网织血小板测定对血小板减少疾病诊断价值的探讨

The value of reticulated platelet counts in diagnosing thrombocytopenic disorders

目的 探讨外周血网织血小板 (RP)数值的变化对各型血小板减少疾病的诊断价值 ;外周血RP与骨髓中巨核细胞 (MK)增生程度的关系。方法 以噻唑橙作为RNA的荧光染料 ,利用流式细胞仪测定外周血中含有RNA的RP ,并计算RP(% )及RP绝对值。结果 (1)正常对照组 :RP(8 4±2 5 ) % ,RP绝对值为 (16 8± 6 8)× 10 9/L。 (2 )原发性血小板减少性紫癜 (ITP)和脾功能亢进症患者RP(% )显著高于正常对照组 ,而RP绝对值显著低于正常对照组 (P <0 0 1) ,在不同MK增生级别的ITP患者中 ,RP(% )、RP绝对值在各组之间均无差异 ;再生障碍性贫血患者RP(% )及绝对值均低于正常对照组 (P <0 0 5 ,P <0 0 1) ;而急性白血病、骨髓增生异常综合征患者RP(% )与正常对照组无明显差异 (P >0 0 5 ) ,但其RP绝对值明显低于正常对照组 (P <0 0 1)。 (3)上述疾病患者 ,经治疗有效者RP(% )恢复正常 ,而无效或疗效欠佳者 ,则RP(% )几无变化。结论 外周血RP测定 ,有助于血小板减少疾病的病因学诊断 ,是血小板减少疾病一有价值的诊断依据 ,也是疗效判断的监控指标。

Objective To evaluate the significance of reticulated platelets (RPs) in the diagnosis of thrombocytopenic disorders and the relationship between RPs and the proliferative degree of megakaryocyte(MK) in bone marrow Methods With thiazole orange as a fluorescent dye, RPs were measured by analyzing the RNA content in platelets with flow cytometry and the percent and absolute counts of RPs were calculated Results (1) The percent and absolute counts of the RPs in a normal group were (8 4±2 5)% and (16 8±6 8)×10 9/L respectively (2) As compared with the normal group, the patients with idiopathic thrombocytopenic purpura(ITP) and hypersplenism had a significantly high percent and low absolute counts of RPs ( P <0 01 ) In patients with aplastic anemia, both the percent and absolute counts of RPs were at low levels ( P <0 05 and P <0 01, respectively) There was no difference of RP percentage between the patients with acute leukemia or myelodysplastic syndromes and normal controls , but the absolute counts of RPs in the former was significantly lower than that in the latter There was no difference between the percent and absolute counts of RPs among ITP patients with different proliferative degree of MK in bone marrow (3) In all the diseases mentioned above, it was shown that RP percentage returned to normal in the effective cases after treatment, but no such change was found in the ineffective cases Conclusions Reticulated platelet counts contribute to the aetiology determination of the thrombocytopenia It is also a valuable diagnostic method and a monitoring marker There is no relationship between reticulated platelet counts and the counts of MK proliferation in bone marrow