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血小板消耗在肝硬化患者血小板减少症发展过程中的意义
作者:胡东辉1  赵康2  刘黎明1  戴丹1 
单位:1. 武汉大学附属湖北省第三人民医院 中西医结合肝病科, 湖北 武汉 430000;
2. 湖北中医药大学, 湖北 武汉 430000
关键词:血小板消耗 血小板减少症 肝硬化 
分类号:R446.11
出版年·卷·期(页码):2018·37·第一期(69-74)
摘要:

目的:评估血小板消耗在肝硬化患者血小板减少症中的意义。方法:回顾2006年2月至2016年2月治疗并死亡的慢性肝脏疾病患者,无肝病的血液病患者为对照组。采用循环血小板计数,巨核细胞数,脾脏指数和是否合并血栓性并发症作为参数来评估血小板产生破坏/隔离-消耗平衡。结果:入选61例患者(20例慢性肝炎患者,41例肝硬化患者)。(1)与非肝硬化组或对照组相比,肝硬化组死亡前5 d的血小板计数显著较少(P < 0.05)、血小板计数与PT/INR值呈显著负相关(r=-0.322,P=0.008);死亡前2至4周的血小板计数及巨核细胞数显著较低(P < 0.05)。(2)肝硬化组脾脏指数比非肝硬化组或对照组均显著更高。(3)肝脏病患者中血栓并发症的发生率比对照组显著更高。与无血栓并发症患者相比[(121±94)×109·L-1],血栓并发症患者死亡前5 d内的血小板计数[(82±43)×109·L-1]显著较低(P=0.03)。而PT/INR值显著较高(P=0.009)。多因素回归分析结果表明,巨核细胞计数、脾脏指数、血栓并发症均是血小板计数的独立决定因子;巨核细胞计数和脾脏指数为死亡前2~4周血小板计数的独立决定因子。结论:肝硬化患者血小板减少症为一种多因子作用的现象,血小板消耗与主要血栓性事件相关。

Objective: To evaluate platelet consumption in patients with cirrhosis during the development of thrombocytopenia. Methods: Patients with chronic liver disease and died from February 2006 to February 2016 were selected as experiment group, those without blood diseases as control group. Platelet count, the number of megakaryocytes, spleen index and a merger of thrombotic complications were used parameters to assess the balance of platelets damage/isolation-consumption. Results: A total of 61 patients were selected(including 20 patients with chronic hepatitis, 41 patients with cirrhosis).(1) Compared with the group control, the platelet count five days before death of group cirrhosis was significantly less(P < 0.05). Platelet counts and PT/INR values showed a significant negative correlation(r=-0.322,P=0.008);platelet count and Spleen indexes 2-4 weeks before death in the group cirrhosis was significantly fewer(P < 0.05). (2) The incidence of thrombotic complications of patients with liver disease was significantly higher than it in group control.(3) Compared with patients without thrombotic complications[(121±94)×109·L-1], platelet count in patients with thromboembolic complications within 5 days before death[(82±43)×109·L-1] was significantly lower(P=0.03). PT/INR values were significantly higher(P=0.009). Multivariate regression analysis showed that megakaryocytes, spleen index, and thromboembolic complications were independent factors determining platelet counts; megakaryocytes and spleen index were independent factors of platelet counts within 2-4 weeks before death. Conclusions: Thrombocytopenia of patients with liver cirrhosis is a multi-factor effected phenomenon, platelet consumption were associated with major thrombotic events.

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