115例特发性血小板减少性紫癜骨髓活检巨核细胞计数与临床疗效关系的研究

Correlation between Clinical Outcome of 115 Patients with Idiopathic Thrombocytopenic Purpura and Megakaryocyte Counts in Bone Marrow Biopsy

本研究首次评价特发性血小板减少性紫癜骨髓涂片及活检巨核细胞计数与临床疗效关系。按临床类型、血小板计数、骨髓涂片及活检巨核细胞计数115例成人ITP患者疗效。结果表明:①急性ITP患者疗效优于慢性ITP患者,2组近期治疗有效率分别为86.6%及60.4%(p<0.01),而远期治疗有效率分别为82.5%及68.9%(p<0.05)。②发病时不同血小板计数的ITP患者,他们的近期及远期疗效无显著差异(p>0.05)。③按发病时骨髓涂片巨核细胞计数进行分组,即涂片巨核细胞计数小于7个/4.5cm2组、7-35个/4.5cm2组、大于35个/4.5cm2组,这3组的近期治疗有效分别率为53.3%、73.8%及86.2%,这3组间相比较有显著差异(p<0.01),其远期治疗有效率分别为42.8%、84.6%及85.5%,而后2组治疗有效率相比较无显著差异(p>0.05),但后2组分别同第1组比较均有显著差异(p<0.01)。④按发病时骨髓组织切片巨核细胞计数进行分组:即切片巨核细胞计数小于8个/mm2组、8-15个/mm2组和大于15个/mm2组,这3组近期治疗有效率分别为53.8%、85.0%及90.3%,后2组治疗有效率比较无显著差异(p>0.05),但2组分别同第1组比较均有显著差异(p<0.01)。这3组的远期治疗有效率分别为33.3%、63.1%及87.9%,3个组间相比较有显著差异(p<0.01)。⑤ITP患者发病时外周血小板计数同骨髓涂片及组织活检切片巨核细胞计数均无相关性(r=0.31,p>0.05;r=0.41,p>0.05)。骨髓涂片同组织切片巨核细胞计数存在正相关(r=0.52,p<0.01)。单因素logistic回归分析结果表明,骨髓涂片及活检巨核细胞计数对远期疗效影响显著。结论:骨髓活检巨核细胞计数可以作为骨髓涂片巨核细胞计数有效补充,可预测特发性血小板减少性紫癜患者的治疗效果。

The aim of study was to explore the influence of the number of megakaryocytes in bone marrow smear and trephine biopsy on clinical outcome of idiopathic thrombocytopenic purpura（ITP）.The clinical outcome of 115 patients with ITP was compared by different clinical subtype,number of blood platelet,number of megakaryocyte in bone marrow smear and trephine biopsy.The results showed that：（1） the clinical outcome of actue ITP was better than that of chronic ITP,the short clinical outcome of acute ITP and chronic ITP were 86.6% vs 60.4% respectively（p0.01）,the long clinical outcome of them were 82.5% vs 68.9% respectively（p0.05）;（2） different number of blood platelet at occurence of diseases had no obviously influence on clinical outcome of patients with ITP;（3） all cases were subgrouped according to number of megakaryocyte in bone marrow smear,the number of megakaryocyte in bone marrow smear less than 7/4.5 cm2 was defined as group Ⅰ,the number of megakaryocyte between 7/4.5 cm2 to 35/4.5 cm2 was defined as group Ⅱ,and the number of megakaryocyte in bone marrow smear greater than 35/4.5 cm2 was defined as group Ⅲ.The effective rates of 3 groups in short term treatment were 53.3%,73.8% and 86.2% respectively,and there were statistical difference between these 3 groups（p0.01）,the effective rates of these 3 groups in long term treatment were 42.8%,84.6% and 85.5% respectively,and there was no statistical different between group Ⅱ and group Ⅲ（p0.05）,but both had statistical difference,as compared with group Ⅰ（p0.01）.（4） all cases were subgrouped by the number of megakaryocyte in trephine biopsy on time of disease occurence,the number of megakaryocyte in bone marrow smear less than 8/mm2 was defined as group Ⅰ,the number of megakaryocyte between 8/ mm2 to 15/mm2 was defined as group Ⅱ,the number of megakaryocyte greater than 15/mm2 was defined as group Ⅲ.The effective rate of these 3 goups in short term treatment were 53.8%、85.0% and 90.3% respectively,group Ⅱ and Ⅲ had no statistical difference each other（p0.05）,but both groups had statistical difference as compared with group Ⅰ（p0.01）.Effective rate of these 3 groups in long term treatment were 33.3%,63.1% and 87.9% respectively,and there were statistical difference between them（p0.01）.（5） the number of blood platelet at time of disease occurence was not related to number of megakaryocyte in bone marrow smear and in trephine biopsy section（r=0.31,p0.05;r=0.41,p0.05）.The number of megakaryocyte in bone marrow smear had positive correlation to that in trephine biopsy slides（r=0.52,p0.01）.In case to use single factor Logistic regression,the results showed that number of megakaryocyte in bone marrow smear and trephine biopsy had obvious influence on long term treatment of ITP.It is concluded that the number of megakaryocyte in trephine biopsy can be used as a available supplement method for bone smear,and can forecast the therapeutic effect of patients with ITP.