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目的研究骨髓单个核细胞(BMMNC)的抗人球蛋白试验(Coombs)和流式细胞术(FACS)检测骨髓细胞膜结合抗体的敏感性、特异性及其对临床诊断的意义。方法分离 BMMNC,进行 Coombs 试验检测患者的自身抗体,对部分 BMMNC-Coombs 试验阴性患者进一步行 FACS 检测。结果 270例自身免疫性血细胞减少症患者 BMMNC-Coombs 试验,164例阳性,阳性率60.7%,免疫相关性全血细胞减少症(IRP)阳性率最高(67.2%),自身免疫性溶血性贫血(AIHA)(63.6%)、免疫性血小板减少性紫癜(ITP)阳性率为57.1%及 Evans 综合征患者的阳性率为43.2%。471例其它原发性、继发性贫血患者及19名正常人 BMMNC-Coombs 试验皆阴性。BMMNC-Coombs 试验阳性患者以 IgG 型、IgG+C_3型、IgG+IgM+IgA+C_3型居多,所占比例分别为30.4%、26.4%和20.8%。FACS 检测61例 BMMNC-Coombs 试验阴性的 IRP 患者,51例自身抗体阳性,阳性率为83.6%,其中以造血干/祖细胞(CD_(34)~+)自身抗体阳性率最高(占94.1%)。结论BMMNC-Coombs 试验对诊断自身免疫性血细胞减少症具有较高的特异性和敏感性,FACS 法更灵敏;IRP 与AIHA、ITP 及 Evans 综合征均有骨髓细胞自身抗体,区别在于 IRP 无成熟血细胞自身抗体。
Objective To study the sensitivity and specificity of Coombs and flow cytometry (FACS) to detect bone marrow cell membrane bound antibody in bone marrow mononuclear cells (BMMNC) and their clinical significance. Methods BMMNC was isolated and Coombs test was used to detect autoantibodies in patients. FACS was further performed on some patients with negative BMMNC-Coombs test. Results The results of BMMNC-Coombs test in 270 patients with autoimmune cytopenia were positive in 164 cases, positive rate was 60.7%, immune-associated pancytopenia (IRP) was the highest (67.2%), autoimmune hemolytic anemia (AIHA ) (63.6%). The positive rate of immune thrombocytopenic purpura (ITP) was 57.1% and that of Evans syndrome was 43.2%. 471 cases of other primary, secondary anemia and 19 normal BMMNC-Coombs test were negative. The majority of patients with positive BMMNC-Coombs test were IgG, IgG + C_3, IgG + IgM + IgA + C_3, accounting for 30.4%, 26.4% and 20.8% respectively. The positive rate of autoantibodies in 51 patients with BMMNC-Coombs test was 83.6% by FACS, of which the autoantibody was the highest (94.1%) with autoantibodies to hematopoietic stem / progenitor cells (CD34 +), . Conclusions The BMMNC-Coombs test is highly specific and sensitive for the diagnosis of autoimmune cytopenia. FACS is more sensitive. IRP and autoantibodies to AIHA, ITP and Evans syndrome all have bone marrow cell autoantibodies except IRP immature blood cells Autoantibodies.