Song Young Hee, Park Soon Ho, Kim Jung Eun, Ahn Jeong Yeal, Seo Yiel Hea, Park Pil Hwan, Kim Kyung Hee
Department of Laboratory Medicine, Gachon University Gil Hospital, Incheon, Korea.
Korean J Lab Med. 2009 Dec;29(6):505-9. doi: 10.3343/kjlm.2009.29.6.505.
For the diagnosis of essential thrombocythemia (ET), no single clinical or laboratory finding of diagnostic value is available and a differential diagnosis of other myeloproliferative neoplasms or reactive thrombocytosis (RT) is needed. Following recent developments in automated blood cell analyzers, various platelet indices can now be measured. In this study, we analyzed whether platelet counts and 6 platelet indices can be used for the differentiation of ET from RT in patients with a platelet count of 600x10(3)/microL or more.
The subjects studied were 31 patients with ET and 224 patients with RT. The platelet counts, mean platelet volume (MPV), plateletcrit (PCT), platelet distribution width (PDW), mean platelet mass (MPM), mean platelet component concentration (MPC) and large platelets (LPLT) were measured by ADVIA 120 (Bayer Diagnostics, USA). The mean values of each item were compared between the two patient groups and the sensitivity and specificity of each item in the diagnosis of ET were determined by ROC curve analysis.
In essential thrombocythemia, all parameters except MPC were significantly higher than in reactive thrombocytosis. For the diagnosis of ET, the sensitivity and specificity were: 74.2% and 84.4%, when the platelet count was > or = 820 x 10(3)/microL; 80.6% and 80.0%, when the plateletcrit was > or = 0.63%; and 64.5% and 99.1%, respectively, when LPLT was > or = 23 x 10(3)/microL.
The platelet counts and platelet indices are useful for the differential diagnosis of thrombocytosis. The plateletcrit and LPLT are particularly useful for the diagnosis of ET when the platelet count is markedly increased.
对于原发性血小板增多症（ET）的诊断，尚无具有诊断价值的单一临床或实验室检查结果，需要与其他骨髓增殖性肿瘤或反应性血小板增多症（RT）进行鉴别诊断。随着自动血细胞分析仪的最新发展，现在可以测量各种血小板指标。在本研究中，我们分析了血小板计数和6种血小板指标是否可用于鉴别血小板计数≥600×10³/μL的患者的ET与RT。
研究对象为31例ET患者和224例RT患者。采用美国拜耳诊断公司的ADVIA 120测定血小板计数、平均血小板体积（MPV）、血小板压积（PCT）、血小板分布宽度（PDW）、平均血小板质量（MPM）、平均血小板成分浓度（MPC）和大血小板（LPLT）。比较两组患者各项指标的平均值，并通过ROC曲线分析确定各项指标在ET诊断中的敏感性和特异性。
在原发性血小板增多症中，除MPC外，所有参数均显著高于反应性血小板增多症。对于ET的诊断，当血小板计数≥820×10³/μL时，敏感性和特异性分别为74.2%和84.4%；当血小板压积≥0.63%时，敏感性和特异性分别为80.6%和80.0%；当LPLT≥23×10³/μL时，敏感性和特异性分别为64.5%和99.1%。
血小板计数和血小板指标有助于血小板增多症的鉴别诊断。当血小板计数显著升高时，血小板压积和LPLT对ET的诊断尤为有用。
