Chen Jian-fang, Yang Lin-hua, Feng Jian-jun, Chang Li-xian, Liu Xiu-e, Lu Yu-jin
Department of Hematology, Second Hospital of Shanxi Medical University, Taiyuan 030001, China.
Zhonghua Nei Ke Za Zhi. 2010 Sep;49(9):765-8.
To assess the clinical significance of detecting the immune markers in idiopathic thrombocytopenic purpura (ITP).
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 immobilization of platelet antigens assay (MAIPA), flow cytometry and sandwich enzyme-linked immunosorbent assay respectively.
Compared with the controls [1.3 ± 0.5/10(5) 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 ± 4.6/10(5) PBMC in acute ITP group, 5.3 ± 3.0/10(5) PBMC in chronic ITP group), platelet-specific antibody (including the anti-GPIIb/IIIa antibody, anti-GPIb/IX 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 CD(8)(+) 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 CD(3)(+) T lymphocyte and CD(4)(+) T lymphocyte and the ratio of CD(4)(+)/CD(8)(+) 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).
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 thrombopoietin in the patients with ITP may improve the diagnosis and guide clinical therapy.
评估检测特发性血小板减少性紫癜（ITP）免疫标志物的临床意义。
分别采用酶联免疫斑点法（ELISPOT）、改良的血小板抗原单克隆抗体固定法（MAIPA）、流式细胞术和夹心酶联免疫吸附测定法，检测64例ITP患者和31例健康对照者中分泌血小板特异性抗体的循环B细胞频率、血小板特异性抗体、T淋巴细胞亚群百分比、网织血小板百分比及血小板生成素水平。
与对照组[1.3±0.5/10(5)外周血单个核细胞（PBMC），(0.33±0.06, 0.41±0.03)，(22.08±4.54)%和(8.19±2.46)%]相比，ITP患者中分泌血小板特异性抗体的循环B细胞频率（急性ITP组为7.6±4.6/10(5) PBMC，慢性ITP组为5.3±3.0/10(5) PBMC）、血小板特异性抗体（包括抗GPIIb/IIIa抗体、抗GPIb/IX抗体）（急性ITP组为0.51±0.11, 0.48±0.06；慢性ITP组为0.49±0.10, 0.46±0.09）、CD(8)(+) T淋巴细胞百分比（27.09±9.86)%、网织血小板百分比[巨核细胞增多组为(24.85±19.18)%，正常巨核细胞组为(23.89±18.90)%]均显著升高（均P<0.05）。急性ITP患者中分泌血小板特异性抗体的循环B细胞频率较慢性ITP患者显著升高（P<0.05）。在T淋巴细胞亚群中，ITP患者的CD(3)(+) T淋巴细胞、CD(4)(+) T淋巴细胞百分比及CD(4)(+)/CD(8)(+)比值[(60.88±14.59)%，(28.41±10.55)%，1.18±0.59]较健康对照者[(69.89±6.43)%，(35.38±5.05)%，1.64±0.29]显著降低（P<0.05）。巨核细胞增多的ITP患者与健康对照者的血小板生成素水平无明显差异（72.09±41.64与75.37±26.32，P>0.05），然而，正常巨核细胞的ITP患者血小板生成素水平明显升高（118.60±70.72，P<0.05）。
检测ITP患者中分泌血小板特异性抗体的循环B细胞频率、血小板特异性抗体、T淋巴细胞亚群百分比、网织血小板百分比及血小板生成素水平可能有助于改善诊断并指导临床治疗。
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