Objective To research the value of four parameters of platelets and the count of megakaryocyte on marrow smear when patients with idiopathic thrombo-cytopenic purpura (ITP) were on first visit. Methods The relationship of four parameters of platelets was analyzed on 200 cases,and the former four parameters of platelets were compared with those after treatment, then observation was made on the platelets rise speed during the treatment process and the relationship between the count of megakaryocyte on marrow smear and the treatment result. Results The count of megakaryocyte on marrow smear of patients with ITP were lower after treatment than that before treatment,69.5±14.6 vs 178.8±54.1( P ＜0.01). Howerer,the ratio of capacity plate megakaryocytes,PLT, platelet hematocrit(PCT) ,platelet hematocrit mean platet volume(MPV) and platelet distribution width(PDW) were higher after treatment than those before treatment, ( 79.4 ± 31.2) ％ vs ( 5.2 ± 2.7 ) ％, ( 86.9 ± 52.3 ) × 109/L vs ( 37.2 ±13.7)× 109/L,(3.10±0. 6) ％ vs (1.40±0.35)％,(9.6±1.7) fl vs (9.0±1.7) fl,(19.2±1.5) ％ vs (17.3±1.3)％(P ＜0.05 or ＜0.01), respectively. The peripheral count of platelets of patients with ITP had nothing to do with curative effects on the first visit,if the count of platelets was above 100 × 109/L within two-weeks' treatment,the basic cure was relatively high(96.0％). The numerous megakaryocyte counts in bone marrow at diagnosis indicated good prognosis that the cure rate was up to 85.7％ when the counts were more than 100 per 1.5 cm× 3 cm of smear. On first visit, the more of the count of megakaryocyte on marrow smear, the better the effectiveness of patients. Conclusion Observing platelet parameters has very important meaning for the ability of marrow producing platelets and observation cure effects. When ITP patients are on first visit, counting the number of megakaryocyte is necessary for diagnosis and prognosis judgement. Re-examining blood pictures and observing platelets rise speed during the treatment process is very valuable for prognosis judgement.%目的 探讨特发性血小板减少性紫癜(idiopathic thrombo-cytopenic purpura,ITP)患者初诊时血小板4项参数及骨髓涂片巨核细胞计数的价值.方法 分析200例ITP患者(ITP组)及60例骨髓检验正常者(正常对照组)血小板4项参数关系,比较治疗前后血小板4项参数变化并观察治疗过程中血小板上升速度及骨髓涂片巨核细胞计数与治疗结果之间的关系.结果 ITP组治疗后巨核细胞数低于治疗前,(69.5±14.6)个/片vs(178.8±54.1)个/片(P＜0.01),产巨核细胞比例、血小板计数(PLT)、血小板压积(PCT)、血小板平均体积(MPV)、血小板分布宽度(PDW)高于治疗前,分别为(79.4±31.2)%vs(5.2±2.7)%、(86.9±52.3)×109/L vs(37.2±13.7)×109/L、(3.10±0.63)%vs(1.40±0.35)%、(9.6±1.7)fl vs(9.0±1.7)fl、(1 9.2±1.5)%vs(17.3±1.3)%(P＜0.05或＜0.01),但巨核细胞数、产巨核细胞比例、PCT、MPV和PDW仍高于正常对照组,PLT则低于正常对照组.ITP患者初诊时PLT不同水平间疗效差异无统计学意义(P＞0.05),而初诊时不同巨核细胞数组间疗效差异有统计学意义(P＜0.01).ITP患者初诊时外周PLT与疗效无关,治疗2周内患者PLT超过100×109/L其基本治愈率较高(96.0%);每单位涂片(1.5 cm×3cm)巨核细胞计数＞100个的患者治愈率达85.7%,初诊时骨髓涂片巨核细胞计数越多,患者的治疗效果越好.结论 观察血小板参数对骨髓产血小板功能及治疗疗效观察有重要意义.ITP患者初诊时进行骨髓检查,并计数巨核细胞数,对诊断及治疗效果的判定均是必要的.在治疗过程中及时复查血像,观察血小板上升速度,对预后的判定亦有重要价值.
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