血小板减少症中异质性的PF4抗体对血小板功能的影响*

doi:10.3969/j.issn.1671-2587.2026.04.013

临床输血与检验 ›› 2026, Vol. 28 ›› Issue (4): 546-552.DOI: 10.3969/j.issn.1671-2587.2026.04.013

血小板减少症中异质性的PF4抗体对血小板功能的影响^*

杨颖, 钱呈睿, 李勤, 郭忠慧, 赵俸涌, 张嘉敏, 杨启修, 王晨, 朱自严

上海市血液中心,上海 200051

收稿日期:2026-07-06 出版日期:2026-08-20 发布日期:2026-08-26
作者简介:杨颖,主要从事输血和移植前后不良反应监测以及机制研究,细胞和免疫治疗研究,（E-mail）yangying@sbc.org.cn。并列第一作者：钱呈睿,主要从事临床输血学、新生儿溶血病、免疫血液学方面研究,（E-mail）freyaqcr@126.com。
基金资助:
^*本课题受上海市血液中心科技基金（No.L24-02）资助

Heterogeneous Effects of Anti-PF4 Antibodies on Platelet Function in Patients with Thrombocytopenia

YANG Ying, QIAN Chengrui, LI Qin, GUO Zhonghui, ZHAO Fengyong, ZHANG Jiamin, YANG Qixiu, WANG Chen, ZHU Ziyan

Shanghai Blood Center, Shanghai 200051

Received:2026-07-06 Online:2026-08-20 Published:2026-08-26

摘要/Abstract

摘要： 目的为了探究血小板减少症患者中是否因PF4抗体存在而影响血小板功能。方法随机收集需要血小板特异性配合的患者血清,以及同期健康献血者血样分装保存;实验当天献血者的同型血小板作为靶细胞。用ELISA方法分析筛查抗PF4抗体,阳性标本则加入肝素后再次检测,计算肝素抑制率,并分析是否混合其他抗体;用抗PF4+标本处理靶血小板后,再用血栓弹力图（TEG）分析血小板聚集以及流式分析血小板的活化。结果 107例患者中12例为抗PF4+,占11.42%,其中3/12为肝素抑制;8/12混合其他非PF4抗体;TEG测得1例低血小板聚集、2例血小板聚集的混合状态,其余9例均诱导高聚集。流式观察到抗PF4+样品比献血者样品诱导更多的CD41a+CD62p+血小板（23.05%±4.88% vs 14.09%±3.24%,P<0.001）。结论血小板减少症患者中可能存在PF4抗体,具有明显异质性,可对输注的血小板凝集功能和活化能力具有不同的影响。

关键词: 血小板减少症, 血小板输注, 抗PF4抗体, 血栓弹力图, 血小板聚集

Abstract: Objective In order to explore whether there are PF4 antibodies in patients with thrombocytopenia and affect platelet function. Methods Serum samples were randomly collected from thrombocytopenic patients referred for specialized platelet cross-matching and from healthy donors, P latelets from donors of the same blood group were randomly selected as target cells. Anti-PF4 antibodies were screened by enzyme-linked immunosorbent assay (ELISA), and positive samples were retested with heparin supplementation. Anti-PF4+ samples were further analyzed for the coexistence of other antibodies. Normal platelets treating with incubated with anti-PF4+ samples, followed by assessment of platelet function via thromboelastography (TEG) and analysis of platelet activation levels using flow cytometry. Results Among 107 patients with thrombocytopenia, 12 (11.42%) were positive for anti-PF4, including 3 showing heparin inhibition and 8 presenting with concurrent non-PF4 antibodies. TEG analysis revealed lower platelet aggregation in 1/12, mixed aggregation patterns in 2/12, and higher aggregation in 9/12. Flowcytometry demonstrated a higher proportion of CD41a+CD62p+ platelets induced by anti-PF4+ sera than that by healthy donors (23.05%±4.88% vs 14.09%±3.24%, P<0.001). Conclusion Anti-PF4 antibodies are present in a subset of thrombocytopenic patients, and exhibit significant functional heterogeneity, which may exert diverse effects on platelet transfusion outcomes.

Key words: Thrombocytopenia, Platelet transfusion, Anti-PF4 antibody, Thromboelastography, Platelet aggregation

中图分类号:

R558.2

杨颖, 钱呈睿, 李勤, 郭忠慧, 赵俸涌, 张嘉敏, 杨启修, 王晨, 朱自严. 血小板减少症中异质性的PF4抗体对血小板功能的影响^*[J]. 临床输血与检验, 2026, 28(4): 546-552.

YANG Ying, QIAN Chengrui, LI Qin, GUO Zhonghui, ZHAO Fengyong, ZHANG Jiamin, YANG Qixiu, WANG Chen, ZHU Ziyan. Heterogeneous Effects of Anti-PF4 Antibodies on Platelet Function in Patients with Thrombocytopenia[J]. JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE, 2026, 28(4): 546-552.

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血小板减少症中异质性的PF4抗体对血小板功能的影响^*

Heterogeneous Effects of Anti-PF4 Antibodies on Platelet Function in Patients with Thrombocytopenia

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