脓毒症患者血小板计数及体积变化趋势的临床意义

Change trend and clinical significance of platelet count and mean platelet volume in septic patients

目的观察脓毒症患者血小板计数(PC)、血小板体积(MPV)的变化趋势,探讨两者相关性及其临床意义。方法应用HEMACELL Plus全自动22项5类血细胞分析仪,通过阻抗法检测40例脓毒症患者发病后1 d、3 d、7 d、10 d的PC、MPV,并回顾性将脓毒症患者分为死亡组和存活组,分析其PC、MPV变化趋势,并进行两者相关性分析。结果①入院时存活组和死亡组患者PC均低于正常生理范围,死亡组PC在各时相点均低于存活组(1 d、3 d P>0.05,7 d、10 d P<0.01)。存活组血小板在入ICU第3天明显下降(P<0.01),继之于第7天、10天持续上升(P均<0.01)。死亡组PC则呈持续下降趋势(P均<0.01)。②入院时存活组和死亡组患者MPV均基本上处于正常生理范围,但是死亡组MPV值比存活组患者高(P均<0.05),病程中存活组患者MPV呈进行性下降趋势,而死亡组患者MPV呈进行性上升趋势(P均<0.01)。③PC与MPV呈显著负相关。结论PC、MPV的变化可能成为脓毒症患者血小板生成和活性紊乱以及骨髓反应的间接标志,常规检测脓毒症患者的PC、MPV变化趋势,尤其早期检测MPV,可能成为评价脓毒症病情及骨髓反应情况的一种快速、可信的手段。

Objective To investigate the change trend and clinical significance of platelet count （PC） and mean platelet volume （MPV） in septic patients. Methods PC and MPV were measured with HEMACELL Plus at 1st, 3rd, 7th and 10th day of sepsis in 40 patients. The septic patients were divided into survivor group and non - survivor group according to the final outcomes. The change trend of PC and MPV and their relationship was analysed. Results PC was slightly lower than normal range immediately after admission in both groups, continuously decreased in the following days （at 7 th and 10 th day, P 〈 0.01 ） in non -survivor group, and decreased first （at 3rd day, P 〈 0.01 ） and then increased （at 7th and 10th day, P 〈 0.01 ） in survivor group. MPV progressively augmented in non - survivor group and gradually minished in survivor group （ compared between groups, P 〈 0.05 ）. PC was significantly and negatively correlated with MPV. Conclusion The changes of PC and MPV may be an indirect sign of disturbance in platelet production and activity and bone marrow response in septic patients. The routine measurement of PC and MPV, especially MPV in the early stage, may be considered as a quick and reliable method to assess the state of sepsis and bone marrow response.