特发性血小板减少性紫癜患者网织血小板与P-选择素的测定

Measurement of reticulated platelets and P-selectin in patient with idiopathic thrombocytopenic purpura

目的 :探讨网织血小板 (RPs)和P 选择素检测在慢性特发性血小板减少症 (cITP)中的临床意义。方法 :采用流式细胞仪技术测定 5 6例cITP患者全血中RPs百分率和绝对值以及P 选择素水平 ,观察其在cITP中的变化 ,并与 30例正常对照组进行比较。结果 :①正常组RPs%为 (7.72 %± 3.0 6 % ) ,RPs绝对值为(13.34± 7.4 8)× 10 9/L ,P 选择素水平为 (6 .78%± 2 .15 % )。②cITP组RPs %及P 选择素水平均高于正常对照组 (P <0 .0 1) ;RPs绝对计数低于正常对照组 (P <0 .0 1)。③cITP患者血小板计数与RP %呈负相关 ,r =-0 .4 0 5 ,P <0 .0 1,血小板计数与P 选择素之间无相关性 ,RPs%及RPs绝对计数与骨髓巨核细胞数及产板巨数目间无明显相关性。④治疗有效患者 ,治疗后RPs%明显下降 ,P 选择素明显降低 ,与治疗前相比 ,差异有显著性 (P <0 .0 1) ;在血小板上升前 ,首先出现RPs%上升 ,P 选择素下降 ,此后随着血小板的持续上升 ,RPs%及P 选择素均逐渐下降。结论 :RPs%、RPs绝对值和P 选择素水平能反映cITP患者骨髓血小板的生成活性及体内血小板的活化破坏状况 ;在治疗中动态观察RPs%和P 选择素水平的变化 ,有助于预测激素对cITP的疗效。

Objective:To investigate the clinical significance of detecting RPs and P-selectin level in patients with cITP.Methods:The percentage and absolute counts of RPs and the P-selectin level were detected in 30 normal controls and 56 patients with cITP with flow cytometry in whole blood method.Results:①In the normal control,RPs% was (7.72%±3.06%),RPs absolute count (13.34±7.48)×109/L,the P-selectin level (6.78%±2.15%).②RPs% and P-selectin level (P<0.01) of cITP group were significantly higher than that of the normal control group;absolute count of RPs was lower than that of the normal control group.③The thrombocyte count in cITP patient was negatively correlated with RP%(r=0.405,P<0.01),but wasn't correlated with P-selectin.PRs% and PRs absolute count were not correlated with MK count and thrombocytogenous megakarycoyte count.④In effectively-treated patients with cITP,RPs% and the P-selectin level significantly decreased after treatment.Compared with the patient before treatment,there was obvious difference.At first,RPs% was elevated,P-selectin level was obviously decreased before the platelets were ascended,RPs% and P-selectin,thereafter,were all gradually declined along with the platelet continuously ascending.Conclusion:RPs%,the absolute count of RPs and the level of P-selectin can reflex the ability of bone marrow thrombocytopoiesis and the condition of platelets'activation and destruction. RPs% and the level of P-selectin were useful in predicting the curative effect of hormone to the patients with cITP.