Koike Y, Yoneyama A, Shirai J, Ishida T, Shoda E, Miyazaki K, Sunaga S, Horie R, Aoki K, Koike K, Ogata I, Tahara T, Kato T, Nakahara K, Kariya T, Higashihara M
First Department of Internal Medicine, Faculty of Medicine, University of Tokyo, Japan.
Thromb Haemost. 1998 Jun;79(6):1106-10.
To evaluate thrombopoiesis in thrombocytopenic disorders, we simultaneously determined reticulated platelet counts in whole blood by FACScan flow cytometry and serum thrombopoietin (TPO) concentrations by a sensitive sandwich ELISA. The subjects were 40 healthy volunteers and 45 thrombocytopenic patients. In idiopathic thrombocytopenic purpura (ITP), the percentage of reticulated platelets was significantly elevated (5.61 +/- 2.02%: mean +/- SD) relative to normal controls (2.17 +/- 0.90%), but serum TPO concentrations (1.91 +/- 1.27 fmol/l) did not differ significantly from the normal range (1.43 +/- 0.62 fmol/l). The patients with aplastic anemia (AA) had decreased reticulated platelet counts and markedly increased serum TPO concentrations (13.65 +/- 10.64 fmol/l). In thrombocytopenic patients with liver cirrhosis (LC), the absolute number of reticulated platelets (1.65 +/- 1.11 x 10(9)/l) decreased similarly that in AA. However, serum TPO concentrations (1.38 +/- 0.50 fmol/l) did not increase in contrast to AA. Our findings suggested a possible dual mechanism of thrombocytopenia in LC; that is, thrombocytopenia in LC results from the decreased TPO production primarily in the liver adding to an increase in platelet sequestration in the spleen.
为评估血小板减少性疾病中的血小板生成情况，我们通过FACScan流式细胞术同时测定全血中网织血小板计数，并通过灵敏的夹心酶联免疫吸附测定法测定血清血小板生成素（TPO）浓度。研究对象为40名健康志愿者和45名血小板减少症患者。在特发性血小板减少性紫癜（ITP）中，相对于正常对照组（2.17±0.90%），网织血小板百分比显著升高（5.61±2.02%：均值±标准差），但血清TPO浓度（1.91±1.27 fmol/l）与正常范围（1.43±0.62 fmol/l）相比无显著差异。再生障碍性贫血（AA）患者的网织血小板计数降低，血清TPO浓度显著升高（13.65±10.64 fmol/l）。在肝硬化（LC）血小板减少症患者中，网织血小板绝对数（1.65±1.11×10⁹/l）与AA患者相似而降低。然而，与AA患者不同，血清TPO浓度（1.38±0.50 fmol/l）并未升高。我们的研究结果提示LC中血小板减少可能存在双重机制；即，LC中的血小板减少主要是由于肝脏中TPO生成减少，再加上脾脏中血小板滞留增加所致。
