Explore The Application Value Of MPV And PDW In Gestational Thrombocytopenia And Pregnancy With Newly Diagnosed ITP

Objective:To explore the mean platelet volume(MPV),platelet volume distribution width(PDW)and platelet count(PC)in the differential diagnosis of gestational thrombocytopenia and pregnancy with newly diagnosed ITP,and further assessed predictive value of MPV in the therapeutic effect of Glucocorticoid(GC)on pregnancy with newly diagnosed ITP.Method:Our study selected 201 cases of GT and 56 cases of ITP from January 2017 to December 2021,to compare the differences of clinical features and clinical outcome of the two groups: age,height,weight,parity,gestational age at admission,placenta previa,placental abruption,mode of delivery,the placenta implantation,anesthesia,blood transfusion,hospitalization days.Analyzed the correlation between PC,MPV,PDW and clinical features,and analyzed the value of the combination of PC,MPV and PDW in the differential diagnosis between GT and pregnancy with newly diagnosed ITP by receiver operating characteristic curve(ROC).Before delivery,a total of 63 patients used GC to increase PLT during pregnancy,including 26 cases in GT group and 37 cases in ITP group.The therapeutic effect of GC between the two groups was analyzed.In ITP group,according to the therapeutic effect of GC,it was further divided into early response group and ineffective group.The differences of PC and MPV before and after treatment were analyzed,and the ROC curve was drawn to analyze the predictive value of MPV for early response of GC treatment.P<0.05 is statistically significant.Results:1.There were 201 cases(78.21%)in GT group and 56 cases(21.79%)in ITP group.There was no significant difference in height,weight,age,twin pregnancy,placenta implantation,placenta previa,placental abruption,transfusion of red blood cells or plasma and hospitalization days between the two groups(P>0.05).The gestational age at admission of ITP group was smaller than that of GT group,but the parturition,premature delivery,cesarean section,general anesthesia,platelet transfusion,estimated blood loss and PPH were higher than those of GT group(P<0.05).2.At the initial diagnosis,there were 179 cases of mild thrombocytopenia(89.1%),13cases(6.5%)of moderate thrombocytopenia and 9 cases(4.5%)of severe thrombocytopenia in GT group,while there were 40 cases(71.4%)of mild thrombocytopenia,13 cases(23.2%)of moderate thrombocytopenia and 3 cases(5.4%)of severe thrombocytopenia in ITP group,with significant difference(P < 0.05).With the progress of pregnancy,the proportion of severe thrombocytopenia in ITP group increased significantly,with 26 cases(46.4%),while that in GT group increased with 20 cases(10%)(P < 0.001).PC in ITP group was smaller than that in GT group,while MPV and PDW were both larger than those in GT group(P <0.001).3.PDW,MPV,PC had no correlation with age,parity,twin pregnancy,premature delivery,mode of delivery,PPH,gestational age and estimated blood loss(P > 0.05).PDW,MPV and PC had significant negative correlation(r=-0.466,P < 0.001;r=-0.554,P <0.001).Besides,there was a significant positive correlation between PDW and MPV(r=0.885,P < 0.001).4.ROC curve was drawn,and the area under the curve(AUC)of PDW,MPV,PC,MPV+PC,PDW+PC,MPV+PDW,combined diagnosis of them were 0.706,0.764,0.715,0.77,0.73,0.793,0.885,respectively.The sensitivity of combined diagnosis of pregnancy complicated with ITP was the highest,which was 87.5%.The specificity of PC diagnosis alone was the highest,which was 78.1%.5.There were 63 cases who increased PLT by GC during pregnancy,including 26 cases of GT,37 cases of ITP,4 cases(15.4%)of early response in GT and 15 cases(40.5%)of early response in ITP(P< 0.05).6.The MPV of the early response group treated by GC was higher than that of the ineffective group in ITP group,with significant difference(P<0.05).In ITP group,Logistic regression showed that MPV can be used as a predictor of curative effect of GC.The AUC of MPV for predicting the therapeutic effect of GC was 0.753,the sensitivity was 86.67%,the specificity was 63.64%,and the cutoff value was 12.8.Conclusion:1.At the initial diagnosis,the PC of ITP group is smaller than that of GT group,and MPV and PDW are both larger than those of GT group.2.There is no obvious correlation between MPV,PDW,PC and general clinical features and clinical outcomes of all subjects.PDW and MPV are negatively correlated with PC,while PDW is positively correlated with MPV.3.The combined diagnosis of MPV+PDW+PC can be used to differentiate pregnancy with newly diagnosed ITP from GT.4.The effect of GC in the treatment of pregnancy with newly diagnosed ITP is better than that of GT.5.MPV can predict the early response of GC in the treatment of pregnancy with newly diagnosed ITP.