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)×10~9·L^(-1)],血栓并发症患者死亡前5 d内的血小板计数[(82±43)×10~9·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)×10 9·L-1],platelet count in patients with thromboembolic complications within 5 days before death[(82±43)×10 9·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.
作者
胡东辉
赵康
刘黎明
戴丹
HU Dong-hui;ZHAO Kang;LIU Li-ming;DAI Dan(Department of Integrated Traditional and Western Medicine,The Third Hospital of Hubei Wuhan University, Wuhan 430032,China;Hubei University of Traditional Chinese Medicine,Wuhan 430065,China)
出处
《东南大学学报（医学版）》
CAS
2018年第1期69-74,共6页
Journal of Southeast University(Medical Science Edition)
基金
湖北省卫生厅科研基金项目(JX5B39)
