摘要
目的探讨血小板生成素(thrombopoietin,TPO)在血小板减少症(heparin induced thrombocytopenia,HIT)患者中的临床诊断价值。方法选取2019年3月至2022年8月景德镇市第三人民医院收治的68例HIT患者作为研究组,根据病因分为感染组(n=7)、肝硬化脾功能亢进组(n=10)、系统性红斑狼疮(systemic lupus erythematosus,SLE)组(n=8)、恶性肿瘤放化疗组(n=9)、恶性血液病组(n=10)、再生障碍性贫血(aplastic anemia,AA)组(n=8)、特发性血小板减少性紫癜(idiopathic thrombocytopenic purpura,ITP)组(n=16);另选取本院同期10名血小板正常者作为对照组。所有研究对象均进行巨核细胞计数及血小板计数(platelet counts,PLT)、TPO水平检测。比较各组巨核细胞计数及PLT、TPO水平,分析TPO水平与巨核细胞计数及PLT与的相关性及巨核细胞计数及PLT、TPO水平对HIT的诊断价值。结果各组巨核细胞计数、PLT及TPO水平比较差异有统计学意义(P<0.05);肝硬化脾功能亢进组、ITP组巨核细胞计数均高于对照组、感染组、恶性肿瘤放化疗组、恶性血液病组、AA组,ITP组巨核细胞计数高于SLE组,恶性肿瘤放化疗组、恶性血液病组、AA组巨核细胞计数均低于对照组、感染组、SLE组,差异有统计学意义(P<0.05);感染组、肝硬化脾功能亢进组、SLE组、恶性肿瘤放化疗组、恶性血液病组、AA组、ITP组PLT水平均低于对照组,差异有统计学意义(P<0.05);恶性肿瘤放化疗组、恶性血液病组、AA组TPO水平均高于对照组、感染组、肝硬化脾功能亢进组、SLE组、ITP组,AA组TPO水平高于恶性肿瘤放化疗组、恶性血液病组,差异有统计学意义(P<0.05);其他各组间巨核细胞计数、PLT水平、TPO水平两两比较差异均无统计学意义。Pearson相关性分析结果显示,恶性肿瘤放化疗组、恶性血液病组、AA组巨核细胞计数、PLT与血清TPO均呈负相关(r<0,P<0.05);感染组、肝硬化脾功能亢进组、SLE组、ITP组巨核细胞计数、PLT与血清TPO无相关性。受试者工作特征(receiver operating characteristic curve,ROC)曲线分析结果显示,TPO诊断HIT的曲线下面积(area under the curve,AUC)最大,为0.771,巨核细胞计数的AUC为0.653,PLT的AUC为0.658,TPO对HIT具有一定诊断价值。结论TPO可作为临床诊断HIT的有效指标。
Objective To investigate the clinical diagnostic value of thrombopoietin(TPO)in patients with heparin induced thrombocytopenia(HIT).Methods A total of 68 patients with thrombocytopenia admitted to The Third People's Hospital of Jingdezhen from March 2019 to August 2022 were selected as the study group,and they were divided into the infection group(n=7),liver cirrhosis and hyposplenism group(n=10),systemic lupus erythematosus(SLE)group(n=8),malignant tumor radiotherapy and chemotherapy group(n=9),malignant blood disease group(n=10),aplastic anemia(AA)group(n=8)and idiopathic thrombocytopenic purpura(ITP)group(n=16)according to the etiology;another 10 patients with normal platelet were selected as the control group.The megakaryocyte count and platelet counts(PLT)and TPO levels were detected in all subjects.The megakaryocyte count and the levels of PLT and TPO were compared among all groups,and the correlation between the megakaryocyte count and PLT and TPO levels was analyzed,and the diagnostic value of megakaryocyte count,PLT and TPO levels was analyzed.Results There were significant differences in megakaryocyte count,PLT and TPO levels among all groups(P<0.05);the megakaryocyte count in the liver cirrhosis and hyposplenism group and ITP group were higher than that in the control group,infection group,malignant tumor radiotherapy and chemotherapy group,malignant blood disease group and the AA group,the megakaryocyte count in the ITP group was higher than that in the SLE group,and the megakaryocyte count in the malignant tumor radiotherapy and chemotherapy group,malignant blood disease group and AA group were lower than that in the control group,infection group and the SLE group,the differences were statistically significant(P<0.05);the levels of PLT in the infection group,liver cirrhosis and hyposplenism group,SLE group,malignant tumor radiotherapy and chemotherapy group,malignant blood disease group,AA group and ITP group were lower than that in the control group,and the differences were statistically significant(P<0.05);the levels of TPO in the malignant tumor radiotherapy and chemotherapy group,malignant blood disease group and the AA group were higher than that in the control group,infection group,liver cirrhosis and hyposplenism group,SLE group and the ITP group,and the levels of TPO in the AA group were higher than that in the malignant tumor radiotherapy and chemotherapy group and the malignant blood disease group,and the differences were statistically significant(P<0.05);there were no significant differences in megakaryocyte count,PLT level and TPO level among the other groups pairwise comparisons.Pearson correlation analysis showed that there were negative correlation between megakaryocytic count,PLT and serum TPO in the malignant tumor radiotherapy and chemotherapy group,malignant hematological disease group and AA group(r<0,P<0.05);there were no correlation between the megakaryocyte count,PLT and TPO in the infection group,liver cirrhosis and hyposplenism group,SLE group and ITP group.Receiver operating characteristic curve(ROC)curve analysis results showed that the AUC of TPO for the diagnosis of HIT was 0.771,the area under the curve(AUC)of megakarucleocyte count for the diagnosis of thrombocytopenia was 0.653,and the AUC of PLT for the diagnosis of HIT was 0.658,and TPO had certain diagnostic value for thrombocytopenia.Conclusion TPO can be used as an effective index for clinical diagnosis of HIT.
作者
赵水明
薛敏
齐龙旺
郑文宏
ZHAO Shuiming;XUE Min;QI Longwang;ZHENG Wenhong(Department of Hematology,The Third People's Hospital of Jingdezhen,Jingdezhen,Jiangxi,333000,China)
出处
《当代医学》
2024年第18期113-117,共5页
Contemporary Medicine
基金
景德镇市科技计划项目(20212SFZC028)。
关键词
血小板减少症
血小板生成素
巨核细胞计数
Heparin induced thrombocytopenia
Thrombopoietin
Megakaryocyte count
