通讯作者: 史洋溢, 1243933737@qq.com

DOI：10.12201/bmr.202407.00049

A study on the influence of different distribution of platelet membrane glycoprotein antibodies on the clinical efficacy of ITP in children and literature review.

• 摘要：目的 探讨三种血小板膜糖蛋白特异性抗体（抗GPⅠb/Ⅸ、GPⅡb/Ⅲa和GPⅠa/Ⅱa抗体）在儿童原发免疫性血小板减少症患者的差异性分布对其一线方案治疗后疗效的影响。方法 2019年12月至2023年12月55例儿童ITP患者纳入研究，分为：抗GPⅠb/Ⅸ抗体阳性组18例和阴性组37例，抗GPⅡb/Ⅲa抗体阳性组30例和阴性组24例，抗GPⅠa/IIa抗体阳性组16例和阴性组38例。应用酶联免疫吸附法同时检测循环血浆和血小板膜放散液中的血小板膜糖蛋白特异性抗体。所有患者予以标准一线方案治疗。分析抗体分布与治疗后血小板计数（*109/L）变化趋势及疗效的关系。结果 所有组别患者在治疗后24小时、72小时、7天血小板计数与治疗前比较均升高（均P<0.05）；但抗GPⅠb/Ⅸ抗体阳性组与阴性组治疗后24小时阳性组（37.69±23.22），阴性组（62.78±31.27）、72小时阳性组（99.38±115.32），阴性组（229.43±167.70）、7天阳性组（150.56±124.89），阴性组（384.80±234.09）的血小板计数比较，阳性组均显著低于阴性组（均P<0.05）；抗GPⅡb/Ⅲa抗体阳性组和阴性组治疗后血小板在各时间点水平无明显差异（均P>0.05）；抗GPⅠa/Ⅱa抗体阳性组与阴性组在治疗后24小时、72小时血小板计数无差异（均P>0.05），而治疗后7天血小板计数在阳性组（213.53±192.20）较阴性组（356.90±253.16）明显更低（P<0.05）。结论 血小板抗体分布不同的儿童ITP患者在一线方案治疗后疗效存在差异，抗GPⅠb/Ⅸ抗体阳性较阴性者疗效更差，抗GPⅡb/Ⅲa抗体阳性和阴性者的疗效无差异，抗GPⅠa/IIa抗体阳性较阴性者7天后疗效更差。

  关键词： 原发免疫性血小板减少症；血小板膜糖蛋白特异性抗体；儿童；血小板计数; ; ; 

   

  Abstract: Objective To investigate the effect of the differential distribution of three platelet membrane glycoprotein-specific antibodies (anti-GP-I b/Ⅸ, GP-II b/ IIIA and GP-II a/ IIIA) on the curative effect of first-line treatment in children with ITP. Methods From December 2019 to December 2023, 55 children with ITP were included in the study, and were divided into: anti-GPⅠb /Ⅸ antibody positive group (18 cases) and negative group (37 cases), anti-GPⅡb /Ⅲa antibody positive group (30 cases) and negative group (24 cases), anti-GPⅠa /IIa antibody positive group (16 cases) and negative group (38 cases). Platelet membrane glycoprotein specific antibodies in circulating plasma and platelet membrane release fluid were detected by enzyme-linked immunosorbent assay. All patients were treated with standard first-line regiments. The relationship between antibody distribution and platelet count after treatment was analyzed. Results Platelet count at 24h, 72h and 7 days after treatment was higher than before treatment in all groups (all P<0.05). However, when comparing the anti‐GPⅠb/Ⅸ antibody‐positive group with the negative group at 24 hours positive group (37.69±23.22), negative group (62.78±31.27), 72 hours positive group (99.38±115.32), negative group (229.43±167.70), and 7 days positive group (150.56±124.89), negative group (384.80±234.09), the platelet counts of the positive group were all significantly lower than the negative group (all P < 0.05); There were no significant differences in the levels of treated platelets between anti-GPⅡb/Ⅲa-antibody positive group and negative group at each time point (all P > 0.05); There was no difference in platelet count between the positive and negative group of anti-GPⅠa/Ⅱa antibodies at 24 hours and 72 hours after treatment (all P > 0.05), while the platelet count at 7 days after treatment was significantly lower in the positive group (213.53±192.20) compared with the negative group (356.90±253.16) (P < 0.05). Conclusion Pediatric ITP patients with different platelet antibody profiles showed differences in their efficacy after treatment with first-line regimens, patients with positive anti-GPⅠb/Ⅸ antibody had worse outcomes than negative patients, patients with positive and negative anti-GPⅡb/Ⅲa antibody did not differ, and patients with positive anti-GPⅠa/Ⅱa antibody had worse outcomes after 7 days compared with negative patients.

  Key words: Primary immune thrombocytopenia; platelet membrane glycoprotein specific antibody; child; platelet count

  提交时间：2024-07-20

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• 序号	提交日期	编号	操作
  1	2024-07-04	bmr.202407.00049V1	下载

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