巨核细胞在儿童原发性免疫性血小板减少症诊治中的价值

Clinical value of megakaryocytes in the diagnosis and treatment of children with immune thrombocytopenic purpura

目的分析巨核细胞在儿童原发性免疫性血小板减少症(ITP)诊治的价值.方法分析诸城市人民医院2014年6月至2018年1月诊治的ITP患儿110例的临床资料,并随访1年以上.按照病程是否大于12个月分为慢性组32例、非慢性组78例,比较两组性别、年龄、初诊病程、血小板计数、淋巴细胞计数、巨核细胞计数、白细胞计数、初始治疗方案的差异.通过多因素分析了解慢性ITP的独立影响因素.分析初诊时病程、淋巴细胞计数评估慢性ITP及初次治疗效果的价值.分析巨核细胞评估初次治疗效果的价值.结果慢性组初诊病程[(5.8±2.26)d]、巨核细胞数量[(210.28±98.67)个/片]长于、高于非慢性组[(3.57±2.05)d、(165.26±78.35)个/片],而淋巴细胞计数[(2.87±0.90)×10^9/L]则低于非慢性组[(3.66±1.12)×10^9/L],差异均有统计学意义(t=4.824、2.299、3.545,均P<0.05).巨核细胞计数不是慢性ITP的独立影响因素(P>0.05),初诊病程是慢性ITP的危险因素(OR=3.826),而淋巴细胞计数则为保护因素(OR=0.471).初诊病程评估慢性ITP的ROC曲线下面积(AUC)=0.648,最佳分界值为4.5 d,敏感度65.4%,特异度为62.5%.而淋巴细胞计数评估慢性ITP的AUC=0.712,最佳分界值为3.01×10^9/L,敏感度59.4%,特异度为78.2%.初诊病程、淋巴细胞计数评估患儿治疗效果无明显意义.巨核细胞增多者初次治疗的疗效优于正常水平者,差异有统计学意义(Z=6.051,P<0.05).结论初诊病程、淋巴细胞计数有助于评估儿童ITP的病程时间,而骨髓巨细胞细胞计数增多患儿的初次治疗效果较佳.

Objective To analyze the clinical value of megakaryocytes in the diagnosis and treatment of children with immune thrombocytopenic purpura(ITP).Methods From June 2014 to January 2018,the clinical data of 110 children with ITP diagnosed and treated in Zhucheng People's Hospital Affiliated to Weifang Medical College were analyzed and followed up for more than 1 year.The children were divided into two groups according to whether the duration of the disease was morethan 12 months(chronic group and non-chronic group).Gender,age,initial course of disease,platelet count,lymphocyte count,megakaryocyte count,white blood cell count,and initial treatment regimen were analyzed and compared between the two groups.Multivariate analysis was used to analyze the independent influencing factors of chronic ITP.The clinical value of the initial diagnosis and lymphocyte counts in evaluation of the effects of chronic ITP and initial treatment were analyzed.The clinical value of megakaryocyte in the assessment of initial treatment was analyzed.Results The initial course of disease[(5.8±2.26)d]and megakaryocyte count[(210.28±98.67)/piece]in the chronic groupwere higher than those in the non-chronic group[(3.57±2.05)d,(165.26±78.35)/piece],and the lymphocyte count[(2.87±0.90)×10^9/L]in the chronic groupwas lower than that in the non-chronic group[(3.66±1.12)×10^9/L],the differences were statistically significant(t=4.824,2.299,3.545,all P<0.05).Megakaryocyte count was not an independent factor of chronic ITP(P>0.05).The initial course of disease was a risk factor for chronic ITP(OR=3.826),while lymphocyte count was a protective factor(OR=0.471).The initial course of disease was evaluated as AUC=0.648 for chronic ITP,with an optimal cut-off value of 4.5 days,a sensitivity of 65.4%,and a specificity of 62.5%.Lymphocyte counts was evaluated as AUC(area under the ROC curve)=0.648 for chronic ITP,the optimal cut-off value was 3.01×10^9/L,the sensitivity was 59.4%,and the specificity was 78.2%.The initial course of disease and lymphocyte count had no significant value in evaluation of the treatment outcome(P<0.05).The initial treatment of patients with increased megakaryocyte counts was better than those with the normal level,and the difference was statistically significant(Z=6.051,P<0.05).Conclusion The initial course of disease and lymphocyte count can help to assess the duration of ITP in children.Patients with increased bone marrow megakaryocyte counts can achieve better results at initial treatment.