慢性乙型肝炎和乙型肝炎肝硬化患者血清血小板生成素水平变化及其临床意义*

doi:10.3969/j.issn.1672-5069.2021.06.031

摘要/Abstract

摘要： 目的探讨乙型肝炎肝硬化(LC)患者血清血小板生成素(TPO)水平变化及其临床意义。方法 2012年1月～2020年1月我院收治的慢性乙型肝炎(CHB)患者72例和乙型肝炎导致的LC患者44例(Child-Pugh A级24例,B级14例,C级6例),采用放射免疫竞争法测定血清TPO水平。结果 LC患者外周血血小板(PLT)计数82(24, 208)×10⁹/L、血清白蛋白(ALB)水平为(31.6±6.7)g/L、凝血酶原时间国际标准化比值(INR)为1.3±0.4、D-二聚体为187(75,495)μg/L和TPO水平为(70.4±25.8)pg/ml,与CHB组【分别为180(36,352)×10⁹/L、(39.2±5.4)g/L、(1.1±0.2)、(102.6±20.6)pg/ml和(102.6±20.6)pg/ml,P<0.05】比,差异显著;6例Child-Pugh C级LC患者外周血PLT计数为56(24,70)×10⁹/L,显著低于14例Child-Pugh B级患者【108(66,170)×10⁹/L,P<0.05】或24例Child-Pugh A级【130(76,208)×10⁹/L,P<0.05】,血清ALB水平为(22.9±7.5)g/L, 显著低于Child-Pugh B级【(32.4±6.1)g/L,P<0.05】或A级【(36.5±7.9) g/L,P<0.05】,INR为(1.4±0.8),显著大于B级【(1.2±0.6),P<0.05】或A级【(1.1±0.5),P<0.05】,血清D-二聚体水平为235(114,495)μg/L,显著高于B级【166(84,298)μg/L,P<0.05】或A级【108(75,169)μg/L,P<0.05】,血清TPO水平为(41.4±26.5)pg/ml,显著低于B级【(60.8±23.6) pg/ml,P<0.05】或A级【(88.6±14.7)pg/ml,P<0.05】;相关性分析结果提示肝硬化患者血清TPO水平与Alb水平和PLT计数呈显著性正相关(r=0.43,r=0.52,P<0.05),而与INR和D-二聚体水平呈显著性负相关(r=-0.38、r=-0.48,P<0.05)。结论随着肝硬化患者肝功能持续减退,其血清TPO水平和外周血PLT计数明显下降,肝功能损伤越严重,这种表现越明显。肝硬化患者外周血PLT计数下降是否与血清TPO水平降低有关,或者应用重组人TPO治疗能否提高PLT计数水平,值得进一步研究。

关键词: 肝硬化, 乙型肝炎, 血小板生成素, 血小板计数

Abstract: Objective The aim of this study was to investigate the changes of serum thrombopoietin (TPO) levels and its relationship with peripheral blood platelet (PLC) counts in patients with hepatitis B liver cirrhosis (LC). Methods 72 patients with chronic hepatitis B (CHB) and 44 with LC were recruited in our hospital between January 2012 and January 2020, and serum TPO levels were detected. Results The peripheral blood PLT counts in patients with LC was 82(24,208)×10⁹/L, serum albumin (ALB)level was(31.6±6.7)g/L, the international normalized ratio of prothrombin time(INR) was (1.3±0.4), serum d-dimer level was 187(75,495)μg/L and serum TPO level was (70.4±25.8)pg/ml, all significantly different as compared to [180(36,352)×10⁹/L, (39.2±5.4)g/L, (1.1±0.2), (102.6±20.6) pg/ml and(102.6±20.6)pg/ml, P<0.05] in patients with CHB; the PLT count in 6 patients with LC of Child-Pugh class C was 56(24, 70)×10⁹/L, significantly lower than [108(66,170)×10⁹/L, P<0.05] in 14 LC patients with Child-Pugh class B or [130(76, 208)×10⁹/L, P<0.05] in 24 patients with Child-Pugh class A, serum ALB level was (22.9±7.5)g/L, significantly lower than[(32.4±6.1)g/L, P<0.05]in patients with Child-Pugh class B or [(36.5±7.9) g/L, P<0.05] in patients with Child-Pugh class A, the INR was(1.4±0.8), significantly higher than [(1.2±0.6), P<0.05] in patients with Child-Pugh class B or [(1.1±0.5), P<0.05] in patients with Child-Pugh class A, serum D-dimer was 235(114, 495)μg/L, significantly higher than [166(84, 298)μg/L, P<0.05] in patients with Child-Pugh class B or [108(75, 169)μg/L, P<0.05] in patients with Child-Pugh class A, serum TPO level was (41.4±26.5)pg/ml, significantly lower than [(60.8±23.6) pg/ml, P<0.05] in patients with Child-Pugh class B or [(88.6±14.7)pg/ml, P<0.05] in patients with Child-Pugh class A; serum TPO level was positively correlated to serum ALB and peripheral blood PLT counts(r=0.43, r=0.52, P<0.05), while it negatively correlated to INR and serum D-dimer (r=-0.38, r=-0.48, P<0.05) in patients with LC. Conclusion With the decline of liver functions, serum TPO levels and peripheral blood PLT counts decrease significantly, and the correlation of decreased PLT counts to serum TPO levels warrants further investigations.

Key words: Liver cirrhosis, Hepatitis B, Thrombopoietin, Platelet counts

薛魁, 徐银海, 张健. 慢性乙型肝炎和乙型肝炎肝硬化患者血清血小板生成素水平变化及其临床意义^*[J]. 实用肝脏病杂志, 2021, 24(6): 891-894.

Xue Kui, Xu Yinhai, Zhang Jian. Changes of serum thrombopoietin levels and its relationship with peripheral blood platelet counts in patients with hepatitis B liver cirrhosis[J]. Journal of Practical Hepatology, 2021, 24(6): 891-894.

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慢性乙型肝炎和乙型肝炎肝硬化患者血清血小板生成素水平变化及其临床意义^*

Changes of serum thrombopoietin levels and its relationship with peripheral blood platelet counts in patients with hepatitis B liver cirrhosis

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