Zhao Lidan, Xu Dong, Qiao Lin, Zhang Xuan
From the Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.L. Zhao*, MD, Attending Physician, Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; D. Xu*, MD, Associate Professor, Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; L. Qiao, MD, Postgraduate, Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; X. Zhang, MD, Professor, Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College.
J Rheumatol. 2016 Jun;43(6):1038-44. doi: 10.3899/jrheum.150829. Epub 2016 May 1.
To analyze the predictive value of megakaryocyte counts in bone marrow (BM-MK) for determining the therapeutic response of severe thrombocytopenia (TP) in patients with systemic lupus erythematosus (SLE).
Thirty-five patients with SLE with severe TP (platelet count ≤ 50 × 10(9)/l) from the Peking Union Medical College Hospital admitted between 2007 and 2014 with appreciable bone marrow aspiration results were analyzed retrospectively. The associations between therapeutic response and clinical manifestations, laboratory findings including BM-MK counts, were evaluated.
Seventeen (49%) and 8 (23%) patients achieved a complete response (CR) and a partial response (PR), respectively, and 10 had no response (NR). The BM-MK counts in each group were 102 ± 25 (0-322), 136 ± 48 (2-419), and 28 ± 12 (0-105) per slide, respectively. Significant differences were observed in the counts of BM-MK between patients who achieved a clinical response (CR + PR) and those who did not (NR; p = 0.007). Patients in the NR group exhibited fewer BM-MK compared with those in the CR and PR groups (p = 0.017 and p = 0.006, respectively). A receiver-operation characteristic analysis identified that a cutoff value of BM-MK counts at 20 performed pretty well in discriminating patients with differential responses to immunotherapy, with sensitivity and specificity and area under the curve of 88%, 70%, and 0.798, respectively.
BM-MK count may serve as a good predicting factor for immunotherapeutic response in patients with SLE with severe TP. Patients with BM-MK counts < 20 per slide tend to exhibit poor clinical response.
分析骨髓巨核细胞计数（BM-MK）对系统性红斑狼疮（SLE）患者严重血小板减少症（TP）治疗反应的预测价值。
回顾性分析2007年至2014年期间在北京协和医院住院的35例SLE伴严重TP（血小板计数≤50×10⁹/L）且骨髓穿刺结果可评估的患者。评估治疗反应与临床表现、包括BM-MK计数在内的实验室检查结果之间的关联。
分别有17例（49%）和8例（23%）患者达到完全缓解（CR）和部分缓解（PR），10例无反应（NR）。每组每张玻片上的BM-MK计数分别为102±25（0 - 322）、136±48（2 - 419）和28±12（0 - 105）。在达到临床反应（CR + PR）的患者与未达到反应（NR）的患者之间，BM-MK计数存在显著差异（p = 0.007）。与CR组和PR组相比，NR组的BM-MK较少（分别为p = 0.017和p = 0.006）。受试者工作特征分析确定，BM-MK计数的临界值为20时，在区分免疫治疗反应不同的患者方面表现良好，敏感性、特异性和曲线下面积分别为88%、70%和0.798。
BM-MK计数可能是SLE伴严重TP患者免疫治疗反应的良好预测因素。每张玻片上BM-MK计数<20的患者往往临床反应较差。
