血小板抗体和T细胞亚群检测在诊断原发免疫性血小板减少症中的意义
|
摘要
目的探讨血小板抗体和T细胞亚群检测在诊断原发免疫性血小板减少症(ITP)中的意义。方法回顾性分析2017年3月至2018年5月广元市第二人民医院收治的143例免疫性血小板减少症患者的临床资料,其中ITP患者93例(ITP组),继发免疫性血小板减少症(sITP)患者50例(sITP组)。选取同期在该院体检的健康志愿者50例为对照组。采用流式细胞仪检测患者血小板抗体(PAIgG、PAIgM、PAIgA)和T细胞亚群(CD3~+、CD4~+、CD8~+、CD4~+/CD8~+)水平。采用受试者工作特征曲线(ROC曲线)评价血小板抗体和T细胞亚群诊断ITP的作用。结果 ITP组患者PAIgG、PAIgM、PAIgA均明显高于sITP组和对照组,差异有统计学意义(P<0.05);CD3~+、CD4~+、CD4~+/CD8~+水平明显低于sITP组和对照组,差异有统计学意义(P<0.05),而CD8~+水平明显高于sITP组和对照组,差异有统计学意义(P<0.05)。ITP组患者PAIgG、PAIgM、PAIgA异常率均明显高于sITP组和对照组,差异有统计学意义(P<0.05);CD3~+、CD4~+、CD8~+、CD4~+/CD8~+异常率均明显高于sITP组和对照组,差异有统计学意义(P<0.05)。血小板抗体联合T细胞亚群诊断ITP的ROC曲线下面积为0.932,灵敏度为86.5%,特异度为87.5%。结论 ITP患者存在血小板抗体升高和T细胞亚群紊乱的现象,联合检测血小板抗体和T细胞亚群能够更加准确地反映患者病情,提高诊断效能,为疾病的临床治疗提供更好的支持。
Objective To investigate the significance of detection of platelet antibody and T cell subsets in diagnosis of primary immune thrombocytopenia(ITP).Methods The clinical data of 143 immune thrombocytopenia patients admitted to a hospital from March 2017 to May 2018 were retrospectively analyzed,including93 patients with ITP(ITP group)and 50 patients with secondary immune thrombocytopenia(sITP)group.50 healthy volunteers in a hospital during the same period were selected as control group.The levels of platelet antibodies(PAIgG,PAIgM,PAIgA)and T cell subsets(CD3~+,CD4~+,CD8~+,CD4~+/CD8~+)were detected by flow cytometry.Receiver operating curve(ROC)was used to evaluate the role of platelet antibodies and T cell subsets in the diagnosis of ITP.Results The PAIgG,PAIgM and PAIgA in ITP group were significantly higher than those in the sITP group and control group,the difference was statistically significant(P<0.05);The levels of CD3~+,CD4~+ and CD4~+/CD8~+ were significantly lower than those in the sITP group and control group,the difference was statistically significant(P<0.05),while the CD8~+ level was significantly higher than that of the control group and the control group,the difference was statistically significant(P<0.05).The abnormal rates of PAIgG,PAIgM and PAIgA in the ITP group were significantly higher than those in the sITP group and control group,the difference was statistically significant(P<0.05),and the abnormal rates of CD3~+,CD4~+,CD8~+ and CD4~+/CD8~+ were significantly higher than those in the sITP group and control group,the difference was statistically significant(P<0.05).The area under the ROC curve(AUC)of platelet antibody combined with T cell subsets in diagnosing ITP was 0.932,sensitivity 86.5% and specificity 87.5%.Conclusion ITP patients have the phenomenon of platelet antibody increase and T cell subgroup disorder.Combined detection of platelet antibody and T cell subsets can more accurately reflect the patient′s condition,improving the diagnostic efficiency,and provide better support for the clinical treatment of disease.
Objective To investigate the significance of detection of platelet antibody and T cell subsets in diagnosis of primary immune thrombocytopenia(ITP).Methods The clinical data of 143 immune thrombocytopenia patients admitted to a hospital from March 2017 to May 2018 were retrospectively analyzed,including93 patients with ITP(ITP group)and 50 patients with secondary immune thrombocytopenia(sITP)group.50 healthy volunteers in a hospital during the same period were selected as control group.The levels of platelet antibodies(PAIgG,PAIgM,PAIgA)and T cell subsets(CD3~+,CD4~+,CD8~+,CD4~+/CD8~+)were detected by flow cytometry.Receiver operating curve(ROC)was used to evaluate the role of platelet antibodies and T cell subsets in the diagnosis of ITP.Results The PAIgG,PAIgM and PAIgA in ITP group were significantly higher than those in the sITP group and control group,the difference was statistically significant(P<0.05);The levels of CD3~+,CD4~+ and CD4~+/CD8~+ were significantly lower than those in the sITP group and control group,the difference was statistically significant(P<0.05),while the CD8~+ level was significantly higher than that of the control group and the control group,the difference was statistically significant(P<0.05).The abnormal rates of PAIgG,PAIgM and PAIgA in the ITP group were significantly higher than those in the sITP group and control group,the difference was statistically significant(P<0.05),and the abnormal rates of CD3~+,CD4~+,CD8~+ and CD4~+/CD8~+ were significantly higher than those in the sITP group and control group,the difference was statistically significant(P<0.05).The area under the ROC curve(AUC)of platelet antibody combined with T cell subsets in diagnosing ITP was 0.932,sensitivity 86.5% and specificity 87.5%.Conclusion ITP patients have the phenomenon of platelet antibody increase and T cell subgroup disorder.Combined detection of platelet antibody and T cell subsets can more accurately reflect the patient′s condition,improving the diagnostic efficiency,and provide better support for the clinical treatment of disease.
引文
[1]肖平,吴祖常.流式细胞术检测血小板相关抗体诊断原发免疫性血小板减少症的价值[J].广西医学,2014,36(8):1055-1057.
[2]贾咏存,李芹,朴文花.血小板相关IgG与网织血小板联合检测在原发免疫性血小板减少症诊断中的应用[J].宁夏医科大学学报,2015,37(8):947-949.
[3]任娜,邱广斌,王成彬.流式细胞术检测血小板相关抗体在免疫性血小板减少症中的应用[J].国际检验医学杂志,2014,35(13):1689-1690.
[4]鲍静,倪合宇,夏瑞祥,等.血小板特异性自身抗体和淋巴细胞亚群检测在免疫性血小板减少症中的临床价值[J].安徽医科大学学报,2012,47(6):691-694.
[5]常涛涛,郝国平.原发性ITP患儿外周血血小板相关抗体和淋巴细胞亚群的变化及临床意义[J].中国医学创新,2013,10(9):1-2.
[6]杜振兰,陈鹏.血小板相关抗体对儿童初发免疫性血小板减少症治疗反应的预测意义[J/CD].中华临床医师杂志(电子版),2013,7(14):6686-6687.
[7]贺怡子,张广森.继发性免疫性血小板减少症病因异质性及研究进展[J].临床血液学杂志,2017,31(2):240-244.
[8]刘川,丁周志.儿童原发性免疫性血小板减少症的发病机制及分型论治新进展[J].中国煤炭工业医学杂志,2016,19(1):163-167.
[9]中华医学会儿科学分会血液学组,《中华儿科杂志》编辑委员会.儿童原发性免疫性血小板减少症诊疗建议[J].中华儿科杂志,2013,51(5):382-384.
[10]侯明.原发免疫性血小板减少症的现状与展望[J].中华血液学杂志,2012,33(9):697-698.
[11]孙媛媛,谢军,鲍扬漪,等.老年原发免疫性血小板减少症患者治疗前后T淋巴细胞亚群的临床研究[J].安徽医学,2015,36(6):688-690.
[12]苏文芳,陈梅英,郑振光.T淋巴细胞亚群、NK细胞及B细胞在急性原发免疫性血小板减少症患儿外周血中的表达[J].海南医学,2016,27(22):3656-3657.
[13]彭征,吕晓兰,欧超伟.免疫性血小板减少症患者3项指标联合检测的临床意义[J].国际检验医学杂志,2015,36(2):274-275.
[14]张雪,陈振萍,巩文玉.血小板相关抗体及淋巴细胞亚群检测在儿童原发免疫性血小板减少症早期治疗效果评估中的作用[J].检验医学与临床,2015,12(20):2981-2983.
[2]贾咏存,李芹,朴文花.血小板相关IgG与网织血小板联合检测在原发免疫性血小板减少症诊断中的应用[J].宁夏医科大学学报,2015,37(8):947-949.
[3]任娜,邱广斌,王成彬.流式细胞术检测血小板相关抗体在免疫性血小板减少症中的应用[J].国际检验医学杂志,2014,35(13):1689-1690.
[4]鲍静,倪合宇,夏瑞祥,等.血小板特异性自身抗体和淋巴细胞亚群检测在免疫性血小板减少症中的临床价值[J].安徽医科大学学报,2012,47(6):691-694.
[5]常涛涛,郝国平.原发性ITP患儿外周血血小板相关抗体和淋巴细胞亚群的变化及临床意义[J].中国医学创新,2013,10(9):1-2.
[6]杜振兰,陈鹏.血小板相关抗体对儿童初发免疫性血小板减少症治疗反应的预测意义[J/CD].中华临床医师杂志(电子版),2013,7(14):6686-6687.
[7]贺怡子,张广森.继发性免疫性血小板减少症病因异质性及研究进展[J].临床血液学杂志,2017,31(2):240-244.
[8]刘川,丁周志.儿童原发性免疫性血小板减少症的发病机制及分型论治新进展[J].中国煤炭工业医学杂志,2016,19(1):163-167.
[9]中华医学会儿科学分会血液学组,《中华儿科杂志》编辑委员会.儿童原发性免疫性血小板减少症诊疗建议[J].中华儿科杂志,2013,51(5):382-384.
[10]侯明.原发免疫性血小板减少症的现状与展望[J].中华血液学杂志,2012,33(9):697-698.
[11]孙媛媛,谢军,鲍扬漪,等.老年原发免疫性血小板减少症患者治疗前后T淋巴细胞亚群的临床研究[J].安徽医学,2015,36(6):688-690.
[12]苏文芳,陈梅英,郑振光.T淋巴细胞亚群、NK细胞及B细胞在急性原发免疫性血小板减少症患儿外周血中的表达[J].海南医学,2016,27(22):3656-3657.
[13]彭征,吕晓兰,欧超伟.免疫性血小板减少症患者3项指标联合检测的临床意义[J].国际检验医学杂志,2015,36(2):274-275.
[14]张雪,陈振萍,巩文玉.血小板相关抗体及淋巴细胞亚群检测在儿童原发免疫性血小板减少症早期治疗效果评估中的作用[J].检验医学与临床,2015,12(20):2981-2983.