特发性血小板减少性紫癜患者GPIIb/IIIa、CD62P表达探讨

目的检测原发性血小板减少性紫癜 (ITP)患者血小板表面GPIIb/IIIa、CD62P的表达情况 ,以探讨其在ITP患者中的临床应用价值。方法采用美国BD公司的FACSCalibur流式细胞仪 ,对32例ITP患者、17例非免疫性血小板减少、21例其它自身免疫性疾病及20例健康正常人的血小板表面GPIIb/IIIa、CD62P的表达情况进行了分析测定。结果ITP患者GPIIb/IIIa血小板阳性表达率明显高于其它三组 (P<0.01) ,但CD62P血小板阳性表达率四组无明显差别(P>0.05) ,15例无临床症状ITP患者GPIIb/IIIa表达明显高于17例有临床症状ITP患者的表达(P<0.01)。结论GPIIb/IIIa作为监测血小板活化指标 ,对ITP的鉴别诊断及监测病情发展、判断预后具有重要意义 ;ITP患者的GPIIb/IIIa表达明显增高 ,但CD62P表达并不增高 ,CD62P并非监测ITP患者循环中活化血小板的理想标志物     

再生障碍性贫血患者治疗前后血清TNF-α、VEGF和TSGF检测的临床意义

目的：探讨了再生障碍性贫血患者治疗前后血清TNF-α、VEGF和TSGF水平的变化及意义。方法：应用放射免疫分析、酶免法和化学法对33例再生障碍性贫血患者进行了血清TNF-α、VEGF和TSGF检测,并与35例正常健康人作比较。结果：再生障碍性贫血患者在治疗前血清TNF-α、TSGF水平非常显著地高于正常人组（P〈0.01）,而血清VEGF水平则非常显著地低于正常人组（P〈0.01）,血清TNF-α和TSGF水平与VEGF水平呈明显负相关（r=-0.5192、-0.6018,P〈0.01）,经治疗3个月后与正常人组比较仍有差异（P〈0.05）。结论：检测再生障碍性贫血患者血清TNF-α、VEGF和TSGF水平的变化对了解病情、指导治疗具有重要的临床价值。     

再生障碍性贫血患者输注红细胞治疗前后血清SOD和红细胞免疫功能检测的临床意义

目的：探讨再生障碍性贫血患者在输注红细胞治疗前后血清SOD和红细胞免疫功能的变化。方法：应用化学法和单克隆抗体法对32例再生障碍性贫血患者进行了血清SOD和红细胞免疫功能的检测,并以35名正常健康人作比较。结果：再生障碍性贫血患者在治疗前血清SOD、RBC-C3bR水平显著降低（P〈0.01）,而RBC-ICR水平显著升高（P〈0.01）,经治疗1个月后,除SOD水平与正常人组比较无显著性差异外（P〉0.05）,RBC-C3bR和RBC-ICR水平与正常人组比较仍有显著性差异（P〈0.05）。结论：再生障碍性贫血患者存在严重的红细胞免疫调节紊乱,检测患者输注红细胞治疗前后血清SOD和红细胞免疫功能的变化对其病情发展和预后判断具有重要的临床价值。     

巨细胞病毒感染与儿童免疫性血小板减少性紫癜的关系探讨

目的探讨人巨细胞病毒（HCMV）感染与儿童免疫性血小板减少性紫癜（ITP）的关系。方法采集154例ITP患儿（ITP组）和50例健康儿童（对照组）的血清样本,用Real-time PCR检测HCMV DNA,ELISA方法检测HCMV IgM、IgG抗体;其中105例ITP患儿和50例健康对照儿童采集了尿液标本,用Real-time PCR检测HCMV DNA,并比较ITP组HCMV DNA阳性患儿与阴性患儿的血小板数量的差异。结果 ITP患儿血清HCMV DNA、HCMV IgM及IgG抗体和尿HCMV DNA阳性率均明显高于健康对照儿童,两组比较差异均有统计学意义（P〈0.01）;ITP组HCMV DNA阳性患儿的血小板数量（29.72±14.54）×109/L与阴性患儿（41.28±18.35）×109/L比较差异有统计学意义（P〈0.05）。结论儿童感染HCMV可能是发生ITP的重要致病因素之一,这对指导临床有效治疗及预防ITP的发生有着积极的意义。     

特发性血小板减少性紫癜患者GPⅡb/Ⅲa、CD62P表达探讨

目的检测原发性血小板减少性紫癜(ITP)患者血小板表面GPⅡb/Ⅲa、CD62P的表达情况,以探讨其在ITP患者中的临床应用价值.方法采用美国BD公司的FACSCalibur流式细胞仪,对32例ITP患者、17例非免疫性血小板减少、21例其它自身免疫性疾病及20例健康正常人的血小板表面GPⅡb/Ⅲa、CD62P的表达情况进行了分析测定.结果ITP患者GPⅡb/Ⅲa血小板阳性表达率明显高于其它三组(P＜0.01),但CD62P血小板阳性表达率四组无明显差别(P＞0.05),15例无临床症状ITP患者GPⅡb/Ⅲa表达明显高于17例有临床症状ITP患者的表达(P＜0.01).结论GPⅡb/Ⅲa作为监测血小板活化指标,对ITP的鉴别诊断及监测病情发展、判断预后具有重要意义;ITP患者的GPⅡb/Ⅲa表达明显增高,但CD62P表达并不增高,CD62P并非监测ITP患者循环中活化血小板的理想标志物.     

特发性血小板减少性紫癜患儿外周血淋巴细胞亚群和血小板抗体及骨髓象的比较

目的研究ITP患儿淋巴细胞亚群、血小板抗体及骨髓象在发病期的变化。方法应用流式细胞术（FCM）检测34例ITP患儿发病期外周血淋巴细胞亚群的水平（CD3＋、CD4＋、CD8＋、CD19＋、CD4＋/CD8＋、NK）。用ELISA法检测血小板表面血小板相关抗体IgG、IgM、IgA。同时抽取患儿骨髓制作骨髓片。结果ITP患儿发病期组CD4＋/CD8＋的比例显著降低,NK细胞显著降低,CD19＋显著增高,ITP患儿组血小板抗体PAIgG、PAIgM和正常对照组比较显著增高（P〈0.01）,同时CD19＋增高与血小抗体PAIgG、PAIgM增高有明显相关性（P〈0.001）。骨髓象中巨核细胞总数和对照组比较显著增高（P〈0.01）,同时原幼巨核细胞总数、颗粒巨核细胞总数明显增高,而产板型巨核细胞总数明显降低。结论ITP患儿存在细胞免疫和体液免疫紊乱。     

ITP及风湿免疫性疾病血小板及粒细胞相关抗体临床意义探讨

目的 对免疫性血小板减少性紫癜(ITP)患者、健康人群以及伴有血小板减少的风湿免疫性疾病患者(系统性红斑狼疮,类风湿关节炎,干燥综合征)体内血小板相关免疫球蛋白(PAIg)及粒细胞相关免疫球蛋白(Ig)水平的阳性率进行比较,探讨其在免疫性血小板减少性疾病发病中的作用和意义.方法 用Beckman Coulter公司XL流式细胞仪对205例ITP患者、133例健康人及64例伴有血小板减少的风湿免疫性疾病患者的血小板及粒细胞表面相关免疫球蛋白水平检测并进行比较.结果 PAIgG在ITP患者及伴有血小板减少的风湿免疫性疾病患者中均升高,与健康人对照组存在差异;PAIgA的增高仅出现在ITP患者中,与健康人对照组存在差异;而伴有血小板减少的风湿免疫性疾病患者中不增高,与健康人对照组无显著差异.PAIgM的增高仅出现在伴有血小板减少的风湿免疫性疾病患者中,与健康人对照组存在差异,而ITP患者与健康人群对照组无显著差异.三种粒细胞相关抗体则均出现于ITP患者及伴有血小板减少的风湿免疫性疾病患者,与健康人群对照组存在差异.结论 ITP虽然定义为器官特异性免疫性疾病,但受累靶细胞决不仅限于血小板,至少还包括白细胞.免疫性血小板减少疾病发病中普遍存在粒细胞相关抗体的出现.PAIgG并非仅出现在ITP患者,结合PAIgA的增高在临床上可能更支持ITP的诊断;而伴有血小板减少的风湿免疫性疾病患者出现的血小板下降可能主要由PAIgM所介导.     

血小板相关抗体在诊断ITP应用中的改进设想

目的:提高血小板相关抗体诊断免疫性血小板减少性紫癜的特异性。方法:选择144例血小板计数低于100×109/L的患者,根据诊断分为ITP组和NITP组;用流式细胞术检测其外周血PAIgG,PAIgA,PAIgM;通过ROC曲线分析确定PAIgG,PAIgA,PAIgM有助于诊断ITP的水平。结果:PAIgG和PAIgM对ITP的最佳诊断界值分别为5%和10%,PAIgG单独诊断ITP的敏感性为71.43%,特异性为79.17%,PAIgG与PAIgM串联诊断ITP的敏感性为60.57%,特异性为87.5%。结论:流式细胞术检测PAIgG和PAIgM,联合ROC曲线分析,对ITP的诊断具有确切价值。     

ITP血小板特异性自身抗体（GPⅡb/Ⅲa和GPIbα）与糖皮质激素和静脉丙种球蛋白临床疗效的关系

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糖皮质激素和静脉丙种球蛋白（静丙）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GPⅡb/ⅡIa,GPIbα特异性自身抗体。结果双抗体阳性组与单一抗GPIbα抗体阳性组总疗效比较,差异无显著性（χ^2=0.995,P〉0.05）双抗体阳性组与单一抗GPⅡb/ⅡIa抗体阳性组总疗效比较,差异有显著性（χ^2=17.439,P〈0.01）,后者优于前者;单一抗GPⅡb/ⅡIa抗体阳性组,双抗体阳性组,双抗体阴性组,糖皮质激素治疗与糖皮质激素联合静丙治疗比较,差异无显著性（P〉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、静丙）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。     

几种临床疾病的血小板相关抗体检测结果分析

目的 :探讨血小板相关抗体在血小板减少症中的临床应用。方法 :选择健康者、血小板低于正常的体检者、血小板减少性紫癜(ITP)、再障 (AA)、肝脏疾患、系统性红斑狼疮 (SLE)患者等采用ELISA法定量测定血小板抗体PAIgG、PAIgM、PAIgA ,并分析ITP患者治疗前后血小板相关抗体的变化。结果 :血小板低于正常的体检者血小板抗体的阳性率 14 .9% ,ITP、AA、SLE等患者血小板相关抗体阳性率与正常组比较有显著差异 ,分别为 78.9%、3 1.2 %、62 .5 % ,肝病者血小板相关抗体与正常组无差异。ITP患者治疗前后三种血小板抗体均有非常显著性变化 (P <0 .0 1)。结论 :血小板相关抗体测定在自身免疫性疾病引起的血小板减少的诊疗中有重要意义     

ELISA for platelet-associated IgG, IgM, and C3, and their clinical application

The platelet-associated IgG (PAIgG) has been reported to elevate in the patients with idiopathic thrombocytopenic purpura (ITP) and other autoimmune diseases. However, low PAIgG levels have been often recognized in thrombocytopenia. We speculated about the increasing of other platelet-associated proteins in those patients, and tried to determine platelet-associated IgM (PAIgM) and platelet-associated C3 (PAC3) using a high sensitive competitive micro-ELISA as well as PAIgG. Our results showed the specific elevation of PAIgM and PAC3 in thrombocytopenia as well as the PAIgG level (p less than 0.01). Further, the weak correlations among these levels were found (PAIgG/PAIgM: n = 7, correlation coefficient (r) = 0.55, PAIgG/PAC3: n = 73, r = 0.61, PAIgM/PAC3: n = 56, r = 0.39). We discussed on the possibility that the PAIgM and PAC3 also could be an indicator for the platelet injury and may cause the short platelet life span resulting thrombocytopenia as well as PAIgG.     

抗内皮细胞抗体和血小板生成素测定在ITP与SLE鉴别中的意义

目的：探讨抗内皮细胞抗体(AECA)和血小板生成素(TPO)测定在鉴别特发性血小板减少性紫癜（ITP）和系统性红斑狼疮（SLE）中的临床意义。 方法: 用ELISA法分别测定76例ITP患者、41例SLE患者及50例正常人血清中的AECA和TPO水平。 结果: SLE组、ITP组患者血清AECA水平明显高于正常对照组（P<0.01）；SLE组患者血清AECA水平显著高于ITP组（P<0.01）；ITP组患者血清TPO水平与正常对照组无显著差异(P>0.05)，而SLE组血清TPO水平显著高于ITP组患者和正常对照组(P<0.01)。 结论: 血清AECA和TPO的测定在鉴别诊断ITP和SLE中有显著的临床意义。     

Platelet associated immunoglobulins and complement in idiopathic thrombocytopenic purpura.

A double antibody sandwich enzyme linked immunosorbent assay (ELISA) was applied to quantitate platelet associated (PA) immunoglobulins G, A and M and complement factors C3c and C4. Fifteen patients with acute and 29 patients with chronic idiopathic thrombocytopenic purpura (ITP) were studied as well as 35 normal controls. Forty-three out of 44 (98%) patients had elevated platelet associated immunoglobulins. PAIgG was elevated in 95%, PAIgA in 82% and PAIgM in 74% of the patients. PAC3 was increased in 86% and PAC4 in 57% of the patients. There was strong correlation between PAC3 and PAIgG but not between PAC4 and PAIgG in acute ITP. In chronic ITP, however, PAC4 correlated strongly and even better than PAC3 with PAIgG. This strengthens the conjecture that the pathogenesis of ITP in many acute cases differs from that of chronic ITP.     

测定血清TGAb和TPOAb在自身免疫性甲状腺疾病中的临床价值

为探讨自身免疫性甲状腺疾病(AITD)患者血清TGAb和TPOAb浓度及临床价值,用RIA测定175例AITD组患者、64例非AITD组患者和57名对照组血清TGAb和TPOAb浓度.结果表明,AITD组中GD、HT患者血清TGAb和TPOAb浓度显著高于对照组(P<0.01),而非AITD组与对照组比较无显著性差异(P>0.05).本文认为检测TGAb和TPOAb有助于了解AITD的发病机制,对AITD的诊治及预后判断具有一定的临床价值.     

Clinical correlates in patients with elevated platelet-associated immunoglobulins

Studies are reported pertaining to platelet-associated IgG (PAIgG) and IgM (PAIgM) in patients with thrombocytopenias considered possibly immune-mediated on clinical grounds. Approximately 14 percent of all patients with these disorders had elevated PAIgM but normal levels of PAIgG. Of patients with classic autoimmune thrombocytopenia (ITP), there was a trend toward more frequently normal levels of PAIgG in chronic ITP compared with patients with acute ITP, but this was not statistically significant. Patients with acute ITP had higher levels of PAIgG and PAIgM in general than those with chronic ITP. Patterns of PAIgG and/or PAIgM elevation were not significantly different when chronic and acute ITP were compared, nor when childhood ITP was compared with adult ITP. Patients with immune thrombocytopenias owing to malignant disorders were likely to have lower levels of PAIgG compared with those with classic ITP. Treated patients with immune thrombocytopenias showed a trend toward earlier response to therapy if they had only elevated PAIgG as opposed to elevated PAIgM alone or elevated PAIgM and PAIgG (p = 0.17). There appear to be great overlaps in the patterns and quantities of PAIgG and PAIgM in patients with immune-mediated thrombocytopenias in widely varied clinical settings. This suggests some underlying common pathophysiologic mechanisms for thrombocytopenia in these clinically diverse disorders. It is believed that the data are most consistent with the hypothesis that thrombocytopenia in patients with elevated PAIgG and/or PAIgM is most probably of immune origin even in such diverse disorders as systemic lupus erythematosus, cirrhosis of the liver, lymphoma, leukemia, cancer, or septic conditions, as well as in ITP.     

Quantitative comparisons of antibody-binding sites of platelet glycoprotein IIb/IIIa in aplastic anemia and idiopathic thrombocytopenic purpura

The numbers of antibody-binding sites of platelet glycoprotein (GP) IIb/IIIa on circulating platelets were analyzed using 4 kinds of antibodies in 34 aplastic anemia (AA) patients, 20 idiopathic thrombocytopenic purpura (ITP) patients, and 14 normal controls. The numbers of antibody-binding sites of CD41, CD41a, CD41b, and CD61 on platelets of the AA patients were less than in the normal controls (p <0.001). In the ITP patients, the numbers of sites for CD41 and CD41a were less than in normal controls (p <0.05). There were significant positive correlations between CD41 and CD41a, CD41b, and CD61 in the 3 groups. There were significant negative correlations between CD41 and CD41b and between CD41a and CD41b in the normal controls, but not in the AA or ITP patients. In summary, the numbers of the 4 antibody-binding sites of GPIIb/IIIa on platelets of AA and ITP patients are different from those in normal controls. Measurements of the antibody-binding sites of GPIIb/IIIa are not necessary for the differential diagnosis of AA and ITP. However, the differences in correlations between the numbers of epitopes in AA and ITP patients suggest that the epitopes of GPIIb/IIIa are altered in these diseases.     

Clinical significance of simultaneous measurement of reticulated platelets and large platelets in idiopathic thrombocytopenic purpura

Frequencies of reticulated platelets (RP) and large platelets (LP) among circulating platelets can now be simultaneously determined using the R-3000 automated reticulocyte counter (Sysmex, Kobe, Japan) equipped with special software. We measured frequencies of RP and LP in patients with idiopathic thrombocytopenic purpura (ITP. acute type n = 5; chronic type n = 39), and healthy normal controls (n = 20). In ITP patients, the platelet-associated IgG (PAIgG) level was also determined. Both RP and LP were significantly higher in chronic ITP patients than those in normal volunteers, and interestingly, the LP in acute ITP was significantly lower than that in chronic ITP although there was no significant difference in RP between acute and chronic ITP. Furthermore, we analyzed the changes in both RP and LP during the clinical course of ITP to monitor the therapeutic effect in 2 patients. An elevation of RP with a steep slope prior to a decrease in the platelet count level was observed. The RP significantly correlated with the PAIgG level. Simultaneous measurement of RP and LP may be helpful for the diagnosis of chronic ITP, for the differentiation of acute from chronic type and for the control of the efficacy of management in ITP, since RP seems to reflect the disease activity of ITP.     

重症肌无力患者血清白细胞介素-10水平变化的研究

目的 :探讨重症肌无力 (MG)患者血清白细胞介素 (IL) 10的变化及其临床意义。方法 :采用双抗体夹心ELISA法检测 36例未经免疫抑制治疗和 30例已使用糖皮质激素 (GC)系统治疗的MG患者及 2 0例健康献血者的血清IL 10水平。结果 :血清IL 10水平在MG患者高于健康者 (P <0 0 1) ,经GC治疗后 ,其水平明显降低 (P <0 0 5 ) ,但仍高于健康者 (P <0 0 5 ) ;在AchRab阳性患者高于AchRab阴性患者 (P <0 0 5 )和正常对照者 (P <0 0 1) ,且与AchRab滴度呈正相关 (P <0 0 1)。IL 10分别在MG未治组和GC治疗组中 ,全身型均高于眼肌型 (P <0 0 5 ) ;病情重者均高于病情轻者 (P <0 0 1) ;急性期均高于慢性期 (P <0 0 5 ) ;伴胸腺异常者均高于胸腺正常者 (P <0 0 5 )。结论 :MG患者血清IL 10水平显著增高 ;IL 10与MG临床特点和AchRab的产生有关 ,在MG发病机制中起重要作用     

Raised expression of APRIL in Chinese patients with immune thrombocytopenia and its clinical implications

Background: Immune thrombocytopenia (ITP) is an immune-mediated disorder in which destruction of platelets is accelerated by anti-platelet autoimmune antibodies. B-cell-activating factor (BAFF) and a proliferation-inducing ligand (APRIL), essential factors for B cell survival are elevated in systemic autoimmune diseases and correlated with clinical findings. High expression of BAFF has been shown in patients with ITP, but the status of APRIL in ITP is still unknown.

Objective: To determine the expression of APRIL and it receptors, B-cell maturation antigen (BCMA) and trans-membrane activator and calcium modulator and cyclophilin ligand interactor (TACI), in patients with ITP, and evaluate the correlation between plasma APRIL levels and platelet accounts or other clinical parameters.

Methods: Plasma samples from 57 patients with ITP, and 30 normal healthy subjects were assayed for APRIL plasma concentration by enzyme linked immunosorbent assay. Real-time quantitative polymerase chain reaction was performed to determine the mRNA expression of APRIL and its receptors (BCMA and TACI) in peripheral blood mononuclear cells (PBMNCs) in 25 normal controls and 34 untreated ITP patients with active disease.

Results: The APRIL levels in the plasma samples from patients with ITP were significantly higher than those from healthy controls (p = 0.000). PBMNCs may be a source of the excess APRIL. Treated patients with normal platelet count have relatively normal plasma APRIL (p = 0.599). Plasma APRIL levels in active patients were significantly correlated with platelet counts (r = ? 0.387 and p = 0.024).

Conclusion: APRIL is over expressed in untreated active ITP patients and might be a pathogenic factor of this disorder.