還流性免疫性血栓症患者における周辺血液バイオマーカー

PERIPHERIAL BLOOD BIOMARKERS IN PATIENTS WITH REFRACTORY IMMUNE THROMBOCYTOPENIA.

• S Metreveli
• I Kvachadze
• N Kikodze
• T Chikovani
• N Janikashvili

抄録

免疫性血小板減少症は、血小板抗原に対する自己抗体が原因で起こる後天的な血小板減少症であり、その発症機序は不明である。本研究の目的は、第一選択治療に抵抗性で第二選択治療として脾臓摘出術を受けたITP患者を対象に、NLR、PLR、PMR、dNLR、SIIの診断的価値を検討することであった。炎症性バイオマーカーの統計解析は、SPSS v.26とGraph Pad Prismを用いて行った。変数間の相関は、スピアマンの相関係数によって決定した。曲線下面積（AUC）、感度、特異度、およびカットオフ値は、受信機動作特性（ROC）曲線を用いて比較した。その結果，ITP患者では，NLRとdNLRが増加し（p<0.0001），SIIレベルが低下し（p=0.0003），PMRとPLRが有意に低下した（p<0.0001）ことが明らかになった．また、PLTはNLR、dNLRと負の相関があり（r=0.605、P<0.01）、SII、PLR、PMRと正の相関があった（SII r=0.799、PLR r=0.863、PMR r=0.40、P<0.01）。ROC曲線解析の結果、PLRとPMRのACUは1.000(P=0.05、P<0.001)、SIIは0.899(P=0.002)、NLRは0.875(P=0.04)、dNLRは0.869(P=0.05)であった。これらの結果から、ITP患者の炎症性因子は年齢をマッチさせた対照群と有意に異なることが明らかになったが、このようなバイオマーカーの有効性を確認するためには、より大規模な研究が必要であると考えられる。

Immune thrombocytopenia is an acquired thrombocytopenia caused by autoantibodies against platelet antigens, the pathogenesis of ITP is incompletely understood. Evidence regarding association between inflammatory factors in patients with ITP who are refractory to first line treatment is limited.The purpose of our study was to investigate the diagnostic value of NLR, PLR, and PMR, dNLR, and SII in ITP patients who were refractory for the first line treatment and had splenectomy as a second-line therapy. Statistical analyses of inflammatory biomarkers were performed using SPSS v.26 and Graph Pad Prism. Correlations between the variables were determined by Spearman's correlation coefficient. The area under the curve (AUC), sensitivity, specificity, and cut-off values were compared using the receiver operating characteristic (ROC) curve. Our data revealed that NLR and dNLR were increased (p<0.0001), while SII level was decreased (p=0.0003), PMR and PLR were also significantly low (p<0.0001) in ITP patients compared with the age matched conrl group. In addition PLT level was negatively correlated with NLR and dNLR (r=-0.605, P<0.01), while there was positive correlation with SII, PLR, PMR (SII r=0.799; PLR r=0.863; PMR r=0.40, P<0.01). ROC curve analysis revealed ACU of PLR and PMR were 1.000 (P=0.05 and P<0.001), followed by SII 0.899 (P=0.002), NLR 0.875 (P=0.04) and dNLR 0.869 (P=0.05). We observed that inflammatory factors in ITP patients significantly differ from the age matched controls, however larger scale research is needed to confirm the validity of such biomarkers.