【摘要】 目的 探讨骨髓细胞学联合凝血检查在血小板减少病因鉴别中的应用价值。方法 选取2021年9月至2023年6月收治的血小板减少患者92例，其中免疫性血小板减少症(immune thrombocytopenia, ITP)患者共38例，骨髓异常增生综合征(Myelodysplastic syndrome, MDS)8例，系统性红斑狼疮(systemic lupus erythematosus, SLE)5例，再生障碍性贫血(aplastic anemia, AA)组6例，血液系统恶性肿瘤组35例(白血病25例，多发性骨髓瘤6例，淋巴瘤4例)。患者均按医嘱进行骨髓细胞学、凝血指标[部分活化凝血酶时间(activated partial thromboplastin time, APTT)、血小板计数(platelet count, PLT)、凝血酶原时间(prothrombin time, PT)、国际标准化比值(international normalized ratio, INR)、凝血酶时间(thrombin time, TT)、D-二聚体(D-Dimer, D-D)、纤维蛋白原(fibrinogen, FIB)]检查，对比不同血小板减少病因患者骨髓细胞学表现、凝血指标，分析不同方案检出率、骨髓细胞学联合凝血检查对血小板减少病因鉴别的诊断价值。结果 ITP组、AA组、MDS组、SLE组、血液系统恶性肿瘤组均存在不同程度骨髓象改变；ITP组、AA组PLT最低，血液系统恶性肿瘤组PT、INR、D-D最高，MDS组TT最高，SLE组APTT和FIB最高，血液系统恶性肿瘤组INR异常升高患者占比高于ITP组、SLE组，血液系统恶性肿瘤组D-D异常升高患者占比高于ITP组、AA组(P<0.05);骨髓细胞学对ITP、血液系统恶性肿瘤检出率高于凝血检查，骨髓细胞学联合凝血检查对ITP、血液系统恶性肿瘤检出率高于骨髓细胞学、凝血检查(P<0.05);骨髓细胞学联合凝血检查鉴别诊断血小板减少病因与金标准的一致性为97.70%,Kappa值为0.964(95%CI:0.818～1.110)。结论 骨髓细胞学、凝血检查在血小板减少病因鉴别中具有一定检出率，其联合检查有助于提高血小板减少病因检出率、诊断价值。更多还原

【Abstract】 Objective To investigate the value of bone marrow cytology combined with coagulation test in identifying the etiology of thrombocytopenia. Methods A total of 92 patients with thrombocytopenia admitted from September 2021 to June 2023 were selected as observation objects, including 38 patients in the immune thrombocytopenia(ITP) group, 8 patients in the myelodysplastic syndrome(MDS) group, 5 patients in the systemic lupus erythematosus(SLE) group and 6 patients in the aplastic anemia(AA) group. There were 35 cases of hematological malignancy(HM), including 25 cases of leukemia, 6 cases of multiple myeloma, and 4 cases of lymphoma. Bone marrow cytology, blood clotting indexes(partial activated thrombin time [APTT], platelet count [PLT], prothrombin time [PT], international standardized ratio [INR], thrombin time [TT], D-dimer [D-D], and fibrinogen [FIB]) were examined in all patients. The bone marrow cytology and coagulation index of patients with different etiologies of thrombocytopenia were compared. The detection rate of different protocols and the value of bone marrow cytology combined with coagulation test in the differential diagnosis of the etiology of thrombocytopenia were analyzed. Results Changes at varying degrees in the bone marrow images were detected in all the ITP group, AA group, MDS group, SLE group and HM group. Patients in the ITP group and AA group had the lowest PLT, and those in the HM group had the highest PT, INR and D-D. Patients in the MDS group had the highest TT, and those in the SLE group had the highest APTT and FIB. The proportion of patients with an abnormally increased INR in the HM group was significantly higher than that of the ITP group and SLE group(P<0.05). The proportion of patients with abnormally increased D-D in the HM group was significantly higher than that of the ITP group and AA group(P<0.05). The detection rate of ITP and HM by bone marrow cytology was significantly higher than that by coagulation test, and the detection rate of ITP and HM by bone marrow cytology combined with coagulation test was significantly higher than a single examination(P<0.05). The consistency between bone marrow cytology and coagulation test in the differential diagnosis of thrombocytopenia was 97.70%, with the Kappa value of 0.964(95%CI: 0.818-1.110). Conclusion Bone marrow cytology and coagulation test have a certain detection rate in identifying the etiology of thrombocytopenia, and their combined examination is helpful to improve the detection rate and diagnostic value of thrombocytopenia etiology.更多还原