原发与继发免疫性血小板减少症患者血小板膜糖蛋白特异性抗体及其与出血评分关系的研究

Correlation of platelet membrane glycoprotein specific antibodies with bleeding scores in patients with primary and secondary immune thrombocytopenia

摘要:

目的 探讨原发与继发免疫性血小板减少症（ITP）患者抗GPⅡb/Ⅲa及GPΙb/Ⅸ抗体的表达、抗体阳性表达与出血评分的关系，以及不同抗体类型出血评分的差异，为原发与继发ITP患者的诊治和出血严重程度提供临床依据。方法 选取2013年10月—2020年8月在新疆医科大学第一附属医院诊断为原发ITP患者（42例）及继发ITP患者（42例）为研究对象，所有患者入院时采用ITP出血评分量表行出血评分。应用改良MAIPA法检测患者抗GPⅡb/Ⅲa和抗GPΙb/Ⅸ抗体。结果 原发与继发组患者抗GPⅡb/Ⅲa抗体、抗GPΙb/Ⅸ抗体阳性率比较，差异无统计学意义（P >0.05），原发组患者抗体表达以抗GPⅡb/Ⅲa抗体为主，继发组抗体表达以抗GPΙb/Ⅸ抗体为主，两者抗体阳性构成比较，差异有统计学意义（P <0.05）。继发组患者整体出血程度较原发组重（P <0.05）。抗体阳性表达与出血程度的关系：①抗GPⅡb/Ⅲa抗体阳性患者出血程度较抗体阴性患者重（P <0.05）。②抗GPΙb/Ⅸ抗体阳性患者出血程度较抗体阴性患者重（P <0.05），双抗体阳性患者出血程度较抗体阴性患者重（P <0.05）。结论 抗GPⅡb/Ⅲa抗体、抗GPΙb/Ⅸ抗体阳性表达对原发与继发ITP无鉴别意义，但原发ITP患者抗体表达以抗GPⅡb/Ⅲa抗体为主，继发ITP患者抗体表达以抗GPΙb/Ⅸ抗体为主。继发ITP患者临床出血程度较原发ITP患者重。抗GPⅡb/Ⅲa抗体、抗GPΙb/Ⅸ抗体及抗体双阳性患者出血程度较抗体阴性患者重。

Abstract:

Objectives To explore the expression of anti-GPⅡb/Ⅲa and anti-GPΙb/Ⅸ antibodies in patients with primary and secondary immune thrombocytopenia (ITP), investigate the relationship between antibody positivity and bleeding scores, and analyze the differences in bleeding severity based on different antibody types. This study aims to provide clinical insights for the diagnosis, treatment, and assessment of bleeding severity in patients with primary and secondary ITP.Methods Patients diagnosed with primary ITP (42 cases) and secondary ITP (42 cases) between October 2013 and August 2020 at the First Affiliated Hospital of Xinjiang Medical University were included. Bleeding scores were assessed using the ITP bleeding score scale upon admission. The modified MAIPA method was employed to detect anti-GPⅡb/Ⅲa and anti-GPΙb/Ⅸ antibodies.Results There was no significant difference in the positivity rates of anti-GPⅡb/Ⅲa and anti-GPΙb/Ⅸ antibodies between the primary and secondary groups (P > 0.05). The primary group predominantly expressed anti-GPⅡb/Ⅲa antibodies, while the secondary group showed a higher expression of anti-GPΙb/Ⅸ antibodies. The difference in the composition of positive antibodies was statistically significant (P < 0.05). The overall bleeding severity was higher in the secondary group compared to the primary group (P < 0.05). The relationship between antibody positivity and bleeding severity was as follows: (1) Patients positive for anti-GPⅡb/Ⅲa antibodies had a more severe bleeding degree than antibody-negative patients (P < 0.05). (2) Patients positive for anti-GPΙb/Ⅸ antibodies had a more severe bleeding degree than antibody-negative patients (P < 0.05), and those with dual antibody positivity had a more severe bleeding degree than antibody-negative patients (P < 0.05).Conclusion The expression of anti-GPⅡb/Ⅲa and anti-GPΙb/Ⅸ antibodies does not differentiate between primary and secondary ITP. However, primary ITP patients predominantly express anti-GPⅡb/Ⅲa antibodies, while secondary ITP patients express anti-GPΙb/Ⅸ antibodies. Secondary ITP patients exhibit a higher clinical bleeding severity compared to primary ITP patients. Patients positive for anti-GPⅡb/Ⅲa antibodies, anti-GPΙb/Ⅸ antibodies, and dual antibody positivity have a more severe bleeding degree than antibody-negative patients.