Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics (Capital Medical University), Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
Hematologic Disease Laboratory, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China.
Pediatr Blood Cancer. 2023 Feb;70(2):e30094. doi: 10.1002/pbc.30094. Epub 2022 Nov 15.
Immune thrombocytopenia (ITP) is an autoimmune-mediated hemorrhagic disease. Anti-glycoprotein autoantibodies play a key role in the pathophysiology of ITP, but the relationship between platelet-specific antibodies and bleeding severity is unclear. This study aimed to analyze the relationship between anti-glycoprotein autoantibodies and bleeding severity in children with newly diagnosed ITP and platelet count less than 10 × 10 /L.
This was a single-center prospective observational study that analyzed children with newly diagnosed ITP and platelet count less than 10 × 10 /L between June 2018 and September 2021 at our hospital. The children were classified into the mild and severe groups based on the bleeding scores. The type and titer of anti-glycoprotein autoantibodies were detected using an enzyme-linked immunosorbent assay (ELISA) kit (PAKAUTO). We analyzed the relationship between bleeding severity and anti-glycoprotein autoantibodies.
A total of 86 cases were enrolled, including 42 in the mild group and 44 in the severe group. Patients with anti-GPIIb/IIIa or anti-GPIb/IX antibodies suffered more severe bleeding than patients without them (χ = 7.303, p = .007; χ = 3.875, p = .049), but there was no significant difference between patients with or without anti-GPIa/IIa antibodies (χ = 0.745, p = .388). When antibodies were analyzed together, patients with three antibodies suffered more severe bleeding than those without three antibodies (χ = 5.053, p = .025). Patients with higher antibody titer in the eluent, but not in the plasma, suffered more severe bleeding in all three antibodies (Z = -2.389, p = .017; Z = -2.108, p = .035; Z = -2.557, p = .011).
Anti-glycoprotein autoantibodies led to more severe bleeding in children under 18 years of age without drug treatment with newly diagnosed ITP and platelet count less than 10 × 10 /L.
免疫性血小板减少症（ITP）是一种自身免疫介导的出血性疾病。抗糖蛋白自身抗体在 ITP 的病理生理学中起着关键作用，但血小板特异性抗体与出血严重程度之间的关系尚不清楚。本研究旨在分析初诊血小板计数<10×10/L 的儿童 ITP 患者中抗糖蛋白自身抗体与出血严重程度的关系。
这是一项单中心前瞻性观察研究，分析了 2018 年 6 月至 2021 年 9 月我院收治的初诊 ITP 且血小板计数<10×10/L 的儿童。根据出血评分将患儿分为轻度组和重度组。采用酶联免疫吸附试验（ELISA）试剂盒（PAKAUTO）检测抗糖蛋白自身抗体的类型和滴度。分析出血严重程度与抗糖蛋白自身抗体的关系。
共纳入 86 例患儿，其中轻度组 42 例，重度组 44 例。与无抗-GPIIb/IIIa 或抗-GPIb/IX 抗体的患儿相比，抗-GPIIb/IIIa 或抗-GPIb/IX 抗体的患儿出血更为严重（χ=7.303，p=0.007；χ=3.875，p=0.049），而无抗-GPIa/IIa 抗体的患儿之间无显著差异（χ=0.745，p=0.388）。当联合分析抗体时，三种抗体均阳性的患儿出血更为严重（χ=5.053，p=0.025）。在洗脱液而非血浆中抗体滴度较高的患儿，所有三种抗体的出血均更为严重（Z=-2.389，p=0.017；Z=-2.108，p=0.035；Z=-2.557，p=0.011）。
在未接受药物治疗的初诊血小板计数<10×10/L 的 18 岁以下儿童 ITP 患者中，抗糖蛋白自身抗体导致出血更为严重。
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