目的 观察免疫性血小板减少症（immune thrombocytopenia，ITP）患儿血清甲状腺球蛋白抗体（thyroglobulin antibody，TGAb）、甲状腺过氧化物酶抗体（thyroid peroxidase antibody，TPOAb）的表达情况。 方法 前瞻性选择2019年10月至2021年10月收治的120例ITP患儿作为ITP组，另选择60例非ITP患儿作为非ITP组。根据ITP临床分型将ITP组患儿分为新诊断ITP（n=53）、持续性ITP（n=42）与慢性ITP（n=25）。比较ITP组与非ITP组、不同ITP临床分型患儿临床资料，分析ITP患儿血清TGAb、TPOAb表达情况，及其与ITP临床分型的关系。 结果 ITP组CD3+、CD4+比例及血小板计数低于非ITP组，CD8+比例及TGAb、TPOAb水平高于非ITP组（P<0.05）；慢性ITP患儿CD3+、CD4+比例及血小板计数低于新诊断ITP、持续性ITP患儿，CD8+比例及TGAb、TPOAb高于新诊断ITP、持续性ITP患儿（P<0.05）。经logistic回归分析结果显示，CD3+、CD4+、CD8+、TGAb、TPOAb表达水平变化与慢性ITP的发生密切相关（P<0.05）；绘制决策曲线，结果显示，在高风险阈值0.0~1.0范围内TGAb联合TPOAb评估儿童ITP临床分型的净收益率始终>0，有临床意义。 结论 TGAb、TPOAb在ITP患儿中呈异常表达，且与患儿ITP临床分型有关。 引
Abstract
Objective To examine the expression of serum thyroglobulin antibody (TGAb) and thyroid peroxidase antibody (TPOAb) in children with immune thrombocytopenia (ITP). Methods A total of 120 children with ITP who were admitted from October 2019 to October 2021 were enrolled as the ITP group. A total of 60 children without ITP were enrolled as the non-ITP group. According to the clinical classification of ITP, the children in the ITP group were further divided into a newly diagnosed ITP group, a persistent ITP group, and a chronic ITP group. The clinical data were compared between the ITP group and the non-ITP group and between the children with different clinical classifications of ITP. The expression levels of serum TGAb and TPOAb in children with ITP were measured and their association with the clinical classification of ITP was analyzed. Results Compared with the non-ITP group, the ITP group had significantly lower levels of CD3+, CD4+, and platelet count (PLT) and significantly higher levels of CD8+, TGAb, and TPOAb (P<0.05). The children with chronic ITP had significantly lower levels of CD3+, CD4+, and PLT and significantly higher levels of CD8+, TGAb, and TPOAb than those with newly diagnosed ITP or persistent ITP (P<0.05). The logistic regression analysis showed that CD3+, CD4+, CD8+, TGAb, and TPOAb were the influencing factors for chronic ITP (P<0.05). A decision curve was plotted, and the results showed that TGAb combined with TPOAb within the high-risk threshold range of 0.0-1.0 had a net benefit rate of >0 in evaluating the clinical classification of ITP in children. Conclusions TGAb and TPOAb are abnormally expressed in children with ITP and are associated with the clinical classification of ITP in children.
关键词
免疫性血小板减少症 /
临床分型 /
甲状腺球蛋白抗体 /
甲状腺过氧化物酶抗体 /
儿童
Key words
Immune thrombocytopenia /
Clinical classification /
Thyroglobulin antibody /
Thyroid peroxidase antibody /
Child
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参考文献
1 Newland A, Lee EJ, McDonald V, et al. Fostamatinib for persistent/chronic adult immune thrombocytopenia[J]. Immunotherapy, 2018, 10(1): 9-25. PMID: 28967793. DOI: 10.2217/imt-2017-0097.
2 吕明恩, 李洋, 刘文洁, 等. 初诊淋巴细胞绝对值与儿童原发性免疫性血小板减少症预后的相关性[J]. 中华实用儿科临床杂志, 2015, 30(15): 1147-1151. DOI: 10.3760/cma.j.issn.2095-428X.2015.15.008.
3 吴定昌, 黄超林, 肖婷. 血清TGAb、TPOAb检测在自身免疫性甲状腺疾病诊断中临床意义[J]. 检验医学与临床, 2013, 10(19): 2530-2531. DOI: 10.3969/j.issn.1672-9455.2013.19.015.
4 Gallo D, Tanda ML, Piantanida E. Predicting the risk of graves disease relapse: commentary on "thyroid peroxidase antibody positivity is associated with relapse-free survival following antithyroid drug treatment for graves disease"[J]. Endocr Pract, 2020, 26(9): 1039-1041. PMID: 33471693. DOI: 10.4158/EP-2020-0230.
5 王敏敏, 曾惠, 郭晓珺. CD4+CD25+CD127-/low调节性T细胞和Th17细胞在ITP发病中的研究进展[J]. 诊断学理论与实践, 2018, 17(2): 220-224. DOI: 10.16150/j.1671-2870.2018.02.020.
6 国家卫生健康委. 儿童原发性免疫性血小板减少症诊疗规范(2019年版)[J]. 全科医学临床与教育, 2019, 17(12): 1059-1062. DOI: 10.13558/j.cnki.issn1672-3686.2019.012.002.
7 Grace RF, Despotovic JM, Bennett CM, et al. Physician decision making in selection of second-line treatments in immune thrombocytopenia in children[J]. Am J Hematol, 2018, 93(7): 882-888. PMID: 29659042. PMCID: PMC6037544. DOI: 10.1002/ajh.25110.
8 Fernández-Plaza S, González de Pablo J, Gálvez E, et al. Variables related to chronic immune thrombocytopenia: experience from a single center and comparison to a meta-analysis[J]. Eur J Pediatr, 2021, 180(7): 2075-2081. PMID: 33594540. DOI: 10.1007/s00431-021-03990-8.
9 Hua M, Li J, Wang C, et al. Aberrant expression of microRNA in CD4+ cells contributes to Th17/Treg imbalance in primary immune thrombocytopenia[J]. Thromb Res, 2019, 177: 70-78. PMID: 30856381. DOI: 10.1016/j.thromres.2019.03.005.
10 Yao L, Liu B, Jiang L, et al. Association of cytotoxic T-lymphocyte antigen 4 gene with immune thrombocytopenia in Chinese Han children[J]. Hematology, 2019, 24(1): 123-128. PMID: 30319055. DOI: 10.1080/10245332.2018.1530179.
11 张敏, 罗嘉, 段雨函. TGAb、TMAb、TPOAb水平与Graves病治疗后甲状腺功能减退发生率的相关性研究[J]. 检验医学与临床, 2017, 14(6): 816-818. DOI: 10.3969/j.issn.1672-9455.2017.06.027.
12 王道成, 毕嘉, 黄丽, 等. 自身免疫性甲状腺功能紊乱孕妇血清TPOAb检测的临床价值[J]. 现代生物医学进展, 2016, 16(17): 3373-3375. DOI: 10.13241/j.cnki.pmb.2016.17.043.
13 Wang Q, Li J, Yu TS, et al. Disrupted balance of CD4+ T-cell subsets in bone marrow of patients with primary immune thrombocytopenia[J]. Int J Biol Sci, 2019, 15(13): 2798-2814. PMID: 31853219. PMCID: PMC6909963. DOI: 10.7150/ijbs.33779.
14 Hosseini S, Payne RJ, Zawawi F, et al. Can preoperative thyroglobulin antibody levels be used as a marker for well differentiated thyroid cancer?[J]. J Otolaryngol Head Neck Surg, 2016, 45(1): 31. PMID: 27179632. PMCID: PMC4868007. DOI: 10.1186/s40463-016-0143-5.
15 李扬, 左新河, 华川, 等. T、B淋巴细胞在自身免疫性甲状腺疾病中的作用机制研究进展[J]. 中国医药导报, 2019, 16(23): 49-52.
16 尚恒, 马金刚, 魏红丽, 等. 辅助性T淋巴细胞17/调节性T淋巴细胞在Graves病合并甲状腺过氧化物酶抗体阳性患者中的机制研究[J]. 临床内科杂志, 2020, 37(4): 276-279. DOI: 10.3969/j.issn.1001-9057.2020.04.010.
17 Eick GN, Cepon-Robins TJ, Devlin MJ, et al. Development and validation of an ELISA for a biomarker of thyroid dysfunction, thyroid peroxidase autoantibodies (TPO-Ab), in dried blood spots[J]. J Physiol Anthropol, 2020, 39(1): 16. PMID: 32678000. PMCID: PMC7364519. DOI: 10.1186/s40101-020-00228-8.
18 孙荷, 胡珊, 骆盛. Anti-TgAb和Anti-TPOAb在自身免疫性甲状腺疾病诊断中的意义[J]. 中国卫生检验杂志, 2010, 20(11): 2866-2867.
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