应用未成熟血小板比例、未成熟血小板绝对值和血栓弹力图评估原发免疫性血小板减少症患者的出血风险

Application of immature platelet fraction 、absolute immature platelet fraction and thrombelastograph on assessment of bleeding risk in patients with immune thrombocytopenia

目的探讨未成熟血小板比例（IPF）、未成熟血小板绝对值（A．IPF）和血栓弹力图（TEG）在原发免疫性血小板减少症（ITP）患者出血倾向评估中的价值。方法采用ITP．BAT出血评分系统对271例ITP患者进行出血评分及出血程度分级，并行IPF、A．IPF检测，其中125例行TEG检测，分析ITP患者出血程度与IPF、A—IPF、TEG各指标的相关性。结果在271例ITP患者中，不同疾病分期和性别患者的出血程度差异无统计学意义（P〉0．05）；儿童以轻度出血为主，与成人出血程度差异有统计学意义（P〈0．05）；出血程度和血小板计数呈负相关（P〈0．001）。在所有患者、PLT〈30×10^9／L患者以及PLT〈30×10^9／L儿童患者中，血小板计数与IPF呈负相关（P〈0．05），与A-IPF、血栓最大幅度（MA）值呈正相关（P〈0．05）。在所有患者及PLT〈30×10^9／L患者中，出血程度和IPF呈正相关（P〈0．001），与A．IPF、MA值呈负相关（P〈0．001）。在PLT〈30×10^9／L儿童患者中，出血程度与IPF、A．IPF、MA值均无相关性（JD〉0．05）。ROC曲线分析显示IPF、A．IPF、MA值评估ITP患者出血风险效能较好，ROC曲线下面积分别为0．745、0．744、0．813（P〈0．001）。多因素分析显示IPF和MA值是预测ITP患者出血倾向的独立因素，综合诊断ROC曲线下面积0．846（P〈0．001），优于单一指标。结论IPF、A-IPF和MA值能够准确评估ITP患者的出血风险．可以作为治疗的参考指标和疗效的观察指标．

Objective To explore the clinical value of immature platelet fraction（IPF）, absolute immature platelet fraction （A-IPF） and thrombelastograph （TEG） on assessment of bleeding risk of immune thrombocytopenia （ITP）. Methods two hundred and seventy-one patients with ITP were assessed based on ITP-BAT bleeding grading system. IPF, A-IPF were determined in 271 patients ,TEG in 125 patients. The correlations between bleeding grades and IPF, A-IPF, variables of TEG in subgroups were analyzed by statistical method. The predictive value of IPF, A-IPF, and variables of TEG on bleeding risk of ITP patients was evaluated. Results There were no significant differences in bleeding degree in all patients with different gender and disease stage （P〉0.05）. Mild bleeding rate in children was higher than that in adult （P〈0.05）. PLT inversely correlated with bleeding grade for the entire cohort （P〈0.001）. In all subjects, PLT〈 30× 10^9/L and pediatric cohorts with PLT〈 30× 10^9/L, PLT were negatively correlated with IPF （P〈0.05）, positive correlated with A-IPF （P〈0.001） and the maximum amplitude （MA） （P〈0.05）. Bleeding grades were significantly correlated with IPF, A-IPF, MA in all subjects and patients with PLT〈 30×10^9/L （P〈0.001）. IPF, A-IPF and MA did not correlate with bleeding grades in children with PLT〈 30× 10^9/L （/9〉0.05）. ROC curve analysis revealed IPF, A-IPF aud MA had better predictive value （AUC 0.745, 0.744, 0.813, P〈0.001 ）. Multivariate analysis showed that IPF and MA were independence factors for predicting bleeding risk in ITP patients and comprehensive predictive value was higher （AUC 0.846, P〈 0.001） than single variable. Conclusion IPF, A-IPF and MA could accurately evaluate bleeding risk in ITP patients. It may be considered as reference index of the treatment and observation index of curative effect.