Objective: To explore the clinical value of immature platelet fraction (IPF), absolute immature platelet fraction (A- IPF) and thrombelastograph (TEG) on assessment of bleeding risk of immune thrombocytopenia (ITP).
Methods: two hundred and seventy- one patients with ITP were assessed based on ITP-BAT bleeding grading system. IPF, A-IPF were determined in 271 patients ,TEG in 125 patients. The correlations between bleeding grades and IPF, A-IPF, variables of TEG in subgroups were analyzed by statistical method. The predictive value of IPF, A-IPF, and variables of TEG on bleeding risk of ITP patients was evaluated.
Results: There were no significant differences in bleeding degree in all patients with different gender and disease stage (P>0.05). Mild bleeding rate in children was higher than that in adult (P<0.05). PLT inversely correlated with bleeding grade for the entire cohort (P<0.001). In all subjects, PLT< 30 × 10⁹/L and pediatric cohorts with PLT< 30 × 10⁹/L, PLT were negatively correlated with IPF (P<0.05), positive correlated with A-IPF (P<0.001) and the maximum amplitude (MA (P<0.05). Bleeding grades were significantly correlated with IPF, A-IPF, MA in all subjects and patients with PLT< 30 × 10⁹/L (P<0.001). IPF, A-IPF and MA did not correlate with bleeding grades in children with PLT< 30 × 10⁹/L (P>0.05). ROC curve analysis revealed IPF, A-IPF and MA had better predictive value (AUC 0.745, 0.744, 0.813, P<0.001). Multivariate analysis showed that IPF and MA were independence factors for predicting bleeding risk in ITP patients and comprehensive predictive value was higher (AUC 0.846, P<0.001) than single variable.
Conclusion: IPF, A-IPF and MA could accurately evaluate bleeding risk in ITP patients. It may be considered as reference index of the treatment and observation index of curative effect.
目的: 探讨未成熟血小板比例(IPF)、未成熟血小板绝对值(A-IPF)和血栓弹力图(TEG)在原发免疫性血小板减少症(ITP)患者出血倾向评估中的价值。
方法: 采用ITP-BAT出血评分系统对271例ITP患者进行出血评分及出血程度分级,并行IPF、A-IPF检测,其中125例行TEG检测,分析ITP患者出血程度与IPF、A-IPF、TEG各指标的相关性。
结果: 在271例ITP患者中,不同疾病分期和性别患者的出血程度差异无统计学意义(P>0.05);儿童以轻度出血为主,与成人出血程度差异有统计学意义(P<0.05);出血程度和血小板计数呈负相关(P<0.001)。在所有患者、PLT<30×109/L患者以及PLT<30×109/L儿童患者中,血小板计数与IPF呈负相关(P<0.05),与A-IPF、血栓最大幅度(MA)值呈正相关(P<0.05)。在所有患者及PLT<30×109/L患者中,出血程度和IPF呈正相关(P<0.001),与A-IPF、MA值呈负相关(P<0.001)。在PLT<30×109/L儿童患者中,出血程度与IPF、A-IPF、MA值均无相关性(P>0.05)。ROC曲线分析显示IPF、A-IPF、MA值评估ITP患者出血风险效能较好,ROC曲线下面积分别为0.745、0.744、0.813(P<0.001)。多因素分析显示IPF和MA值是预测ITP患者出血倾向的独立因素,综合诊断ROC曲线下面积0.846(P<0.001),优于单一指标。
结论: IPF、A-IPF和MA值能够准确评估ITP患者的出血风险,可以作为治疗的参考指标和疗效的观察指标。