Objective: To investigate the changes of mean platelet volume (MPV), platelet distribution width (PDW) and platelet associated antibodies (PAIg) in children with acute immune thrombocytopenic purpura (aITP), and to explore the diagnostic value of MPV, PDW, PAIg and their combination for megakaryocyte dysmaturity in aITP children.
Methods: Plt count, MPV and PDW of 36 aITP children were measured by using Sysmex XN automatic blood cell analyzer, and 33 children with acquired thrombocytopenic purpura (ATP) without megakaryocyte dysmaturity. The expression of PAIg was detected by flow cytometry, and the number and classification of megakaryocytes in the bone marrow were performed by marrow cytology. The diagnostic significances of MPV, PDW, PAIg and their combination as well as the sensitivity and specificity for megakaryocytes dysmaturity in aITP were assessed through calculating the area under ROC curve (AUC), after determining the influence of each parameters on the megakaryocyte dysmaturity by Logistic regression.
Results: MPV, PDW and PAIg of aITP children were significantly higher than those of the ATP children (P＜0.05), while the Plt count and number of thromocytogenic megakaryocytes per area (1.5 cm×3 cm) were less than those of the controls (P＜0.05). Count of RBC and WBC, percentages of neutrophil granulocytes and lymphocydes in aITP were similar to those in the controls（P＞0.05）. The results of Logistic regression showed that Plt count, MPV, PDW and PAIg were the factors influencing megakaryocyte dysmaturity in aITP children, and the regression model has a high statistical significance (χ2=65.491，P=0.001) and r square (R2=0.713). The AUC of the combined detection of Plt count, MPV, PDW and PAIg was 0.863, which was much higher than that of Plt count, MPV, PDW, PAIg individually or in pairs. The sensitivity and specificity of the combined detection were 79.167% and 89.697%, which were higher than those of Plt count, MPV, PDW, PAIg individually or in pairs.
Conclusion: The diagnostic significance of MPV and PDW for megakaryocyte dysmaturity in aITP are insufficient, but the diagnostic efficacy can be improved by combined examination with PAIg.
题目: MPV、PDW联合PAIg对急性原发免疫性血小板减少症患儿骨髓巨核细胞成熟障碍诊断价值的研究.
目的: 探讨平均血小板体积（MPV）、血小板体积分布宽度（PDW）、血小板相关抗体（PAIg）在急性原发免疫性血小板减少症（aITP）患儿中的变化及其联合检测对aITP骨髓巨核细胞成熟障碍的诊断价值.
方法: 用Sysmex XN血细胞自动分析仪分别检测36例aITP患儿和33例未累及巨核细胞系的获得性血小板减少症患儿（ATP）的血小板数量及其相关参数、骨髓巨核细胞数量及其分类；应用流式细胞术分别检测2组PAIg水平；SPSS软件处理数据，分析两组患者MPV、PDW、PAIg的分布，经多因素Logistic回归分析患儿骨髓巨核细胞成熟的影响因素后，绘制ROC曲线，计算MPV、PDW、PAIg及其联合检测对aITP患儿骨髓巨核细胞成熟障碍的诊断的ROC曲线面积（AUC）、灵敏度和特异度.
结果: 与ATP患儿组相比，aITP组MPV、PDW及PAIg升高，Plt和产板型巨核细胞降低，组间差异均有统计学意义（P＜0.05），而两组间RBC、WBC、中性粒细胞、淋巴细胞、单位面积巨核细胞数差异无统计学意义（P＞0.05）。多因素Logistic回归分析结果显示，Plt、MPV、PDW及PAIg进入回归模型，其回归模型有统计学意义（χ2=65.491，P=0.000，R2=0.713）。MPV+PDW+PAIg 联合检测的AUC为0.863，其灵敏度和特异度分别为79.167%和89.697%，均高于单独检测及MPV、PDW、 PAIg两两联合检测.
结论: MPV及PDW用于aITP骨髓巨核细胞成熟障碍的诊断存在不足，联合PAIg检测能够提高诊断效能.