Toprak Selami Kocak, Erismis Betul, Karakus Sema, Kursun Nazmiye, Haberal Aysegul, Ulusoy Mustafa Gurhan
Department of Hematology, Faculty of Medicine, Baskent University, 06490 Ankara, Turkey.
ScientificWorldJournal. 2012;2012:598653. doi: 10.1100/2012/598653. Epub 2012 Sep 10.
In the presence of a pathogenetic mutation in JAK2 or MPL, a differential diagnosis of essential thrombocythemia (ET) from reactive causes is relatively simple. However, in patients with suspected ET who lack JAK2 and MPL mutations, the exclusion of secondary causes is especially important. The study was aimed to explore the clinical application of particularly mean platelet volume (MPV), hemoglobin, red blood cell indices, white blood cell, serum iron profile, and C-reactive protein level in the differential diagnosis of thrombocytosis. Medical records of 49 patients, consisting of reactive thrombocytosis (RT) and ET were retrospectively reviewed. The mean MPV level in RT group was 7.49 fL, and in ET group was 8.80 fL (P < 0.01). A cutoff point of <8.33 fL was found to have significant predictive value according to ROC curve analysis. This cutoff was associated with 83% positive predictive value (PPV) and 74% negative predictive value (NPV) in the diagnosis of ET and had a sensitivity of 65% and specificity of 89% for ET. Investigation of MPV is cheap, quick, and noninvasive, and may serve as a predictor of primary thrombocytosis. High sensitivity, specificity, PPV, and NPV enable this test an important tool and a possible surrogate marker in clinical practice.
在存在JAK2或MPL致病突变的情况下，将原发性血小板增多症（ET）与反应性病因进行鉴别诊断相对简单。然而，在疑似ET但缺乏JAK2和MPL突变的患者中，排除继发原因尤为重要。本研究旨在探讨平均血小板体积（MPV）、血红蛋白、红细胞指数、白细胞、血清铁指标和C反应蛋白水平在血小板增多症鉴别诊断中的临床应用。回顾性分析了49例反应性血小板增多症（RT）和ET患者的病历。RT组的平均MPV水平为7.49 fL，ET组为8.80 fL（P<0.01）。根据ROC曲线分析，发现<8.33 fL的截断点具有显著的预测价值。该截断点在ET诊断中的阳性预测值（PPV）为83%，阴性预测值（NPV）为74%，对ET的敏感性为65%，特异性为89%。MPV检测便宜、快速且无创，可作为原发性血小板增多症的预测指标。高敏感性、特异性、PPV和NPV使该检测成为临床实践中的重要工具和可能的替代标志物。
