儿童免疫性血小板减少症初次发病时血浆促血小板生成素水平与疾病发生及发展的关系

Pilot Study of the relationship between the progress of childhood immunne thrombocytopenia and serum thrombopoietin at initial diagnosis

目的探讨儿童免疫性血小板减少症(immune thrombocytopenia,ITP)初次发病时血浆促血小板生成素(thrombopoietin,TPO)水平与疾病进展的关系,了解疾病初发时血浆TPO浓度与血小板计数、骨髓巨核细胞计数和治疗反应的相关性。方法收集2012年4月-2012年9月期间北京儿童医院血液病中心收治的初次发病的ITP患儿的临床资料,同时检测其血浆TPO水平;随访入组病例3个月时的临床转归,将病例分为缓解组和未缓解组,分析TPO水平与初发时血小板、骨髓巨核细胞数目关系;与早期治疗反应及病程3个月时疾病状态的关系。结果共收集到33例,中位年龄3岁(2个月～12岁);未缓解组6例,缓解组27例。TPO水平与治疗前血小板数值(P=0.789,r=-0.048)、与骨髓巨核细胞数(P=0.724,r=-0.064)、与早期治疗反应(P=0.910,r=-0.021),均无明确相关性;未缓解组和缓解组的血浆TPO水平差异无显著性(P=0.469)。结论儿童ITP初发时血浆TPO水平与发病时血小板减少的程度无明确相关性,也不能反映骨髓巨核细胞的血小板生发能力,且与早期治疗反应无明确相关性,不能作为判断疾病预后的指标。

Objective To explore the relationship between the progress of childhood immune thrombocytopenia （ITP） and serum thrombopoietin （TPO） at initial diagnosis,and find the correlation among serum TPO,platelet counts,megakaryocyte （MK） counts and therapeutic effect.Methods Clinical data of newly diagnosed ITP patients in Hematology Oncology Center of Beijing Children＇s Hospital from April 2012 to September 2012 were collected retrospectively.The serum TPO levels were detected.After 3-month follow-up,the cases were divided into remission group and non-remission group.The correlation among TPO,platelet counts and MK counts were investigated.Besides,the relationship among TPO,therapeutic effect and the progress of ITP at the 3rd month were observed and analyzed.Results A total of 33 cases including 27 in remission group and 6 in non-remission group were analyzed （aged 2 months to 12 years,with a median age of 3 years）.There was no correlation between TPO and platelet counts before therapy （P =0.789,r =-0.048） ; no correlation was found between TPO and MK counts （P =0.724,r =-0.064） ; as such,there was no correlation between TPO and early therapeutic effect （P =0.910,r =-0.021）.Furthermore,no significant difference of TPO level between two groups was found （P =0.469）.Conclusions There is no significant correlation between TPO and platelet counts at newly diagnosed ITP cases.TPO level could neither reflect the thrombopoiesis of megakaryocytes nor evaluate the therapeutic effect.In conclusion,TPO could not be used as a predictor for the prognosis of childhood ITP.