应用未成熟血小板比例、未成熟血小板绝对值和血栓弹力图评估原发免疫性血小板减少症患者的出血风险

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<30×10(9)/L and pediatric cohorts with PLT<30×10(9)/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<30×10(9)/L (P<0.001). IPF, A-IPF and MA did not correlate with bleeding grades in children with PLT<30×10(9)/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.