Kelton J G, Neame P B, Gauldie J, Hirsh J
N Engl J Med. 1979 Apr 5;300(14):760-4. doi: 10.1056/NEJM197904053001404.
The mechanism of thrombocytopenia, a frequent complication of septicemia, is obscure, but indirect evidence suggests that the immune system may be involved. To investigate this possibility, we quantitated platelet-associated IgG on platelets obtained from 44 patients during 46 episodes of septicemia. Thrombocytopenia occurred in 21 of 46 episodes (46 per cent). Platelet-associated IgG was elevated in eight of 11 episodes of gram-negative septicemia and thrombocytopenia (47.3 +/- 11.7 fg of IgG per platelet [mean +/- S.E.]) and in one of 20 patients with gram-negative septicemia and normal platelet counts (5.9 +/- 1.1) (P less than 0.001). Elevated levels occurred in eight of 10 patients with gram-positive septicemia and thrombocytopenia (55.3 +/- 14.7 fg of IgG per platelet) and in none of 11 patients with gram-positive septicemia and normal platelet counts (5.6 +/- 1.7) (P less than 0.001). Serial testing during the thrombocytopenia and recovery showed an inverse relation between the platelet count and platelet-associated IgG. Thrombocytopenia in some patients with septicemia may be related to the binding of IgG to platelets.
血小板减少是败血症常见的并发症，其机制尚不清楚，但间接证据表明免疫系统可能与之有关。为了研究这种可能性，我们对44例败血症患者在46次发病期间所采集血小板上的血小板相关IgG进行了定量分析。46次发病中有21次出现血小板减少（46%）。在11次革兰阴性败血症并发血小板减少的病例中，有8次血小板相关IgG升高（每血小板47.3±11.7 fg IgG[平均值±标准误]），在20例革兰阴性败血症且血小板计数正常的患者中，有1例升高（5.9±1.1）（P<0.001）。在10例革兰阳性败血症并发血小板减少的患者中，有8例水平升高（每血小板55.3±14.7 fg IgG），而在11例革兰阳性败血症且血小板计数正常的患者中无一例升高（5.6±1.7）（P<0.001）。在血小板减少及恢复过程中的系列检测显示，血小板计数与血小板相关IgG呈负相关。部分败血症患者的血小板减少可能与IgG与血小板的结合有关。
