关键词:

儿童, 血小板减少症, 免疫性血小板减少症, 血小板平均体积, 大血小板比例

Abstract:

Objective　To explore the clinical value of platelet count (PLT), platelet pressure product (PCT), platelet volume distribution width (PDW), platelet mean volume (MPV), and large platelet ratio (P-LCR) in the diagnosis and treatment of common thrombocytopenia in children. Methods　This was a retrospective study. Seventy-six children with immune thrombocytopenia (ITP) treated at Nanyang Central Hospital from December 2021 to January 2024 were selected, including 47 boys and 29 girls; they were 2 (7, 11) years old. Eighty children with leukemia and 75 with aplastic anemia were selected as a case group, including 95 boys and 60 girls; they were 9 (5, 13) years old. In the same period, 182 healthy children with normal physical examination were selected as a control group, including 103 boys and 79 girls; they were 8 (4, 14) years old. The blood routine was detected by the Mindray BC-7500 hematology analyzer. The results of PLT, PCT, PDW, MPV, and P-LCR were collected. The differences in platelet-derived values between the ITP group, the case group, and the control group were analyzed by the t test and Mann-Whitney U test. The Spearman rank correlation was used to analyze the correlation between different platelet-derived values. The diagnostic efficacy of the platelet-derived values for ITP was assessed using the receiver operating characteristic curve (ROC). Results　The PLT and PCT in the ITP group were lower than those in the control group [14.00 (4.25, 41.75)×10⁹/L vs. 308.00 (276.50, 347.25)×10⁹/L and 0.02 (0.01, 0.07)% vs. 0.27(0.24, 0.30)%]; the MPV and P-LCR in the ITP group were higher than those in the control group [11.00 (9.50, 12.70) fl vs. 8.70 (8.20, 9.33) fl and 40.00 (31.00, 50.00)% vs. 16.80 (13.50, 21.50)%]; there were statistical differences (all P<0.001). The PLT, MPV, and PCT in the ITP group were lower than those in the leukemia group or the aplastic anemia group, while the P-LCR was higher (all P<0.001). In the children with ITP, MPV was positively correlated with PCT and P-LCR (r=0.50 and 0.83; both P<0.001), but PCT was not correlated with P-LCR (P>0.05). MPV had high differential diagnostic value for ITP, with an area under the curve of 0.87, a sensitivity of 99.99%, and a specificity of 81.30%; when the maximum of the Jordon index was taken, its cutoff value was 14.05 fl. The combined detection of MPV, PCT, and P-LCR could further improve the differential diagnostic value of ITP (AUC=0.96). After the treatment, the PLT and PCT were higher than those after the treatment [189.00 (118.00, 320.50)×10⁹/L vs. 12.50 (4.00, 34.00)×10⁹/L and 0.20 (0.15, 0.31)% vs. 0.02(0.01, 0.06)%], while the PDW and P-LCR were lower [16.00 (14.65, 16.40) fl vs. 16.50 (15.95, 17.60) fl and 29.85 (22.33, 38.78)% vs. 40.00 (30.85, 50.40)%]; there were statistical differences (all P<0.001). After the treatment, the PDW, MPV, and P-LCR in the ITP group were higher than those in the control group, while the PLT and PCT were lower (all P<0.05). Conclusions　PCT, MPV, and P-LCR differ between children with ITP and bone marrow-associated thrombocytopenia. The combination of the three helps differentially diagnose ITP.

Key words:

Children, Thrombocytopenia, Immune thrombocytopenia, Mean platelet volume, Large platelet ratio