脓毒症患者血小板计数及体积变化趋势的临床意义

The trend and clinical significance of platelet count and mean platelet volume in patients with sepsis

目的:观察脓毒症患者血小板计数(PC)、血小板体积(MPV)变化趋势,探讨两者相关性及其临床意义。方法:应用HEMACELLPlus全自动二十二项五类血细胞分析仪,通过阻抗法检测80例脓毒症患者发病后1、3、7、10d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、3dP>0.05,7、10dP<0.01)。存活组PC在入ICU第3天明显下降(P<0.01),继之于第7、10天持续上升(均P<0.01)。死亡组PC则呈持续下降趋势(均P<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(均P<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(均P<0.01)。(3)PC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 trend and clinical significance of the platelet count （PC） and mean platelet volume （MPV） in patients with sepsis, and their relationship. Methods PC, MPV were measured with HEMACELL Plus at 1, 3, 7, 10 day after the onset of sepsis in 80 patients. The septic patients were divided into survivors and non-survivors according to the results of following up. The trend of PC and MPV and their relationship were analysed. Results （1）PC was slightly lowered in both groups immediately after admission. The PC was lower in non-survivors than that in survivors at different periods （ 1 d, 3 d P 〉 0.05 ; 7 d, 10 d P 〈 0.01 ）. PC in survivors decreased significantly on the third day after admission （P 〈 0.01 ）, and continued to rise （P 〈 0.01 ）. In non-survivors, PC decreased continuously after admission （P 〈 0.01 ）. （2）MPV was within normal range, the MPV values were much higher in non-survivors than that in survivors at different periods（P 〈 0.05）. However, MPV progressively decreased in survivors, while it increased in non- survivors （P 〈 0.01 ）. （3） There was significant negative correlation between PC and MPV. Conclusions The changes of PC, MPV can be an indirect sign of disturbance in platelet production and activity, and bone marrow response in sepsis. The routine measurement of PC and MPV, especially MPV in the early stage, can be considered as a quick and reliable guide in the assessment of bone marrow response to sepsis evolution.