地塞米松对特发性血小板减少性紫癜骨髓涂片中巨核细胞形态学的影响

Effect of Dexamethasone on the bone marrow smear morphology of megakaryocytes in idiopathic thrombocytopenic purpura

目的了解地塞米松(D X M)对特发性血小板减少性紫癜(ITP)骨髓涂片中巨核细胞的形态学改变。方法收集42例ITP初诊患者作为ITP组和22名健康人作为对照组,其中ITP组标本分别在大剂量D X M治疗前和治疗两周后采样,即D X M治疗前和D X M治疗后。然后分别采集上述分组对象的骨髓并涂片,与对照组骨髓片一并在显微镜下对巨核细胞进行分类,并记录D X M治疗前、D X M治疗后以及对照组的血小板数目。结果 D X M治疗前比值与D X M治疗后比值、对照组比值相比较,差异均具有统计学意义(P<0.01),但治疗后比值与对照组比值相比较,差异无统计学意义(P>0.05);同时,D X M治疗后外周血小板数较治疗前明显升高(P<0.01),但与对照组相比仍较低(P<0.01)。结论 D X M在治疗ITP过程中,可直接或间接促使巨核细胞凋亡,从而使血小板生成增加。

【Objective】To understand Dexamethasone（DXM） on bone marrow smear morphological changes of megakaryocytes in idiopathic thrombocytopenic purpura（ITP）.【Methods】42 patients with newly diagnosed ITP as ITP group and 22 healthy people as control group,ITP group in which samples were large doses of DXM in the treatment of samples before and after treatment for two weeks,that is,DXM before treatment and DXM after treatment.Bone marrow of the grouped objects were collected and smeared,and then classified megakaryocytes under the microscope,at the same time,record the platelet count of DXM before treatment,DXM after treatment and control group.【Results】The ratio of DXM before treatment had statistical significance compared with DXM after treatment and control group（P 0.01）,but the ratio of DXM after treatment had not statistical significance compared with control group（P 0.05）.Simultaneously,the platelet count of DXM after treatment was significantly higher than DXM before treatment（P 0.01）,but still low compared with the control group（P 0.01）.【Conclusion】In the process of the treatment of ITP,DXM directly or indirectly promotes apoptosis of megakaryocytes,which generate increased platelet count.