간비교차이유통계학의의(x2=10.811,P=0.013).항GPⅡb/Ⅲa조:단일IgG항체양성、단일IgM항체양성、IgG+IgM쌍항체양성、IgG+IgM쌍항체음성환자치료유효솔분별위73.3％、71.0％、61.9％、68.9％,사조간항체류형비교차이무통계학의의(x2=1.374,P=0.719).결론 혈소판특이성자신항체위GP Ⅰ bα-IgG형적성인ITP환자대대제량지새미송충격치료적치료반응교차.
Objective To investigate the different outcomes by dexamethasone in adults immune thrombocytopenia purpura (ITP) with different types ofplatelet specific-autoantibodies.Methods A total of 185 ITP were enrolled,61 males and 124 females,with a median age of 42 (18-83) years,including 117 newly diagnosed,35 persistent,and 33 chronic cases.All the patients received the dexamethasone at an initial dose of 40 mg per day for 4 days and a low dose of 5-10 mg for 3-4 weeks.The platelet specificautoantibodies were identified by the modified monoclonal antibody-specific immobilization of platelet antigen (MAIPA) assay.Results Among the IgG positive patients,the response rates in anti-GP Ⅱ b/Ⅲ a antibody,anti-GP Ⅰ bα antibody,both antibody positive,and both antibody negative were 87.5％,50.0％,68.0％,and 72.3％ (x2=11.489,P ＜ 0.05),respectively.Among the IgM positive patients,the response rates in the four groups were 82.1％,71.4％,61.9％,and 68.9％ (x2=2.719,P=0.437),respectively.Among the GP Ⅰ bα antibody positive patients,the response rates in IgG alone,IgM alone,both positive,and both negative were 52.4％,59.1％,76.1％,and 77.9％ (x2=10.811,P＜ 0.05),respectively.Among the GP Ⅱ b/Ⅲ a antibody positive patients,the response rates in the four groups were 73.3％,71.0％,78.6％,and 66.3％ (x2=1.374,P=0.719),respectively.Conclusion ITP patients with GP Ⅰ bα-IgG antibody have worse response to dexamethasone treatment.
