혈소판증가증 감별진단을 위한 ADVIA 120을 이용한 혈소판지수의 유용성 평가
Evaluation of Platelet Indices for Differential Diagnosis of Thrombocytosis by ADVIA 120
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배경 : 진성혈소판증가증은 진단을 위한 단일 임상적 혹은 검 사소견이 없어 항상 다른 골수증식종양 및 반응성혈소판증가증 과 감별이 필요하다. 자동혈구계산기의 발전으로 다양한 혈소 판지수들의 측정이 가능해졌고, 이에 저자들은 혈소판 수 60만 이상인 진성혈소판증가증과 반응성혈소판증가증 환자 양군에 서 혈소판 수와 혈소판지수 6개 항목의 비교를 통해 감별진단에 도움이 되는지 분석해 보았다. 방법 : 진성혈소판증가증 31명과 반응성혈소판증가증 224명 을 대상으로 ADVIA 120 (Bayer Diagnostics, USA)으로 측정 한 혈소판 수와 평균혈소판용적, 혈소판용적치, 혈소판분포너 비, 평균혈소판중량, 평균혈소판성분농도, 거대혈소판지수의 평균과 범위를 비교하고 각각의 민감도와 특이도를 ROC 분석 을 통해 구하였다. 결과 : 진성혈소판증가증에서 평균혈소판성분농도를 제외한 모든 항목이 높게 나타나고 통계적으로 유의하였으며 혈소판 수가 820×103/μL 이상일 때 민감도와 특이도는 각각 74.2%, 84.4%였고 혈소판용적치가 0.63% 이상일 때 민감도와 특이도 는 각각 80.6%, 80.0%였고 거대혈소판지수가 23×103/μL 이 상일 때 민감도는 64.5%, 특이도는 99.1%로 높게 나타났다. 결론 : 혈소판증가증 환자의 감별진단에 혈소판 수 및 혈소판 지수의 비교분석은 유용하며 특히 혈소판 수가 크게 증가된 환 자에서 혈소판용적치와 거대혈소판지수를 비교하면 진성혈소 판증가증을 감별진단하는데 도움이 될 것으로 사료된다.
Abstract
Background : For the diagnosis of essential thrombocythemia (ET), no single clinical or laboratory finding of diagnostic value is available and a differential diagnosis of other myeloproliferative neoplasms or reactive thrombocytosis (RT) is needed. Following recent developments in automated blood cell analyzers, various platelet indices can now be measured. In this study, we analyzed whether platelet counts and 6 platelet indices can be used for the differentiation of ET from RT in patients with a platelet count of 600×103/μL or more. Methods : The subjects studied were 31 patients with ET and 224 patients with RT. The platelet counts, mean platelet volume (MPV), plateletcrit (PCT), platelet distribution width (PDW), mean platelet mass (MPM), mean platelet component concentration (MPC) and large platelets (LPLT) were measured by ADVIA 120 (Bayer Diagnostics, USA). The mean values of each item were compared between the two patient groups and the sensitivity and specificity of each item in the diagnosis of ET were determined by ROC curve analysis. Results : In essential thrombocythemia, all parameters except MPC were significantly higher than in reactive thrombocytosis. For the diagnosis of ET, the sensitivity and specificity were: 74.2% and 84.4%, when the platelet count was ≥820×103/μL; 80.6% and 80.0%, when the plateletcrit was ≥ 0.63%; and 64.5% and 99.1%, respectively, when LPLT was ≥23×103/μL. Conclusions : The platelet counts and platelet indices are useful for the differential diagnosis of thrombocytosis. The plateletcrit and LPLT are particularly useful for the diagnosis of ET when the platelet count is markedly increased.
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