血小板生成素与慢性特发性血小板减少性紫癜的相关研究

目的探讨慢性特发性血小板减少性紫癜(CITP)患者Tpo水平及其与网织血小板(RP)、血小板计数(BPC)、骨髓巨核细胞及其成熟度的关系,以及Tpo水平在治疗中的预测作用.方法夹心酶联免疫吸附试验测定血清Tpo水平;噻唑橙染色,流式细胞仪检测RP;骨髓巨核细胞双重荧光染色后,多光子激光扫描共聚焦显微镜检测成熟度.结果22名正常对照和33例CITP患者血清Tpo水平分别为(204.05±65.70)ng/L和(345.46±222.23)ng/L(P>0.05);23例再生障碍性贫血(AA)及10例急性髓细胞白血病(AML)Tpo水平分别为(1427.62±468.84)ng/L和(596.09±462.95)ng/L,均较对照组显著升高(P<0.05);CITP组RP比例明显增高,AA组及AML组网织血小板绝对计数(RPC)明显降低;CITP患者糖皮质激素治疗无效组的Tpo水平高于有效及对照组(P<0.05).结论CITP组Tpo水平较对照组无明显升高.Tpo水平与RPC、RP比例相结合可反映骨髓血小板生成情况,鉴别血小板减少原因.Tpo水平与巨核细胞成熟度无相关性.血清Tpo水平可作为预测CITP患者对治疗反应的指标之一.

The relativity study of thrombopoietin and chronic idiopathic thrombocytopenic purpura

OBJECTIVE: To explore the relationship between thrombopoietin (Tpo) levels and reticulated platelet (RP), blood platelet count (BPC), maturity of megakaryocytes in patients with chronic idiopathic thrombocytopenic purpura (CITP), and the prediction evaluation according to Tpo levels. METHODS: Serum level of Tpo was measured by a sandwich-ELISA procedure, RP by flow cytometry after stained with thizole orange (TO), and maturity of megakaryocytes by laser scanning confocal microscopy (LSCM). RESULTS: The serum level of Tpo was (204.05 +/- 65.70) ng/L in 23 normal controls and (345.46 +/- 222.23) ng/L in 33 patients with CITP, being no significant difference between the two groups (P > 0.05). Compared with controls, serum Tpo levels in 22 aplastic anemia(AA) patients [(1427.62 +/- 468.84) ng/L] and 10 acute myelogenous leukemia (AML) patients [(596.09 +/- 462.95) ng/L] were increased significantly (P < 0.05). The RPC was significantly lower in AA and AML patients (P < 0.05). The RP% was increased significantly in CITP and AML patients (P < 0.05). The Tpo level was higher in CITP patients with no response to glucocorticoid therapy than in those with response (P < 0.05). CONCLUSION: Serum level of Tpo was not increased in patients with CITP. The RP%, RPC and Tpo levels could reflect thrombocytopoiesis and differentiate the causes of thrombocytopenia. The serum level of Tpo could be useful in prediction of the response to therapy in CITP patients.