蒋玲 钟丽丽 廖龙跃

【摘要】 目的：探討免疫性血小板减少性紫癜（ITP）患儿血小板相关抗体（PAIgG、PAIgM、PAIgA）水平变化及其与预后的关系。方法：回顾性分析本院2017年1月-2020年9月82例ITP患儿的临床资料，并将其作为研究组，另选取本院同期体检的50例健康儿童作为对照组。研究组患儿根据病情严重程度分为轻度组（n=19）、中度组（n=34）和重度组（n=29），并根据预后情况分为预后良好组（n=65）和预后不良组（n=17）。采集各组空腹静脉血，采用酶联免疫吸附法检测各组PAIgG、PAIgM、PAIgA水平，分析ITP患儿PAIgG、pAIgM、PAIgA水平变化，使用ROC曲线分析其与预后的关系。结果：研究组PAIgG、PAIgM、PAIgA水平均高于对照组，差异均有统计学意义（P<0.05）。不同病情严重程度ITP患儿PAIgG、PAIgM、PAIgA水平比较，差异均有统计学意义（P<0.05）。重度组PAIgG、PAIgM、PAIgA水平均高于中度组和轻度组，中度组PAIgG、PAIgM、PAIgA水平均高于轻度组，差异均有统计学意义（P<0.05）。预后良好组PAIgG、PAIgM、PAIgA水平均低于预后不良组，差异均有统计学意义（P<0.05）。由ROC曲线可知，PAIgG、PAIgM、PAIgA三者联合预测ITP患儿的AUC为0.901，高于三者单独预测的0.724、0.715、0.710（P<0.05）。结论：ITP患儿PAIgG、pAIgM、PAIgA水平升高，三者与病情严重程度及预后相关，可作为临床评估预后的参考指标。

【关键词】 免疫性血小板减少性紫癜 血小板抗体 预后

Changes of PAIgG， PAIgM and PAIgA Levels in Children with Immune Thrombocytopenic Purpura and Their Relationship with Prognosis/JIANG Ling， ZHONG Lili， LIAO Longyue. //Medical Innovation of China， 2021， 18（12）： 0-089

[Abstract] Objective： To explore the changes of platelet-related antibodies （PAIgG， PAIgM， PAIgA） levels in children with immune thrombocytopenic purpura （ITP） and their relationship with prognosis. Method： The clinical data of 82 children with ITP in our hospital from January 2017 to September 2020 were retrospectively analyzed， and they were selected as the research group， and 50 healthy children who underwent physical examination in the same period in our hospital were selected as the control group. The children in the study group were divided into mild group （n=19）， moderate group （n=34） and severe group （n=29） according to the severity of the disease. According to the prognosis， they were divided into good prognosis group （n=65） and poor prognosis group （n=17）. Fastening venous blood was collected in each group， and the levels of PAIgG， PAIgM and PAIgA in each group were detected by ELISA. Changes in PAIgG， PAIgM and PAIgA levels in ITP children were analyzed， and the relationships between PAIgG， PAIgM and PAIgA and prognosis were analyzed by ROC curve. Result： The levels of PAIgG， PAIgM and PAIgA in the study group were higher than those in the control group， the differences were statistically significant （P<0.05）. Comparison of PAIgG， PAIgM and PAIgA levels in ITP children with different severity of disease， the differences were statistically significant （P<0.05）. The levels of PAIgG， PAIgM and PAIgA in severe group were higher than those in moderate group and mild group， and the levels of PAIgG， PAIgM and PAIgA in moderate group were higher than those in mild group， the differences were statistically significant （P<0.05）. The levels of PAIgG， PAIgM and PAIgA in the good prognosis group were lower than those in the poor prognosis group， the differences were statistically significant （P<0.05）. According to the ROC curve， the AUC of PAIgG， PAIgM and PAIgA in children with ITP was 0.901， which was higher than 0.724， 0.715 and 0.710 of the single prediction of three （P<0.05）. Conclusion： The levels of PAIgG， PAIgM and PAIgA increase in ITP children， which are correlated with the severity of the disease and prognosis， and could be used as a reference index for clinical evaluation of prognosis.

[Key words] Immune thrombocytopenic purpura Platelet antibody Prognosis

First-authors address： Xinyu Peoples Hospital， Xinyu 338000， China

doi：10.3969/j.issn.1674-4985.2021.12.020

免疫性血小板减少性紫癜（ITP）是巨噬细胞及血小板在免疫紊乱作用下生成减少而引起的获得性自身免疫性出血性疾病，患儿临床以血小板减少、黏膜及皮肤自发性出血等为主要表现[1-2]。近年来我国ITP发病率呈升高趋势，但其发病具体机制仍处于研究中，临床致力于寻找诊断及预测ITP预后的可靠指标[3]。血小板相关抗体（PAIg）是临床诊断出血性疾病的重要指标，多项报道均显示，大部分ITP患儿会出现PAIg水平升高，其中包括PAIgG、PAIgM及PAIgA[4-6]。随着医学技术的发展，临床对出血性疾病与PAIg关系的研究不断开展，但关于PAIg与ITP患儿病情严重程度及预后关系的报道较少。基于此，本研究探讨ITP患儿PAIgG、PAIgM、PAIgA水平变化及其与预后的关系，现报道如下。

1 资料与方法

1.1 一般资料 回顾性分析2017年1月-2020年9月本院82例ITP患儿的临床资料，并将其作为研究组。……