各種疾患におけるPAIgGの特異性と臨床的有用性

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  • SPECIFICITY AND CLINICAL SIGNIFICANCE OF PLATELET-ASSOCIATED IgG WITH VARIOUS DISEASES

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各種疾患におけるPAIgGを酵素抗体法で測定した。PAIgG値(mean±SD, ng/10^7 cells)は健常者(N=49)で16.6±3.9,特発性血小板減少症(ITP, N=25)で202.4±226.2,肝硬変叉は慢性肝炎(N=27)で270.3±151.0,再生不良性貧血(N=6)で274.9±62.0であった。その他薬剤による血小板減少症で254.7,播種性血管内凝固症候群で235.5, 665.8,悪性貧血で297.9,血栓性血小板減少症(TTP)で576.6,溶血性貧血で222.3,105.6であった。ITP患者の血小板数とPAIgG値間には有意の逆相関があったが,肝疾患におけるZTT値とPAIgG値間には相関がなかった。ITP症例では治療による血小板の正常化とともに,PAIgG値も正常化し,治療に不応になるとともに増加した。TTPや溶血性貧血症例でも,各種治療により病態が良好となるとともに正常化した。これらの事よりPAIgG値はITP以外の非免疫性血小板減少症でも増加することが分り,この結果は従来非免疫性血小板減少症と考えられていた病態の中にも,実際には免疫学的機序が存在している可能性を,或いは本研究で測定したPAIgG値は血小板表面ではなく,全PAIgG(α顆粒に含まれる)を反映している可能性を示唆している。しかしながらPAIgG値の測定は臨床応用において無意味ではなく,各種血小板減少をきたす疾病での病態把握には有用であるのが分かった。
Platelet associated IgG (PAIgG) were measured by enzyme-linked immunoassay. The level of PAIgG (mean±SD, ng/10^7 cells) was 16.6±3.9 in healthy subjects (N=49); 202.4±226.2 in idiopathic thrombocytopenic purpura (ITP, N=25); 270.3±151.0; in liver cirrhosis or chronic hepatitis (LC or CH, N=27); 274.9±62.0 in aplastic anemia (N=6). The value of PAIgG was also increased in drug-induced thrombocytopenia (254.7); disseminated intravascular coagulation (DIC, 235.5, 665.8), pernicious anemia (297.9), thrombotic thrombocytopenic purpura (TTP, 576.6), hemolytic anemia (222.3, 105.6). There was an inverse correlation between PAIgG and the ITP patient's platelet counts, but no relationship was discernible between PAIgG and platelet counts or ZTT in liver disease. In ITP patients who were followed serially during treatment, the platelet counts normalized in response to therapy; those were associated with a return of PAIgG levels into the normal range, but it increased when the disease became refractory to treatment. In TTP and hemolytic anemia, PAIgG decreased to normal value after those disease were controlled by various therapy. This result indicates that PAIgG increases not only in ITP, but also in many non-immune thrombocytopenic cases and that immune mechanisms may mediate many more thrombocytopenic disorders than have been previously thought likely, or alternatively, PAIgG may not be a reflection of platelet surface IgG, but total PAIgG (contained in platelet α-granule). This study, however, does not indicate PAIgG measurements should not be performed, because the quantification of PAIgG by this method have a clinical usefulness in the monitoring disease states.

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