血小板去除术联合多种药物治疗血小板增多症的疗效观察及血栓弹力图检测的作用

Clinical Study of Platelet Sepration Plus Drugs and Evalution by Thrombelastography on Essential Thrombocythemia

目的观察血小板去除术联合羟基脲,α-2 b干扰素及抗血小板药物治疗原发性血小板增多症(ET)的疗效。并评价血栓弹力图检测在血小板增多症中的应用价值。方法采用COBE SPECTRA和MCS+两种血细胞分离机对31例患者行血小板去除术,同时联合羟基脲,干扰素及常规抗血小板药物治疗。并应用血栓弹力图(TEG)监测患者去除治疗前后的凝血功能指标。结果 1血小板去除治疗后患者外周血中血小板计数明显下降,联合使用羟基脲/α-2b干扰素及抗血小板药物治疗,使病情得到较快和稳定的控制。2血小板去除治疗后,患者TEG检测结果显示血小板功能指标MA值明显降低,综合凝血指数CI值明显改善,R值,Angle角没有明显改变。3血小板的功能指标MA值与血小板计数之间没有明显相关性。结论血小板去除治疗联合羟基脲/干扰素及抗血小板药物治疗原发性血小板增多症疗效显著,血栓弹力图监测ET患者的凝血功能对指导治疗有重要意义。

Objective This retrospective study aims to assess the efficacy of the clinical effcet of therapeutic platelet reducion plus Hydroxyurea and IFNα-2b on essential thrombocythemia （ET）and evaluate the thrombelastography（TEG） system on ET.Methods 31 patients were treated with Hydroxyurea and IFNα-2b after therapeutic platelet reducion.TEG parameters were measured serially before and after therapeutic platelet reducion.Excel was used for data entry and SPSS 17.0 for data analysis.Results ①The platelet count of peripheral blood decreased significantly after therapeutic platelet reducion plus Hydroxyurea and IFNα-2b treated.②The TEG assays showed that clot strength （MA,maximal amplitude）significantly decreased and coagulation index（CI） was significantly improved.However,R time and angle were not changed significantly.③No significant correlation between PLT count increments and MA.Conclusion This study demonstrates that therapeutic platelet reducion plus Hydroxyurea and IFNα-2b treated significantly effect on ET.The TEG assay may prove useful in guiding treatment decisions on ET.