[Marrow megakaryocyte count as a response predictor of severe thrombocytopenia in patients with primary Sjogren syndrome].
[Marrow megakaryocyte count as a response predictor of severe thrombocytopenia in patients with primary Sjogren syndrome].
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DOI：
10.3760/cma.j.issn.0578-1426.2019.04.009
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发表时间：
2019-04-01
期刊：
影响因子：
--
通讯作者：
Zeng, X F
中科院分区：
文献类型：
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作者：
Xue, Y;Xu, D;Zeng, X F
目的：探讨原发性干燥综合征（pSS）严重血小板减少（TP）患者治疗效果和预后的预测因素。方法：对2010年至2016年北京协和医院收治的pSS合并重度TP（血小板计数≤50*10（9）/L）患者根据治疗效果进行分类并进行回顾性分析。收集反应参数和临床数据，包括骨髓抽吸结果和实验室检查结果。结果：最终分析了 30 名患者，其中 20 名患者的骨髓抽吸结果明显。分别有 14 名和 7 名患者获得完全缓解（CR）和部分缓解（PR），另外 9 名患者未获得缓解（NR）。每组每张玻片的骨髓巨核细胞计数：CR 患者为 13.0（9.2，23.5），PR 患者为 7.0（7.0，20.0），NR 患者为 5.0（1.0，6.0）。临床缓解（CR+PR）患者的BM-MK计数显着高于NR患者（P=0.006）。受试者操作特征分析显示，每张载玻片 BM-MK 计数的截止值为 6.5，通过不同的反应对患者进行分层，灵敏度为 13/14，特异性为 6/7，曲线下面积为 0.879。单变量分析表明，每张玻片 BM-MK 计数 > 6.5 时预后较好。结论：BM-MK 计数可能是 pSS 和严重 TP 患者缓解的预测因素。每张玻片 BM-MK 计数≤6.5 的患者代表血小板改善较差。
Objective: To explore the predictive factors for determining the therapeutic response and prognosis of severe thrombocytopenia (TP) in patients with primary Sjogren syndrome(pSS). Method: Patients with pSS and severe TP (platelet count ≤ 50*10(9)/L) admitted between 2010 to 2016 at Peking Union Medical College Hospital were classified according to their therapeutic response and analyzed retrospectively. The response parameters and clinical data including bone marrow aspiration results and laboratory findings were collected. Result: Thirty patients were finally analyzed, including twenty with appreciable bone marrow aspiration results. Fourteen and 7 patients achieved a complete response (CR) and a partial response (PR) respectively, other 9 patients with no response (NR). The megakaryocyte counts in bone marrow (BM-MK) counts per slide in each group were 13.0 (9.2,23.5) in CR patients, 7.0 (7.0,20.0) in PR patients, and 5.0 (1.0,6.0) in NR patients. BM-MK counts in patients with clinical response (CR+PR) were significantly higher than those with NR (P=0.006). A receiver-operation characteristic analysis revealed a cutoff value of BM-MK counts at 6.5 per slide stratifying patients by different responses with a sensitivity of 13/14, a specificity of 6/7, and area under the curve of 0.879. Univariate analysis indicated a better prognosis as BM-MK counts>6.5 per slide. Conclusion: BM-MK count could be a predictive factor of response in patients with pSS and severe TP. Patients with BM-MK counts≤6.5 per slide represent worse platelet improvement..