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.
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。