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血小板糖蛋白Ⅱb/Ⅲa 自身抗体阳性与初诊免疫性血小板减少症患者对激素治疗反应的关系。

Association between P-Selectin Autoantibody Positive and Response to Steroid Treatment in Newly Diagnosed Immune Thrombocytopenia Patients.

机构信息

Department of Blood, Hulunbeir People's Hospital, Hulunbeir, China.

出版信息

Acta Haematol. 2022;145(5):499-504. doi: 10.1159/000524535. Epub 2022 Apr 11.

DOI:10.1159/000524535
PMID:35405676
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9808632/
Abstract

OBJECTIVE

This study aimed to detect the association between P-selectin autoantibody positive and response to steroid treatment in newly diagnosed immune thrombocytopenia (ITP) patients.

METHODS

The data from 105 newly diagnosed adult ITP patients administered with first-line of steroid treatment from October 2016 to May 2021 were retrospectively analyzed. Treatment responses were evaluated within 3 months after the onset of treatment.

RESULTS

Among the 105 patients, 80.00% (84/105) of patients presented with platelet glycoprotein-specific antibody positive; 44.76% (47/105) patients were anti-P-selectin positive, while 35.24% (37/105) were anti-P-selectin negative. No significant difference in overall response was observed between patients who were anti-P-selectin positive and those who were anti-P-selectin negative (74.47% vs. 89.19, χ2 = 2.910, p = 0.088). But patients who were anti-P-selectin negative had significantly higher complete response rate, compared to those who were anti-P-selectin positive (72.97% vs. 48.94%, χ2 = 4,965, p = 0.026). Logistic regression analysis revealed that anti-GP IIb/IIIa positive (OR = 3.114, p = 0.010, 95% CI: 1.313-7.388) and anti-P-selectin positive (OR = 0.309, p = 0.036, 95% CI: 0.127-0.753) were two factors that could affect patients' response.

CONCLUSIONS

Our study found that ITP patients with anti-GP IIb/IIIa may have a higher response to steroid treatment, but anti-P-selectin-mediated-ITP might be less responsive to steroid treatment. In adults with ITP, the presence of anti-P-selectin autoantibodies is a predictive factor for poor response to steroid treatment.

摘要

目的

本研究旨在检测新诊断的免疫性血小板减少症(ITP)患者中 P 选择素自身抗体阳性与对类固醇治疗反应之间的关系。

方法

回顾性分析了 2016 年 10 月至 2021 年 5 月期间接受一线类固醇治疗的 105 例新诊断的成年 ITP 患者的数据。在治疗开始后 3 个月内评估治疗反应。

结果

在 105 例患者中,80.00%(84/105)的患者血小板糖蛋白特异性抗体阳性;44.76%(47/105)的患者抗 P 选择素阳性,而 35.24%(37/105)的患者抗 P 选择素阴性。抗 P 选择素阳性与抗 P 选择素阴性患者的总体反应无显著差异(74.47%比 89.19%,χ2=2.910,p=0.088)。但抗 P 选择素阴性患者的完全缓解率明显高于抗 P 选择素阳性患者(72.97%比 48.94%,χ2=4,p=0.026)。Logistic 回归分析显示,抗 GP IIb/IIIa 阳性(OR=3.114,p=0.010,95%CI:1.313-7.388)和抗 P 选择素阳性(OR=0.309,p=0.036,95%CI:0.127-0.753)是影响患者反应的两个因素。

结论

本研究发现,ITP 患者抗 GP IIb/IIIa 可能对类固醇治疗有更高的反应,但抗 P 选择素介导的 ITP 可能对类固醇治疗反应不佳。在成人 ITP 中,抗 P 选择素自身抗体的存在是对类固醇治疗反应不良的预测因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d44b/9808632/3b28eb7572b5/aha-0145-0499-g01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d44b/9808632/3b28eb7572b5/aha-0145-0499-g01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d44b/9808632/3b28eb7572b5/aha-0145-0499-g01.jpg

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Clin Exp Hepatol. 2021 Jun;7(2):231-240. doi: 10.5114/ceh.2021.107566. Epub 2021 Jun 30.
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Immune Thrombocytopenia: Recent Advances in Pathogenesis and Treatments.免疫性血小板减少症:发病机制与治疗的最新进展
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Clinical efficacy of high-dose dexamethasone with sequential prednisone maintenance therapy for newly diagnosed adult immune thrombocytopenia in a real-world setting.
高剂量地塞米松序贯泼尼松维持疗法在真实世界中对新诊断的成人免疫性血小板减少症的临床疗效。
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Emerging Therapies in Immune Thrombocytopenia.免疫性血小板减少症的新兴疗法
J Clin Med. 2021 Mar 2;10(5):1004. doi: 10.3390/jcm10051004.
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Updated international consensus report on the investigation and management of primary immune thrombocytopenia.更新的原发性免疫性血小板减少症的调查和管理国际共识报告。
Blood Adv. 2019 Nov 26;3(22):3780-3817. doi: 10.1182/bloodadvances.2019000812.
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