Lamy T, Moisan A, Dauriac C, Ghandour C, Morice P, Le Prise P Y
Department of Hematology, Hopital Pontchaillou, Rennes, France.
J Nucl Med. 1993 Feb;34(2):182-6.
We present a retrospective analysis of 111In-platelet sequestration studies in 111 patients with the clinical diagnosis of idiopathic thrombocytopenic purpura (ITP). Fifty-one of these patients underwent splenectomy, independent of the results of the 111In-platelet studies to determine if these isotopic results could accurately predict a beneficial response to splenectomy. Between January 1984 and June 1990, 111 patients who presented with ITP were subjected to a study of autologous 111In-labeled platelets through autotransfusion. The platelet sequestration site was splenic (81%), mixed (12%), or hepatic (7%). Fifty-one patients with persistent drug-resistant thrombocytopenia underwent splenectomy regardless of the isotopic results: 33 patients beyond 6 mo after diagnosis and 18 with high hemorrhagic risks before this delay. The follow-up median duration was 2.9 yr. Thirty-three of the 38 patients with splenic sequestration showed a normalized platelet count, as opposed to 2 of the 13 with mixed or hepatic sequestration (p < 0.001). In addition, platelet survival extended beyond 8 days in six patients, with no apparent sequestration site. The platelet isotopic study performed with this technique appears to be indicated in ITP: it guides clinicians in their decision to perform splenectomy and relates to a more central mechanism certain thrombocytopenias that are inappropriately categorized as ITP.
我们对111例临床诊断为特发性血小板减少性紫癜（ITP）的患者进行了铟-111标记血小板滞留研究的回顾性分析。其中51例患者接受了脾切除术，与铟-111标记血小板研究的结果无关，以确定这些同位素结果是否能准确预测脾切除术的有益反应。在1984年1月至1990年6月期间，111例ITP患者通过自体输血接受了自体铟-111标记血小板的研究。血小板滞留部位为脾脏（81%）、混合性（12%）或肝脏（7%）。51例持续性耐药性血小板减少患者无论同位素结果如何均接受了脾切除术：33例为诊断后6个月以上的患者，18例为在此延迟之前有高出血风险的患者。随访中位时间为2.9年。38例脾脏滞留患者中有33例血小板计数恢复正常，而13例混合性或肝脏滞留患者中有2例恢复正常（p<0.001）。此外，6例患者的血小板生存期延长至8天以上，且无明显滞留部位。用该技术进行的血小板同位素研究似乎适用于ITP：它指导临床医生决定是否进行脾切除术，并与某些被不恰当地归类为ITP的血小板减少症的更核心机制相关。
