Prospective evaluation of the immunobead assay for the diagnosis of adult chronic immune thrombocytopenic purpura (ITP)
Prospective evaluation of the immunobead assay for the diagnosis of adult chronic immune thrombocytopenic purpura (ITP)
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DOI：
10.1046/j.1538-7836.2003.00091.x
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发表时间：
2003-03-01
影响因子：
10.4
通讯作者：
Tani, P
中科院分区：
文献类型：
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作者：
McMillan, R;Wang, L;Tani, P
慢性免疫性血小板减少性紫癜（ITP）是一种以抗体诱导的血小板破坏为特征的自身免疫性疾病。为了更好地确定抗原特异性检测在成人慢性ITP中的作用，我们前瞻性地检测了282例慢性ITP患者和289例其他原因引起的血小板减少症患者的血小板相关自身抗体，这些抗体针对糖蛋白（GP）IIb/ IIIa或GPIb/IX。我们将慢性ITP分为四个亚组：脾切除术前轻度（血小板计数>30 000穆尔（-1），无需治疗）、脾切除术前重度（血小板计数< 30 000穆尔（-1），需要治疗，但不需要脾切除术）、脾切除术后缓解（脾切除术后部分或完全缓解，无需进一步治疗）和脾切除术后难治性（脾切除术失败后需要治疗）。积极成果：全ITP组55.4%，脾切除前轻度组31.1%，脾切除前重度组42.6%，脾切除后缓解组50.0%，脾切除后难治组87.8%。此外，阳性程度随着患者疾病的严重程度而增加。如果在与其他疾病相关的血小板减少症患者中不考虑与免疫性血小板减少症一致的临床因素，则该测定的最低特异性为84.4%。然而，如果考虑与免疫性血小板减少症一致的临床因素，并且仅将可疑免疫性血小板减少症患者和“失访”患者纳入假阳性组，则特异性为93.1%。我们的结论是，如果免疫珠试验是阳性的，免疫性血小板减少症的存在是非常可能的，抗原特异性检测是诊断成人慢性ITP有用。
Chronic immune thrombocytopenic purpura (ITP) is an autoimmune disease characterized by antibody-induced platelet destruction. To better define the role of antigen-specific assays in adult chronic ITP, we prospectively measured platelet-associated autoantibody against either glycoprotein (GP) IIb/ IIIa or GPIb/IX in 282 patients with chronic ITP and 289 patients with thrombocytopenia of other causes. We divided chronic ITP into four subgroups: presplenectomy, mild (platelet count >30 000 muL(-1) requiring no therapy), presplenectomy, severe (platelet count < 30 000 muL(-1) requiring therapy but not splenectomy), postsplenectomy, remission (postsplenectomy partial or complete remission without further therapy) and postsplenectomy refractory (required therapy after splenectomy failure). Positive results: total ITP group, 55.4%; presplenectomy, mild, 31.1%; presplenectomy, severe, 42.6%; postsplenectomy, remission, 50.0%; and postsplenectomy, refractory, 87.8%. In addition, the degree of positivity increased with the severity of the patient's disease. The assay had a minimum specificity of 84.4% if clinical factors, consistent with immune thrombocytopenia, were not considered in patients with thrombocytopenia associated with other diseases. However, if clinical factors consistent with immune thrombocytopenia were considered and only patients with questionable immune thrombocytopenia and patients 'lost to follow-up' were included in the false-positive group the specificity was 93.1%. We conclude that the presence of immune thrombocytopenia is highly probable if the immunobead assay is positive and that antigen-specific assays are diagnostically useful in adult chronic ITP.