Clinical value of megakaryocytes in the diagnosis and treatment of children with immune thrombocytopenic purpura

Abstract

Objective To analyze the clinical value of megakaryocytes in the diagnosis and treatment of children with immune thrombocytopenic purpura(ITP). Methods From June 2014 to January 2018, the clinical data of 110 children with ITP diagnosed and treated in Zhucheng People's Hospital Affiliated to Weifang Medical College were analyzed and followed up for more than 1 year.The children were divided into two groups according to whether the duration of the disease was morethan 12 months(chronic group and non-chronic group). Gender, age, initial course of disease, platelet count, lymphocyte count, megakaryocyte count, white blood cell count, and initial treatment regimen were analyzed and compared between the two groups.Multivariate analysis was used to analyze the independent influencing factors of chronic ITP.The clinical value of the initial diagnosis and lymphocyte counts in evaluation of the effects of chronic ITP and initial treatment were analyzed.The clinical value of megakaryocyte in the assessment of initial treatment was analyzed. Results The initial course of disease[(5.8±2.26)d]and megakaryocyte count[(210.28±98.67)/piece] in the chronic groupwere higher than those in the non-chronic group[(3.57±2.05)d, (165.26±78.35)/piece], and the lymphocyte count[(2.87±0.90)×109/L] in the chronic groupwas lower than that in the non-chronic group[(3.66±1.12)×109/L], the differences were statistically significant(t=4.824, 2.299, 3.545, all P 0.05). The initial course of disease was a risk factor for chronic ITP(OR=3.826), while lymphocyte count was a protective factor(OR=0.471). The initial course of disease was evaluated as AUC=0.648 for chronic ITP, with an optimal cut-off value of 4.5 days, a sensitivity of 65.4%, and a specificity of 62.5%.Lymphocyte counts was evaluated as AUC(area under the ROC curve)=0.648 for chronic ITP, the optimal cut-off value was 3.01×109/L, the sensitivity was 59.4%, and the specificity was 78.2%.The initial course of disease and lymphocyte count had no significant value in evaluation of the treatment outcome (P<0.05). The initial treatment of patients with increased megakaryocyte counts was better than those with the normal level, and the difference was statistically significant(Z=6.051, P<0.05). Conclusion The initial course of disease and lymphocyte count can help to assess the duration of ITP in children.Patients with increased bone marrow megakaryocyte counts can achieve better results at initial treatment. Key words: Megakaryocytes; Purpura, thrombocytopenic, idiopathic; Time factors; Lymphocytes; Diagnosis; Treatment outcome; Risk factors; Child