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Abstract：
BACKGROUND: In adult immune thrombocytopenia (ITP), an acquired autoimmune bleeding disorder, anti-platelet autoantibody testing may be useful as a rule-in test. Childhood ITP has different disease characteristics, and the diagnostic and prognostic value of anti-platelet antibody testing remains uncertain.
OBJECTIVE: To systematically review the diagnostic accuracy of anti-platelet autoantibody testing in childhood ITP.
METHODS: PubMed and EMBASE were searched for studies evaluating immunoassays in childhood ITP. Study quality was assessed (QUADAS2), and evidence was synthesized descriptively.
RESULTS: In total, 40 studies (1606 patients) were identified. Nine studies reported sufficient data to determine diagnostic accuracy measures. Anti-platelet IgG antibody testing showed a moderate sensitivity (0·36-0·80 platelet-associated IgG [direct test]; 0·19-0·39 circulating IgG [indirect test]). In studies that reported control data, including patients with non-immune thrombocytopenia, specificity was very good (0·80-1·00). Glycoprotein-specific immunoassays showed comparable sensitivity (three studies) and predominantly identified IgG anti-GP IIb/IIIa antibodies, with few IgG anti-GP Ib/IX antibodies. Anti-platelet IgM antibodies were identified in a substantial proportion of children (sensitivity 0·62-0·64 for direct and indirect tests).
CONCLUSIONS: The diagnostic evaluation of IgG and IgM anti-platelet antibodies may be useful as a rule-in test for ITP. In children with insufficient platelets for a direct test, indirect tests may be performed instead. A negative test does not rule out the diagnosis of ITP. Future studies should evaluate the value of anti-platelet antibody tests in thrombocytopenic children with suspected ITP.
OBJECTIVE: To systematically review the diagnostic accuracy of anti-platelet autoantibody testing in childhood ITP.
METHODS: PubMed and EMBASE were searched for studies evaluating immunoassays in childhood ITP. Study quality was assessed (QUADAS2), and evidence was synthesized descriptively.
RESULTS: In total, 40 studies (1606 patients) were identified. Nine studies reported sufficient data to determine diagnostic accuracy measures. Anti-platelet IgG antibody testing showed a moderate sensitivity (0·36-0·80 platelet-associated IgG [direct test]; 0·19-0·39 circulating IgG [indirect test]). In studies that reported control data, including patients with non-immune thrombocytopenia, specificity was very good (0·80-1·00). Glycoprotein-specific immunoassays showed comparable sensitivity (three studies) and predominantly identified IgG anti-GP IIb/IIIa antibodies, with few IgG anti-GP Ib/IX antibodies. Anti-platelet IgM antibodies were identified in a substantial proportion of children (sensitivity 0·62-0·64 for direct and indirect tests).
CONCLUSIONS: The diagnostic evaluation of IgG and IgM anti-platelet antibodies may be useful as a rule-in test for ITP. In children with insufficient platelets for a direct test, indirect tests may be performed instead. A negative test does not rule out the diagnosis of ITP. Future studies should evaluate the value of anti-platelet antibody tests in thrombocytopenic children with suspected ITP.
摘要：
背景：在成人免疫性血小板减少症（ITP）中，获得性自身免疫性出血性疾病,抗血小板自身抗体检测可作为常规检测。儿童ITP有不同的疾病特点，抗血小板抗体检测的诊断和预后价值仍不确定.
目的：系统评价抗血小板自身抗体检测在儿童ITP诊断中的准确性。
方法：在PubMed和EMBASE中搜索评估儿童ITP免疫测定的研究。评估研究质量（QUADAS2），证据是描述性合成的。
结果：总计，确定了40项研究（1606名患者）。九项研究报告了足够的数据来确定诊断准确性指标。抗血小板IgG抗体测试显示中等敏感性（0·36-0·80血小板相关IgG[直接测试]；0·19-0·39循环IgG[间接测试]）。在报告控制数据的研究中，包括非免疫性血小板减少症患者，特异性非常好（0·80-1·00）。糖蛋白特异性免疫测定显示出相当的敏感性（三项研究），主要鉴定出IgG抗GPIIb/IIIa抗体，与少数IgG抗GPIb/IX抗体。在相当比例的儿童中鉴定出抗血小板IgM抗体（直接和间接测试的敏感性为0·62-0·64）。
结论：IgG和IgM抗血小板抗体的诊断性评估可作为ITP的常规检验。在血小板不足以进行直接测试的儿童中，可以进行间接测试。阴性测试不排除ITP的诊断。未来的研究应评估抗血小板抗体测试在疑似ITP的血小板减少性儿童中的价值。
目的：系统评价抗血小板自身抗体检测在儿童ITP诊断中的准确性。
方法：在PubMed和EMBASE中搜索评估儿童ITP免疫测定的研究。评估研究质量（QUADAS2），证据是描述性合成的。
结果：总计，确定了40项研究（1606名患者）。九项研究报告了足够的数据来确定诊断准确性指标。抗血小板IgG抗体测试显示中等敏感性（0·36-0·80血小板相关IgG[直接测试]；0·19-0·39循环IgG[间接测试]）。在报告控制数据的研究中，包括非免疫性血小板减少症患者，特异性非常好（0·80-1·00）。糖蛋白特异性免疫测定显示出相当的敏感性（三项研究），主要鉴定出IgG抗GPIIb/IIIa抗体，与少数IgG抗GPIb/IX抗体。在相当比例的儿童中鉴定出抗血小板IgM抗体（直接和间接测试的敏感性为0·62-0·64）。
结论：IgG和IgM抗血小板抗体的诊断性评估可作为ITP的常规检验。在血小板不足以进行直接测试的儿童中，可以进行间接测试。阴性测试不排除ITP的诊断。未来的研究应评估抗血小板抗体测试在疑似ITP的血小板减少性儿童中的价值。
