Clinical Study Of Partial Laboratory Index On Primary Immune Thrombocytopenia In Adults

Objective:To analyze the changes of platelet parameters,bone marrow megakaryocytes,peripheral blood lymphocytes and antinuclear antibody spectrum in adult patients with primary immune thrombocytopenia,having a acquaintance with the changes of the above indexes in ITP,and to explore the clinical value in the diagnosis and treatment of ITP.Methods: A total of 133 cases of adult ITP were selected from January 2014 to January2018 in the Department of Hematology and immunology of Affiliated Hospital of Yan’an University,they were ITP group.54 patients with primary aplastic anemia(AA)received were selected as group AA.152 patients with malnutrition anaemia in this department were treated as bone marrow control group.In the same period,60 cases of normal physical examination in the medical examination department of our hospital were used as the healthy control group.The parameters of peripheral blood platelets in group ITP before and after treatment,before treatment in group AA and in healthy control group were collected by automatic blood analyzer,it includes PLT,PCT,MPV,PDW and P-LCR.,observing the difference of platelet parameters in the three groups;and the degree of thrombocytopenia before treatment in group ITP and group AA was grouped(dividing four groups:PLT>50×10~9/L 、 50～30×10~9/L 、 30～10×10~9/L 、<10×10~9/L),observing whether there is a difference between the two groups in the degree of platelet parameters decrease.Megakaryocyte count before treatment in group ITP and group AA by bone marrow aspiration microscopy,the number of megakaryocyte in the ITP group was divided into groups(7~35 in normal group,36~100 in mild increase group,101~200 in increased group,>201 in extreme group),exploring the factors associated with the change.The T lymphocyte,B lymphocyte,NK lymphocyte and T lymphocyte subsets,including helping T cells(CD4+),inhibitory T cells(CD8+)and the ratio of CD4+/ CD8+,were detected by flow cytometry(FCM)in group ITP and group AA before treatment,comparing the differences between the two groups.The anti nuclear antibody spectrum of ITP patients was detected by immunoblotting,one or more of the test results were "borderline" as the critical group,all total(-)patients were negative group,and the differences of the indexes between the two groups were compared.Data statistical analysis of all collected data by SPSS21.0 statistics software,in order to explore the changes of platelet parameters,megakaryocyte,lymphocyte and antinuclear antibody in ITP disease,to explore this indexes’ clinical value of diagnosis,disease risk and treatment in ITP.Results:1.Changes of platelet parameters1.1 There was a significant difference in the degree of thrombocytopenia between newly diagnosed ITP patients and AA patients(P<0.05),showing that the degree of thrombocytopenia in ITP patients was relatively mild,and in AA patients was heavier.1.2 Comparison of platelet parameters in group ITP and group AA before treatment:MPV,PDW and P-LCR were higher than AA group and control group(P<0.05),PLT and PCT higher than AA group and lower than control group(P<0.05);PLT and PCT in group AA were lower than control group(P<0.05),there was no significant between AA and control group in MPV,PDW and P-LCR(P>0.05).1.3 Comparison of platelet parameters in group ITP before and after treatment:PLT and PCT were significantly higher than before treatment(P<0.05),but still low than control group(P<0.05);MPV,PDW and P-LCR were significantly reduced(P<0.05),and there was no significant difference between MPV,PDW and P-LCR between ITP and control group(P>0.05).1.4 Linear correlation between platelet parameters1.4.1 There was a linear correlation between five platelet parameters,PLT,PCT,MPV,PDW and P-LCR(P<0.05),except for the linear correlation between PLT and PDW in group ITP(P>0.05),PLT and PCT,MPV and PDW,MPV and P-LCR,PDW,and P-LCR have a high linear correlation(R>0.7,P<0.05).1.4.2 There was a linear correlation between five platelet parameters,PLT,PCT,MPV,PDW and P-LCR(P<0.05),except for the linear correlation between PLT and MPV in group AA(P>0.05),PLT and PCT,MPV,P-LCR,PDW and P-LCR were highly linear correlation(R>0.7,P<0.05).2.Changes of megakaryocyte in bone marrow2.1 Comparison of bone marrow smears between ITP group and bone marrow control group:two groups show active hyperplasia of megakaryocytes,the distribution of platelet in ITP group were scattered,instead of the normal distribution of piles;megakaryocytes of ITP group significantly higher than control group(P<0.05);2.2 Correlation analysis of bone marrow megakaryocyte count in ITP patients with other laboratory indicators: further analysis of the correlation between age,PLT,PCT,MPV,PDW,P-LCR,T lymphocytes,B lymphocytes and megakaryocytes: only age and bone marrow megakaryocytes are associated(P<0.01),PLT and bone marrow There was no correlation between megakaryocyte(P>0.01).2.3 The difference between ITP patients with different bone marrow megakaryocyte array: compared with the normal group,the mild elevation group,the obviously elevated group and the extreme elevation group,all the clinical indexes were found to be negative correlation between age and bone marrow megakaryocyte count(P<0.05),that is,the smaller the age of ITP,the higher the bone marrow megakaryocytes;the older the bone,the bone.The number of megakaryocytes is less.3.Peripheral blood lymphocyte change:The B lymphocyte was higher than AA group(P<0.05),T lymphocyte was lower than group AA(P<0.05),there was no significant difference in the ratio of CD4+,CD8+ and CD4+/CD8+ in T lymphocyte subsets between two groups(P>0.05).4.Detection of anti nuclear antibody spectrum in group ITP:The comparison between the two groups of clinical indicators showed that: the differences of megakaryocyte count,CD4/CD8 ratio and PDW and P-LCR after treatment were statistically significant(P<0.05),that is the bone marrow MK,the PDW and P-LCR after treatment in critical group were higher than those in the negative group,the ratio of CD4/CD8 was lower than that of the negative group.Conclusion:1.The platelet parameters of MPV,PDW and P-LCR in the first diagnosed ITP patients were significantly higher before treatment,and they could be restored to normal after treatment,suggesting that these three platelet parameters have some auxiliary value in the diagnosis and evaluation of the curative effect of ITP.2.The age of the ITP patients in the first diagnosis was negatively correlated with the bone marrow megakaryocyte count,that is,the larger the age of the patient,the less the megakaryocyte count,the smaller the age of the patient,the more the megakaryocyte count.3.The distribution of platelets in bone marrow and the count of bone marrow megakaryocytes play an important role in the diagnosis of ITP.4.The pathogenesis of ITP is mainly B cell immunity.The pathogenesis of AA is mainly due to abnormal T cell immunity.5.The severity of thrombocytopenia in newly diagnosed ITP patients is lighter than that of newly diagnosed AA patients,and the risk of bleeding is relatively low.6.The antinuclear antibody test results showed that the critical value or total negative had no definite clinical significance for the treatment and prognosis of ITP patients.