University of Exeter Collaboration for Academic Primary Care and the South West Peninsula Deanery, College of Medicine and Health, University of Exeter, Exeter.
DISCO Cancer Diagnostics Group, University of Exeter Medical School, College House, St Luke's Campus, University of Exeter, Exeter.
Br J Gen Pract. 2020 Nov 26;70(701):e852-e857. doi: 10.3399/bjgp20X713501. Print 2020 Dec.
Thrombocytosis is an excess of platelets, which is diagnosed as a platelet count >400 × 10/l. An association of thrombocytosis with undiagnosed cancer has recently been established, but the association with non-malignant disease has not been studied in primary care.
To examine, in English primary care, the 1-year incidence of non-malignant diseases in patients with new thrombocytosis and the incidence of pre-existing non-malignant diseases in patients who develop new thrombocytosis.
Prospective cohort study using English Clinical Practice Research Datalink data from 2000 to 2013.
Newly incident and pre-existing rates of non-malignant diseases associated with thrombocytosis were compared between patients with thrombocytosis and age- and sex-matched patients with a normal platelet count. Fifteen candidate non-malignant diseases were identified from literature searches.
In the thrombocytosis cohort of 39 850 patients, 4579 (11.5%) were newly diagnosed with any one of the candidate diseases, compared with 443 out of 9684 patients (4.6%) in the normal platelet count cohort (relative risk [RR] 2.5, 95% confidence intervals [CI] = 2.3 to 2.8); iron-deficiency anaemia was the most common new diagnosis (4.5% of patients with thrombocytosis, RR 4.9, 95% CI = 4.0 to 6.1). A total of 22 612 (57.0%) patients with thrombocytosis had a pre-existing non-malignant diagnosis compared with 4846 patients (50%) in the normal platelet count cohort (odds ratio 1.3, 95% CI = 1.2 to 1.4). There was no statistically significant difference in cancer diagnoses between patients with and without pre-existing disease in the thrombocytosis cohort.
Thrombocytosis is associated with several non-malignant diseases. Clinicians can use these findings as part of their holistic diagnostic approach to help guide further investigations and management of patients with thrombocytosis.
血小板增多是指血小板计数超过 400×10/l，即为异常。近期研究发现血小板增多与未确诊的癌症相关，但在初级保健中，血小板增多与非恶性疾病的相关性尚未得到研究。
在英国初级保健中，检测新发血小板增多患者中 1 年内非恶性疾病的发病率，以及新发血小板增多患者中原有非恶性疾病的发病率。
本研究使用了 2000 年至 2013 年的英国临床实践研究数据链接（Clinical Practice Research Datalink）中的前瞻性队列研究数据。
比较血小板增多患者与血小板计数正常的年龄和性别匹配患者的新发和原有非恶性疾病的发病率。通过文献检索确定了 15 种候选非恶性疾病。
在 39850 例血小板增多患者中，有 4579 例（11.5%）被新诊断出患有任何一种候选疾病，而在 9684 例血小板计数正常的患者中，仅有 443 例（4.6%）（相对风险 [RR] 2.5，95%置信区间 [CI] 2.3 至 2.8）；缺铁性贫血是最常见的新诊断（血小板增多患者的 4.5%，RR 4.9，95% CI 4.0 至 6.1）。与血小板计数正常的患者相比，共有 22612 例（57.0%）血小板增多患者有原有非恶性疾病诊断，而在血小板计数正常的患者中，仅有 4846 例（50%）（比值比 1.3，95% CI 1.2 至 1.4）。在血小板增多患者中，有或无原有疾病的患者之间的癌症诊断无统计学差异。
血小板增多与多种非恶性疾病相关。临床医生可以将这些发现作为其整体诊断方法的一部分，帮助指导对血小板增多患者的进一步检查和管理。
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