自身免疫抗体检测在恶性血液疾病的临床应用研究

摘要

Objective To evaluate the clinical significance of autoimmune antibodies in the diagnosis and therapy of hematologic malignancies. Methods During the period of 2011 to 2016,453 patients with hematologic malignancies in Zhejiang provincial TCM hospital were enrolled in this retrospective analysis. The antibodies profiles were tested for each patients by using immunoblotting and indirect immunofluorescence. Results The positive rates of MDS and CLL were higher than those of other malignant hematologic diseases,accounting for 29.7%(27/91)and 27.5%(19/69) respectively. Among the detected autoimmune antibodies,ANA positive rate was the highest,accounting for 11.7%(53/453),while positive rate of Anti-PR3 was lowest,accounting for 2.6%(12/453). RBC and PLT counts in CLL patients with positive antibodies were lower than in those with negative ones,and WBC count in MDS patients with positive antibodies was lower than in those with negative ones. Conclusions Autoimmunity is more frequently observed in CLL and MDS than other malignant hematologic diseases,associated with hemocytopenia. It's helpful for clinical doctors to deepen the understanding of the pathogenesis of MDS and CLL,and to help clinical treatment according to different patients' immune status to detect the autoimmune antibodies.%目的 评价自身免疫抗体检测在恶性血液疾病诊疗中的临床价值.方法 回顾分析2012年1月至2016年6月453例血液疾病患者外周血ANA、anti-MPO、anti-PR3、AIHA-IgG、PAIg检测结果,采用间接免疫荧光法检测ANA,免疫印记法检测anti-MPO、anti-PR3、PAIg,抗人球蛋白试验检测AIHA-IgG,同时比较外周血细胞计数与自身免疫抗体之间的关联性.结果 MDS和CLL患者自身免疫抗体阳性率高于其它恶性血液疾病,分别占29.7%和27.5%;在所检测自身免疫抗体中ANA阳性率最高,占11.7%,Anti-PR3阳性率最低,占2.6%;自身免疫抗体阳性CLL患者RBC和PLT计数较阴性患者低,而自身免疫抗体阳性MDS患者WBC计数较阴性患者低,差异均有统计学意义(P<0.05).结论 MDS和CLL较其它恶性血液疾病更易并发自身免疫反应,且与患者外周血细胞减少相关,自身免疫性抗体检测有助于加深临床对MDS和CLL的发病机制的认识,帮助临床根据不同患者自身免疫状况采取相应治疗方案.