原发性免疫性血小板减少症患者骨髓TPO及c-mpl水平测定意义  

Significance of bone marrow TPO and c-Mpl levels in diagnosis of primary immune thrombocytopenia

作　　者：黄菊[1] 卫仿仙 韩艳霞[2] 沈闪华 王宙政[2] HUANG Ju;WEI Fangxian;HAN Yanxia;SHEN Shanhua;WANG Zhouzheng(Shanghai Public Health Clinical Center,Fudan University,Shanghai 201508,China;不详)

机构地区：[1]上海市公共卫生临床中心,复旦大学附属公共卫生临床中心,上海201508 [2]嘉兴学院附属第二医院,嘉兴市第二医院,浙江嘉兴314000

出　　处：《实用医学杂志》2021年第15期1982-1987,共6页The Journal of Practical Medicine

基　　金：嘉兴市第二医院院级课题(编号:Y2015-104);嘉兴市科技局科研基金项目(编号:2018AD32028)。

摘　　要：目的测定原发性免疫性血小板减少症(ITP)患者骨髓TPO及其受体c-mpl的表达情况,评价二者在ITP诊断中的意义及其与疗效的相关性,并探讨影响糖皮质激素疗效的因素。方法通过检测50例ITP患者及20例脾功能亢进症患者和16例骨髓增生异常综合征(MDS)患者骨髓中巨核细胞总数、产板巨核细胞数及产巨比,分别应用双抗体夹心酶联免疫法(ABC-ELISA法)检测骨髓TPO水平,并应用流式细胞仪检测骨髓c-mpl表达水平,并以SPSS 19.0统计软件进行分析。结果ITP组总巨核细胞、产板巨核细胞均较MDS组和脾功能亢进症组高,但产巨比更低,差异均有统计学意义(P<0.05),而TPO和c-mpl表达水平却比MDS、脾功能亢进症患者低,差异也均有统计学意义(P<0.05);在PLT<30×109/L ITP组中TPO、c-mpl水平高于PLT≥30×109/L ITP患者组,差异有统计学意义(P<0.05);通过对PLT<30×109/LITP患者中治疗有效组和无效组分析发现治疗反应时间越短、产巨比越低、出血评分越高,治疗反应越好,存在一定的相关性。结论TPO和c-mpl可以作为ITP与MDS及脾功能亢进症鉴别诊断的依据,在ITP治疗过程中治疗反应时间、产巨比、出血评分有助于治疗反应预后判断依据,但尚需积累更多病例资料进一步探讨。Objective To explore the role of bone marrow TPO and its receptor c-Mpl in the diagnosis primary immune thrombocytopenia(ITP),study their correlation with curative effects,and explore the factors influencing the therapeutic effect of glucocorticoid.Methods The total number of megakaryocytes,the number of thromocytogenic megakaryocytes and the ratio of them in the bone marrows of 50 ITP patients(ITP group),20 hypersplenism patients(hypertension group)and 16 MDS patients(MDS group)were compared.ABC-ELISA and flow cytometry were used to detect the TPO level and expression level of c-Mpl in the bone marrows.The data were analyzed by SPSS 19.0.Results The total numbers of megakaryocytes and the thromocytogenic megakaryocytes in the ITP group were significantly larger than those in the MDS group and the hypersplenism group,but the number of megakaryocytes in the ITP group was significantly smaller than those in the MDS group(P<0.05)and however,the levels of TPO and c-Mpl were significantly lower than MDS and hypersplenism(P<0.05).The levels of TPO and c-Mpl were significantly higher in PLT<30×109/L ITP sub-group than in PLT≥30×109/L ITP subgroup(P<0.05).The analysis of the effective group and the ineffective group among the ITP patients showed that the shorter the treatment response time was,the lower the ratio of labor to macrosomia,the higher the bleeding score and the better the treatment response.Conclusion TPO and c-Mpl can be used as the indicators for the differential diagnosis of ITP,MDS and hypersplenism.In the course of ITP treatment,the response time,the ratio of thromocytogenic megakaryocyte to total megakaryocytes and the bleeding score are helpful for investigating the prognosis of treatment response,but more case data are needed for further discussion.

关 键 词：血小板减少症 原发性 免疫性 血小板生成素 受体 C-MPL 

分 类 号：R5582[医药卫生—血液循环系统疾病]