The Correlation And Clinical Application Of Platelet Indices And Serum Lipid Profiles In Immune Thrombocytopenia

BackgroundImmune thrombocytopenia(ITP)is an autoimmune disease characterized by isolated thrombocytopenia.The main pathogenesis includes generation of pathological anti-platelet antibodies,T cell-mediated immune destruction and impaired thrombopoiesis.Platelet count(PC)is a common clinical test and platelet indices(PI),as a group of derived platelet parameters obtained directly or indirectly from the automatic complete blood analyzer,are related to platelet function and proliferation kinetics and have diagnostic and prognostic values in various diseases.PI mainly include mean platelet volume(MPV),platelet distribution width(PDW),plateletcrit(PCT)and platelet larger cell ratio(P-LCR).In ITP patients,changes in platelet indices can be used to identify thrombocytopenia caused by multiple factors and as prognostic markers of recurrence and treatment efficacy.Lipids as important components of the platelet membrane structure,are involved in various physiological processes during platelet activation and thrombopoiesis.Studies have found that in certain inflammatory diseases,serum lipids could affect platelet formation and activity,and then change the morphology of platelet in circulating blood,thus cause changes in platelet indices.However,the correlation between platelets and serum lipids is still unclear in ITP.Therefore,we hypothesized that in ITP patients,serum lipids are also linked with thrombopoiesis and activation of platelets,and expected to verify this hypothesis by analyzing the correlation between blood lipid profile and platelet indices,megakaryocyte numbers and bleedings.ObjectiveTo verify the changes in platelet indices during treatment and the correlation between platelet indices and megakaryocyte numbers,therapeutic effects in ITP patients;To investigate the correlations of serum lipid profile with platelet indices,megakaryocyte number,hemorrhage symptoms and therapeutic effects.MethodsThe clinical data of hospitalized ITP patients were analyzed retrospectively and then the correlation analyses were performed,including the results of platelet indices before and after treatment,urine occult blood test,fecal occult blood test and serum lipids,symptoms of skin,oral and nasal bleedings,treatment regimen,platelet transfusion and the number of megakaryocytes.Results(1)A total of 457 patients were enrolled in this study with an average age of 47.14 years,including 196 males(average age of 47.67 years)and 261 females(average age of 46.74 years).There were no significant differences in age,hemorrhages,number of megakaryocytes and platelet indices between men and women.The levels of Cho,HDL-C,ApoA1 and NEFA in women were significantly higher than those in men,and Hcy was lower than that in men.(2)Correlation analysis between platelet indies before treatment showed that there were significant correlations between PC and PDW,MPV,PCT,PDW and MPV,P-LCR,MPV and P-LCR,which were all in line with the linear relationships(3)Correlation analysis of platelet indices and serum lipids before treatment showed that there were significant correlations between PC and TG,PCT and TG,NEFA,and the linear relationship between NEFA and PCT is statistically significant.The correlations have gender differences while there were significant correlations between PDW and Hcy,MPV and PLA2,PCT and HDL-C,NEFA,P-LCR and HDL-C in men,PC and TG,PCT and TG in women.(4)Correlation analysis of hemorrhages before treatment showed urine occult blood and PC,ApoA1,NEFA,fecal occult blood and age,hemorrhage of skin and PDW,CHO,HDL-C,ApoA1,oral hemorrhage and LDL-C,nasal hemorrhage and age,general hemorrhages and CHO,HDL-C,LDL-C were significantly correlated(5)Correlation analysis of bone marrow megakaryocytes showed that the number of megakaryocytes were significantly correlated with NEFA(6)After treatment,PC,MPV and PCT increased significantly,and PDW decreased significantly.The difference ratio of PC was significantly correlated with HDL-C.ConclusionsIn ITP patients,platelet indices changed significantly after treatment,but had no correlation with hemorrhages and megakaryocyte number.Serum lipid levels not only have impact on platelet indices,but also correlate with bleeding symptoms,megakaryocyte number and changes of platelet indices after treatment,demonstrating serum lipids have notable influence on thrombopoiesis and platelet activation in ITP patients.