儿童特发性血小板减少性紫癜小巨核细胞的研究

A study on micromegakaryocyte in children with idiopathic thrombocytopenic purpura

目的 探讨巨核细胞生长发育、小巨核细胞的出现在儿童特发性血小板减少性紫癜(idiopathicthrombocytopeniapurpura ,ITP)中的意义。 方法 对 4 6例儿童ITP进行常规骨髓形态学、骨髓涂片CD41免疫酶标染色检测 ,并采用ELISA方法检测血小板相关抗体的含量。并分为急性ITP(acuteITP ,AITP)组和慢性ITP(chronicITP ,CITP)组进行统计学分析。结果 4 6例中 36例为AITP ,10例为CITP ;4 5例骨髓巨核细胞计数增高或正常 ,1例降低者为CITP。小巨核细胞检出率为98% (45 / 4 6 ) ,I型淋巴样小巨核细胞检出率为 35 % (16 / 4 6 )。CITPI型淋巴样小巨核细胞的检出率及计数高于AITP ,其他三型小巨核细胞计数低于AITP ,产板巨核细胞比例以及各型小巨核细胞数量与血小板相关抗体的含量无相关性。结论 儿童ITP骨髓巨核细胞系存在不同程度病态造血 ,其原因可能并非完全由于免疫因素 ,部分病例可能以骨髓巨核细胞自身异常为主。I型淋巴样小巨核细胞的出现以及数量的高低可在一定程度上提示ITP病程的长短和预后。

Objective Bone marrow megakaryocytes overly proliferate and abnormally develop among patients with idiopathic thrombocytopenic purpura (ITP) Previous studies showed that it resulted from the abnormal immune function of the body But the changes in megakaryocytes, especially in micromegkaryocytes in this disease are unclear The present study was designed to explore the growth and development status of megakaryocytes and the significance of changes in micromegakaryocytes in pediatric cases Methods Routine bone marrow smears assay and enzyme labeling for micromegakaryocytes with CD41 monoclonal antibody (McAb) were performed in 46 children with ITP The level of platelet associated immunoglobulin (PA Ig) was measured with ELISA Results Among 46 children, 36 had acute ITP (AITP)and 10 chronic ITP (CITP) The number of megakaryocytes increased or was normal in 45 patients, but decreased only in 1 case of CITP The positive rate of micromegakaryocytes and type I micromegakaryocytes was 98%(45/46) and 35%(16/46), respectively The positive rate of type I micromegakaryocytes was higher in CITP (50%) cases than that in AITP (31%) cases, but the median of the other three types of micromegakaryocytes in CITP cases (159) was lower than that in the AITP cases (336) There was no relationship between the numbre of all types of megakaryocytes and the level of PA Ig Conclusion Majority of patients with ITP showed an increase in micromegakaryocytes, especially in type II, III and IV The immune disturbance might not be the only reason for ITP The abnormality of quality of megakaryocytes might be one of the potential causes for thrombocytopenia in some cases of ITP, especially in those of CITP The appearance and the number of type I micromegakaryocytes might reflect the prognosis of cases of ITP