网织血小板检测在肿瘤化疗所致血小板减少症患者中的应用  

Application of reticulated platelet in chemotherapy-induced thrombocytopenia cancer patients

作　　者：孙晓洁[1] 刘进 桂霞[1] 程虹[3] 阿先古丽.阿不力孜 

机构地区：[1]新疆医科大学附属肿瘤医院输血科,新疆乌鲁木齐830011 [2]新疆维吾尔自治区第一济困医院检验科,新疆乌鲁木齐830011 [3]新疆医科大学附属肿瘤医院检验科,新疆乌鲁木齐830011

出　　处：《东南大学学报（医学版）》2016年第6期918-922,共5页Journal of Southeast University(Medical Science Edition)

基　　金：新疆医科大学科研创新基金资助项目(XYDCX201473)

摘　　要：目的:探讨把网织血小板(reticulated platelet,RP)和网织血小板比例(immature platelet fraction ratio,IPF%)两个反映血小板新陈代谢情况的指标纳入2014年肿瘤化疗所致血小板减少症(chemotherapy-induced thrombocytopenia,CIT)诊治专家共识的可能性。方法:按照无出血症状的CIT患者的诊断标准将155例肿瘤患者纳入研究,收集治疗前的全血标本,SYSMEX公司的XN系列全自动血细胞分析仪对其进行RP和IPF%检测。按照专家共识把病例分为PLT≤10×10~9L^(-1)组,10×10~9L^(-1)<PLT<75×10~9L^(-1)组和75×10~9L^(-1)≤PLT<100×10~9L^(-1)组,比较3组间RP和IPF%的差异,利用受试者工作特征曲线(receiver operator characteristic curve,ROC)得到RP和IPF%预测无出血症状CIT患者需要进行预防性血小板输注的预测价值。结果:PLT≤10×10~9L^(-1)组RP和IPF%分别为(1.8±1.1)×10~9L^(-1)和(25.8±7.3)%,10×10~9L^(-1)<PLT<75×10~9L^(-1)组RP和IPF%分别为(4.6±1.9)×10~9L^(-1)和(11.0±3.5)%,75×10~9L^(-1)≤PLT<100×10~9L^(-1)组RP和IPF%分别为(7.1±2.7)×10~9L^(-1)和(8.7±3.8)%,任意两组患者RP和IPF%差异均有统计学意义(均P<0.05)。以目前的专家共识为金标准,得出RP和IPF%预测无出血症状的CIT患者需进行预防性血小板输注的准确性分别为66.5%和82.6%,其中IPF%的预测价值更高。结论:IPF%作为RP和PLT的比值,能更好地反映出无出血症状CIT患者机体内血小板新陈代谢的情况,可作为一个有价值的预测指标为无出血症状的CIT患者是否需要预防性输注血小板提供依据,进而纳入2014年CIT诊治专家共识。Objective： To explore the probability to bring the reticulated platelet（ RP） and immature platelet fraction ratio（ IPF%） into the expert consensus（ 2014 Edition） of chemotherapy-induced thrombocytopenia（ CIT）.Methods： According to the diagnostic criteria for CIT without symptoms of hemorrhage,155 cases of cancer patients were enrolled. Whole blood samples were collected before the treatment,then RP and IPF% were detected by SYSMEX-XN automatic blood cell analyzer. Divided the patients into three groups according to expert consensus,including PLT≤10 × 109L-1group,10 × 109L-1〈 PLT 〈 75 × 109L-1group,75 × 109L-1≤PLT 〈100 × 109L-1group. RP and IPF% were compared between any two groups. Predictive value of RP and IPF% for prophylactic platelet transfusion in CIT without symptoms of hemorrhage were got by receiver operator characteristic curve（ ROC）. Results： RP and IPF% were（ 1. 8 ± 1. 1） × 109L-1and（ 25. 8 ± 7. 3） % in the group of PLT ≤10 × 109L-1; RP and IPF% were（ 4. 6 ±1. 9） ×109L-1and（ 11. 0 ± 3. 5） % in the group of 10 × 109L-1〈 PLT 〈75 × 109L-1; RP and IPF% were（ 7. 1 ± 2. 7） × 109L-1and（ 8. 7 ± 3. 8） % in the group of 75 × 109L-1≤PLT 〈100 × 109L-1. RP and IPF% had statistical differences between any two groups（ all P 〈 0. 05）. When the current expert consensus as the gold standard,the accuracy of prediction were 66. 5% and 82. 6% by RP and IPF% to predict whether it was need to prophylactic platelet transfusion for CIT without symptoms of hemorrhage,IPF% had higher predictive value. Conclusion： IPF% as the ratio between RP and PLT,which can be better to reflect the metabolism of platelets in CIT without symptoms of hemorrhage. It can be used as a valuable predictor of the prophylactic platelet transfusion in CIT without symptoms of hemorrhage patients,and brought into the expert consensus（ 2014 Edition） of CIT.

关 键 词：网织血小板 网织血小板比例 肿瘤化疗所致血小板减少症 无出血症状 

分 类 号：R730.43[医药卫生—肿瘤]