Mehta Y S, Ghosh K, Badakere S S, Pathare A V, Mohanty Dipika
Institute of Immunohaematology, KEM Hospital Campus, Mumbai, India.
J Lab Clin Med. 2003 Aug;142(2):113-20. doi: 10.1016/S0022-2143(03)00104-5.
The severity and clinical course of idiopathic thrombocytopenic purpura (ITP) vary from patient to patient. The factors responsible for this variation are not well understood. In this study we attempted to evaluate the role of antiidiotypic antibodies in the immunoregulation of the disease. We investigated 114 cases of chronic ITP in adults. We determined antiidiotypic antibodies against antiplatelet antibodies using (a) idiotype-binding enzyme-linked immunosorbent assay (ELISA), (b) paratope-blocking ELISA, and (c) Western blotting. Results indicated that 80.6%, 11.2%, and 8.3% of the patients, respectively, presented with antiidiotypes against antibodies to GPIIb/IIIa, GPIb/IX, and both GPIIb/IIIa and GPIb/IX. More than 70% of the patients who showed high levels of blocking of antiidiotypic antibodies went into complete remission, compared with less than 5% of patients who showed low levels of such antibodies (P <.01). Disease severity was also found to be inversely related (P < 0.01) to the degree of blocking of antiidiotypic antibodies. The results of this study suggest that antiidiotypic antibodies against antiplatelet antibodies are a potential prognostic marker in chronic ITP.
特发性血小板减少性紫癜（ITP）的严重程度和临床病程因患者而异。导致这种差异的因素尚未完全明确。在本研究中，我们试图评估抗独特型抗体在该疾病免疫调节中的作用。我们调查了114例成人慢性ITP患者。我们使用（a）独特型结合酶联免疫吸附测定（ELISA）、（b）互补位阻断ELISA和（c）蛋白质印迹法测定了针对抗血小板抗体的抗独特型抗体。结果表明，分别有80.6%、11.2%和8.3%的患者出现针对糖蛋白IIb/IIIa（GPIIb/IIIa）抗体、糖蛋白Ib/IX（GPIb/IX）抗体以及GPIIb/IIIa和GPIb/IX两者抗体的抗独特型抗体。与抗独特型抗体阻断水平低的患者中不到5%的比例相比，抗独特型抗体阻断水平高的患者中有超过70%完全缓解（P <.01）。还发现疾病严重程度与抗独特型抗体的阻断程度呈负相关（P < 0.01）。本研究结果表明，针对抗血小板抗体的抗独特型抗体是慢性ITP的一种潜在预后标志物。
