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网织血小板检测在肿瘤化疗所致血小板减少症患者中的应用
作者：孙晓洁1  刘进2  桂霞1  程虹3  阿先古丽· 阿不力孜3 
单位：1. 新疆医科大学附属肿瘤医院 输血科, 新疆 乌鲁木齐 830011;
2. 新疆维吾尔自治区第一济困医院 检验科, 新疆 乌鲁木齐 830011;
3. 新疆医科大学附属肿瘤医院 检验科, 新疆 乌鲁木齐 830011
关键词：网织血小板 网织血小板比例 肿瘤化疗所致血小板减少症 无出血症状 
分类号：R730.43
出版年·卷·期（页码）：2016·35·第六期（918-922）
摘要：

目的：探讨把网织血小板（reticulated platelet，RP）和网织血小板比例（immature platelet fraction ratio，IPF%）两个反映血小板新陈代谢情况的指标纳入2014年肿瘤化疗所致血小板减少症（chemotherapy-induced thrombocytopenia，CIT）诊治专家共识的可能性。方法：按照无出血症状的CIT患者的诊断标准将155例肿瘤患者纳入研究，收集治疗前的全血标本，SYSMEX公司的XN系列全自动血细胞分析仪对其进行RP和IPF%检测。按照专家共识把病例分为PLT≤10×109 L-1组，10×109 L-1 < PLT < 75×109 L-1组和75×109 L-1≤PLT < 100×109 L-1组，比较3组间RP和IPF%的差异，利用受试者工作特征曲线（receiver operator characteristic curve，ROC）得到RP和IPF%预测无出血症状CIT患者需要进行预防性血小板输注的预测价值。结果：PLT≤10×109 L-1组RP和IPF%分别为（1.8±1.1）×109 L-1和（25.8±7.3）%，10×109 L-1 < PLT < 75×109 L-1组RP和IPF%分别为（4.6±1.9）×109 L-1和（11.0±3.5）%，75×109 L-1≤PLT < 100×109 L-1组RP和IPF%分别为（7.1±2.7）×109 L-1和（8.7±3.8）%，任意两组患者RP和IPF%差异均有统计学意义（均P<0.05）。以目前的专家共识为金标准，得出RP和IPF%预测无出血症状的CIT患者需进行预防性血小板输注的准确性分别为66.5%和82.6%，其中IPF%的预测价值更高。结论：IPF%作为RP和PLT的比值，能更好地反映出无出血症状CIT患者机体内血小板新陈代谢的情况，可作为一个有价值的预测指标为无出血症状的CIT患者是否需要预防性输注血小板提供依据，进而纳入2014年CIT诊治专家共识。

Objective: To explore the probability to bring the reticulated platelet(RP) and immature platelet fraction ratio(IPF%) into the expert consensus(2014 Edition) of chemotherapy-induced thrombocytopenia(CIT). Methods: According to the diagnostic criteria for CIT without symptoms of hemorrhage, 155 cases of cancer patients were enrolled. Whole blood samples were collected before the treatment, then RP and IPF% were detected by SYSMEX-XN automatic blood cell analyzer. Divided the patients into three groups according to expert consensus, including PLT≤10×109 L-1 group, 10×109 L-1 < PLT < 75×109 L-1 group, 75×109 L-1≤PLT < 100×109 L-1 group. RP and IPF% were compared between any two groups. Predictive value of RP and IPF% for prophylactic platelet transfusion in CIT without symptoms of hemorrhage were got by receiver operator characteristic curve(ROC). Results: RP and IPF% were(1.8±1.1)×109 L-1 and(25.8±7.3)% in the group of PLT≤10×109 L-1; RP and IPF% were(4.6±1.9)×109 L-1 and(11.0±3.5)% in the group of 10×109 L-1 < PLT < 75×109 L-1; RP and IPF% were(7.1±2.7)×109 L-1 and(8.7±3.8)% in the group of 75×109 L-1≤PLT < 100×109 L-1. RP and IPF% had statistical differences between any two groups(all P<0.05). When the current expert consensus as the gold standard, the accuracy of prediction were 66.5% and 82.6% by RP and IPF% to predict whether it was need to prophylactic platelet transfusion for CIT without symptoms of hemorrhage, IPF% had higher predictive value. Conclusion: IPF% as the ratio between RP and PLT, which can be better to reflect the metabolism of platelets in CIT without symptoms of hemorrhage. It can be used as a valuable predictor of the prophylactic platelet transfusion in CIT without symptoms of hemorrhage patients, and brought into the expert consensus(2014 Edition) of CIT.
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