特发性血小板减少性紫癜患者巨核细胞成熟程度的预后意义

Prognostic Significance of Bone Marrow Megakaryocyte Maturation in Patients with Idiopathic Thrombocytopenic Purpura

目的探讨特发性血小板减少性紫癜(ITP)骨髓巨核细胞(MK)成熟程度的临床意义。方法对145例ITP及30例非ITP患者的巨核细胞数量、各亚阶段比例、胞浆颗粒特征进行比较分析,并结合ITP患者的治疗效果以探讨MK成熟程度的预后意义。结果ITP组MK数量明显增加,其中原巨、幼巨、颗粒巨明显增加,而产板巨核明显减少,血小板形成不良,与非ITP组比较差异均有极显著性(P<0.01)。ITP患者MK增多和正常者比减少者有更好的疗效,无论是初始治疗还是停药后的远期效果;MK胞浆颗粒越多,或伴有血小板形成趋势或有血小板形成者,较胞浆颗粒稀少或有空泡者不仅更易获得缓解、近期完全缓解率高,而且亦有更好的远期效果(P<0.05)。结论ITP患者MK数量和成熟程度不仅具有诊断价值,而且还具有预后意义。

Objective To investigate the prognostic significance of bone marrow megakaryocyte （MK） maturation in patients with idiopathic thrombocytopenic purpura （ITP）. Methods The maturation degree of MK, MK counts and clinical outcome were evaluated in 145 patients with ITP. Results Megarkaryocyte number was significantly higher, the megakaryocytes were shifted towards more immature forms, platelet production rate was significantly decreased in ITP as compared to controls（P 〈0.01 ）. There were more better responses（ ie： initial treatment response and long-term outcomes） in the patients with increased and normal numbers of MK compared with the patients with decreased numbers of MK. The plasma particle of MK and ability of platelet production were correlated significantly with the responses （ P 〈 0.05 ）. Conclusion The number and maturation of megakaryocytes might reflect the diagnosis and prognosis of cases of ITP.