应用重复测量统计方法动态观察ITP患者血小板参数恢复

Dynamic Observation of Platelet Parameters Recovery in Patients with ITP by Repeated Measurement Statistical Method

目的探讨重复测量统计方法在免疫性血小板减少症(immune thrombocytopenic purpura,ITP)患者治疗后血小板恢复过程中的应用。方法采用平行对照设计,随机抽取具有激素治疗完全反应的初发ITP患者89例,其中小儿组48例,成人组41例,回顾分析血小板及其参数随时间的变化情况。2组均治疗至少3个月,并于治疗前、治疗第1、3、5、7、9、15、30、60、90天检测外周血细胞计数,记录血小板计数(PLT)、平均血小板体积(MPV)、血小板分布宽度(PDW)、大血小板比值(LCR)、血小板比积(PCT)。应用重复测量的统计方法建立血小板及相关参数的恢复过程模型。结果多元统计分析结果表明PLT、PCT存在时间效应(F=12.363,P<0.001;F=14.945,P<0.001)和组别效应(F=4.884,P=0.036;F=5.553,P=0.026);MPV、LCR、PDW不存在组别效应(F=0.038,P=0.847;F=0.413,P=0.526;F=3.455,P=0.074),MPV、PDW存在time*group交互作用(F=16.557,P<0.001;F=4.878,P=0.036)。结论小儿组和成人组血小板参数恢复情况不同,小儿组恢复情况更佳。血小板相关参数可以预测ITP疗效,应重视血小板及参数在ITP患者血小板恢复过程中的作用。

Objective To investigate the application of repeated measurement statistical method in the recovery of platelets in patients with immune thrombocytopenia(ITP)after treatment.Methods A parallel control design was used.89 patients with initial ITP with complete response to hormone therapy,including 48 cases in pediatric group and 41 cases in adult group,were randomly selected.Changes of platelet and its parameters over time were retrospectively analyzed.Patients in both groups were treated for at least 3 months,and peripheral blood cell counts were measured before treatment and on 1st,3th,5th,7th,9th,15th,30th,60th,90th day after treatment.Platelet count(PLT),mean platelet volume(MPV),platelet distribution width(PDW),large platelet ratio(LCR),and plateletcrit(PCT)were recorded.The recovery process model of platelet and its related parameters were established by repeated measurement statistical method.Results Multivariate statistical analysis results show that PLT and PCT had time effect(F=12.363,P<0.001;F=14.945,P<0.001)and group effect(F=4.884,P=0.036;F=5.553,P=0.026);MPV,LCR and PDW had no group effect(F=0.038,P=0.847;F=0.413,P=0.526;F=3.455,P=0.074),MPV and PDW had time*group interaction(F=16.557,P<0.001;F=4.878,P=0.036).Conclusion The recovery of platelet parameters was different between pediatric group and adult group,and the recovery of pediatric group was better.Platelet and its related parameters can predict the efficacy of ITP.It is necessary to pay attention to the role of platelet and its related parameters in the process of platelet recovery in patients with ITP.