网织血小板在血小板减少性疾病中的检测及意义

Value of reticulated platelet counts in diagnosing thrombocytopenic disorders

关键词:  血小板减少  网织血小板  流式细胞术

Key words:  thrombocytopenia  reticulated platelet  flow cytometry

摘要:

［目的］探讨外周血网织血小板（reticulated platelet，RP）数值的变化对各型血小板减少疾病的诊断价值；外周血RP与骨髓中巨核细胞（megakaryocyte，MK）增生程度的关系。［方法］以噻唑橙作为RNA的荧光染料，利用流式细胞仪测定外周血中含有RNA的RP，并计算RP（%）及RP绝对值。［结果］正常对照组：RP（8.6± 2.5）%，RP绝对值为（17.1 ± 6.5）×10⁹ /L。原发性血小板减少性紫癜（ITP）患者RP（%）高于正常组，而RP绝对值低于正常组（P<0.01），在不同MK 增生级别的ITP患者中，RP（%），RP绝对值在各组之间差异均无显著性意义；再生障碍性贫血患者RP（%）及绝对值均低于正常对照组(P<0.05，P<0.01)；而急性白血病患者RP（%）与正常对照组比较差异无显著性意义（P>0.05），但其RP绝对值低于正常对照组（P<0.01）。上述疾病患者，经治疗有效者RP（%）恢复正常，而治疗无效或欠佳者，则RP（%）基本无变化。［结论］外周血RP测定，有助于血小板减少性疾病的病因学诊断治疗监控。外周血RP与骨髓中MK增生的程度无相关性。

Abstract:

［Objective］To evaluate the significance of reticulated platelets(RPs) in the diagnosis of thrombocytopenic disorders and the relationship between RPs and the proliferative degree of megakaryocyte(MK) in bone marrow.［Methods］With thiazole orange as a fluorescent dye ,RPs were measured by analyzing the RNA content in platelets with flow cytometry and the pecent and the absolute counts of RPs were calculated.［Results］The percent and absolute counts of the RPs in a normal group are(8.6± 2.5)%and（17.1 ± 6.5）×10⁹/L ,the patients with idiopathic thrombocytopenic purpura (ITP) had a significantly high percent and a low absolute counts of RPs(P<0.01). In patients with aplastic anemia, both the percent and the absolute counts of RPs were at low levels(P<0.05,P<0.01,respectively). There was no difference of RP percentage between the patients with acute leukemia and normal controis, but the absolute counts of RPs in the former was significantly lower than that in the latter .There was no difference between the percent and absolute counts of RPs among ITP patients with different the latter .There was no difference between the percent and absolute counts of RPs among ITP patients with different proliferative degree of MK in bone marrow. In all the diseases mentioned above ,it was shown that RP percentage returned to normal in the effective cases after treatment ,but no such change was found in the ineffective cases.［Conclusion］Reticulated platelet counts contribute to the aetiology determination of the thrombocytopenia .It is also a valuable diagnostic method and a monitoring marker .There is no relationship between reticulated platele counts and the counts of MK proliferation in bone marrow.