血小板抗体和血清白细胞介素在特发性血小板减少性紫癜患者诊断及预后分析研究

摘要

Objective To explore the application value of platelet antibodies (PAIgG,PAIgA,and PAIgM) and serum interleukins (IL-6,IL-17,and IL-18) in the diagnosis and prognosis of idiopathic thrombocytopenic purpura(ITP).Methods A total of 125 ITP patients admitted to the our department from March,2014 to December,2017 were selected as study objects;and 50 healthy examinees were selected as a control group.The serum levels of PAIgG,PAIgA,PAIgM,IL-6,IL-17,IL-18,and platelet(PLT) were measured in each group;and the differences between these groups were analyzed.The clinical efficacy of ITP was followed up.The differences of the above indicators after treatment were evaluated.Results The serum levels of PAIgG,PAIgA,PAIgM,IL-6,IL-17,and IL-18 were all higher and the PLT count was lower in the acute ITP group and the chronic ITP group than in the control group (all P ＜ 0.05).Pearson correlation analysis showed that IL-6,IL-17,IL-18,PAIgG,PAIgA,and PAIgM were positively correlated with PLT (r=0.215-0.508,P ＜ 0.05),and that IL-6,IL-17,IL-18,PAIgG,PAIgA,and PAIgM were negatively correlated with PLT (r=-0.295 ～-0.417,P ＜ 0.05).The serum levels of PAIgG,PAIgA,PAIgM,IL-6,IL-17,and IL-18 in patients with ITP in the response group were lower than those in the non-response group (P ＜ 0.05).The area under curve (AUC) of the diagnosis of ITP by platelet antibody combined with interleukin was 0.922 (95％ CI:0.853-0.991,P ＜ 0.05),and the AUC predicting the efficacy of ITP was 0.830 (95％ CI:0.729 ～ 0.931,P ＜ 0.05).Conclusion The levels of platelet antibodies and interleukins in ITP patients is significantly increased,which is related to PLT count and ITP treatment effect.The combination of platelet antibody and interleukin is of high value in diagnosing ITP and judging ITP efficacy.They can be used as effective serological indicators in the diagnosis and prognosis of ITP.%目的 探讨血小板相关抗体PAIg(PAIgG、PAIgA、PAIgM)和血清白细胞介素(IL-6、IL-17、IL-18)在特发性血小板减少性紫癜(ITP)诊断及预后的应用价值.方法 选择2014年3月至2017年12月本院血液科收治的125例ITP患者为研究对象,并选择50例门诊体检健康者为对照组.检测各组血清PAIgG、PAIgA、PAIgM、IL-6、IL-17、IL-18、血小板(PLT)水平,分析组间差异.追踪ITP临床治疗效果,评价治疗后上述指标的组间差异.结果 急性ITP组、慢性ITP组血清PAIgG、PAIgA、PAIgM、IL-6、IL-17、IL-18均高于对照组,PLT计数低于对照组,差异均有统计学意义(均P＜0.05);Pearson相关分析显示,IL-6、IL-8、IL-10、PAIgG、PAIgA、PAIgM均呈正相关(r=0.215 ～ 0.508,P＜0.05),IL-6、IL-8、IL-10、PAIgG、PAIgA、PAIgM与PLT呈负相关(r=-0.295～-0.417,P＜0.05);ITP患者治疗有反应组血清PAIgG、PAIgA、PAIgM、IL-6、IL-17、IL-18水平均低于治疗无反应组,差异均有统计学意义(均P＜ 0.05);血小板抗体联合白细胞介素诊断ITP的曲线下面积(AUC)为0.922(95％CI:0.853 ～ 0.991),预测ITP疗效的AUC为0.830(95％CI:0.729～0.931),差异均有统计学意义(均P＜0.05).结论 ITP患者血小板抗体、白细胞介素水平明显上调,其水平与PLT计数、ITP治疗效果有关,联合血小板抗体和白细胞介素诊断ITP、判断ITP疗效价值较高,可作为ITP诊断和判断预后的有效血清学指标.