再生障碍性贫血患者血清中TPO水平变化的临床意义

摘要

目的:评价血清中血小板生成素(TPO)水平在再生障碍性贫血(AA)患者诊疗中的临床意义.方法:以119例健康志愿者和54例AA患者为研究对象.从54例患者中共收集92份样本,其中43份为初诊患者,23份样本为治疗后仍处于骨髓抑制期的患者,10份来源于部分缓解(PR)患者,16份来源于完全缓解(CR)患者.用免疫酶联吸附法(ELISA)检测血清中的TPO水平.用自动血细胞分析仪计数外周血细胞.结合骨髓细胞学及骨髓活检的检查结果对确诊的AA患者进行分型诊断.对不同年龄、性别、不同分型及治疗后血小板计数和TPO水平之间的关系进行了相关分析.结果:健康志愿者血清中TPO水平为95.3±54.0 pg/ml.极重型再生障碍性贫血(vSAA)、重型再生障碍性贫血(SAA)及非重型再生障碍性贫血(nSAA)血清中TPO水平分别为2908±623、2708±623和2684±891 pg/ml,各型AA患者的TPO水平之间无明显差异(P＞0.05),但显著高于健康对照组(P＜0.001).43例初诊患者在治疗前TPO水平最高,为2728±1704 pg/ml,23例在接受免疫抑制治疗(IST)后仍处于骨髓抑制期患者血清TPO水平为1598±1692 pg/ml,PR患者TPO水平为1912±1011 pg/ml,CR患者TPO水平为1009 ±590 pg/ml,与健康对照相比差异有统计学意义(P ＜0.001).PR患者的TPO水平高于CR患者(P＜0.001).PR和CR患者TPO水平低于初诊及治疗后处于骨髓抑制期的患者(P ＜0.001).TPO水平与Plt数量呈负相关(r=-0.53,P ＜0.001).对于AA患者,在收集样本前2周内未输注Plt,其TPO水平与Plt数量呈负相关(r=-0.70,P＜0.001).尽管PR患者Plt为117×109/L,CR患者Plt计数为167×109/L,但二者TPO水平无统计学差异(P＞0.05).结论:AA患者无论缓解与否,其TPO水平都显著高于健康对照组,提示TPO通路在AA患者的机制中可能存在异常.%Objective:To evaluate the clinical significance of thrombopoietin (TPO) level in diagnosis of pateints with aplastic anaemia (AA).Methods:The TPO levels in sera from 54 AA patients and 119 healthy controls were examined.A total of 92 samples were collected from AA patients including 43 samples harvested at diagnosis,23 samples in the cytopenic period after treatment,and 26 samples of patients in partial (n =10) or complete remission (n =16)following immunosuppressive treatment.Serum TPO levels were assessed by a sandwich-antibody ELISA that utilized a polyclonal rabbit antiserum for both capture and signal.Results:Serum samples from normal donors revealed a mean TPO level of 95.3 ± 54.0 pg/ml,the mean TPO levels in AA sera collected at diagnosis and before onset of treatment were 2728 ± 1074 pg/ml (P ＜0.001) compared with normal controls;mean platelet count at that time:27 × 109/L).Serum TPO levels of AA patients in partial or complete remission after immunosuppressive treatment were significantly lower than TPO levels at diagnosis (P ＜ 0.001).However,despite normal platelet counts (mean 167 × 109/L),TPO levels remained significantly elevated in complete remission (mean TPO 1009 ± 6590 pg/ml (P ＜ 0.001) compared with normal controls.There was a significant negative correlation between serum TPO levels and platelet counts in AA patients (coefficient of correlation r =-0.70,P ＜ 0.001).Conclusion:TPO levels are highly elevated in sera of patients with AA.Thrombopoietin did not return to normal levels in remission,indicating normal platelet count in remission of AA needs sustained high level of TPO.