肝硬化患者血常规与骨髓细胞学对比分析及脾切除术优选探讨

李惠敏; 陈艺卓; 赵睿; 黄霄; 黄飞; 李欢欢

doi:10.3969/j.issn.1001-5256.2023.09.028

肝硬化患者血常规与骨髓细胞学对比分析及脾切除术优选探讨

DOI: 10.3969/j.issn.1001-5256.2023.09.028

李惠敏¹,
陈艺卓²,
赵睿^3, , ,,
黄霄²,
黄飞²,
李欢欢²

1.
西安交通大学第一临床医学院妇产科，西安 710061
2.
兰州大学第二临床医学院肝病科，兰州 730000
3.
兰州大学第二医院肝病科，兰州 730000

基金项目:

兰州大学第二医院萃英学子科研培育计划项目 (CYXZ2020－27)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：赵睿、李惠敏、陈艺卓、黄霄负责课题设计，资料分析，撰写论文；李惠敏、黄霄、黄飞、李欢欢参与收集数据，修改论文；赵睿负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
赵睿， ldeyzr@126.com （ORCID： 0000－0002－7986－0518）

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出版历程
- 收稿日期: 2022-11-24
- 录用日期: 2022-12-29
- 出版日期: 2023-09-19

A comparative analysis of the hemogram and myelogram of patients with liver cirrhosis and the advantages and disadvantages of splenectomy

1.
Department of Obstetrics and Gynecology，The First Clinical Medical College of Xi’an Jiaotong University，Xi’an 710061，China
2.
The Second Clinical Medical College，Lanzhou University，Lanzhou 730000，China
3.
Department of Liver Diseases，Lanzhou University Second Hospital，Lanzhou 730000，China

Research funding:

The Second Hospital of Lanzhou University CUIYING Students Research And Cultivation Program (CYXZ2020－27)

More Information

Corresponding author: ZHAO Rui， ldeyzr@126.com （ORCID： 0000－0002－7986－0518）

摘要

摘要: 肝硬化分为代偿期和失代偿期，代偿期症状不典型，但失代偿期临床表现多样，其中大部分存在脾功能亢进，即脾肿大合并血常规异常（白细胞、红细胞、血小板计数减少）。在我国，脾切除的适应证包括继发性脾功能亢进、脾脏占位病变、外伤性脾破裂等，其中继发性脾功能亢进中最常见为肝硬化失代偿期。但经切除后有部分患者未见明显改善且面临一系列并发症。一直以来肝硬化失代偿期患者的血常规变化，主要是与脾功能亢进有关，但肝功能失代偿期引起的骨髓细胞学变化未予重视，更是容易忽视。正确诊断此类患者血常规变化的原因才是选择治疗方式的关键。因此，通过总结肝功能失代偿期患者血常规与其骨髓细胞学的关系变化，提示盲目切除脾脏的弊端，为失代偿合并脾功能亢进患者的治疗方法提供正确认识和指导。
- 肝硬化 /
- 脾功能亢进 /
- 脾切除术
Abstract: Compensated liver cirrhosis （CLC） and decompensated liver cirrhosis （DLC） are the two clinically distinct stages of liver cirrhosis. CLC often has atypical symptoms， while DLC has a variety of clinical manifestations， mainly hypersplenism， i.e.， splenomegaly with abnormal hemogram （reductions in white blood cell count， red blood cell count， and platelet count）. In China， the indications for splenectomy include secondary hypersplenism， space－occupying lesions in the spleen， and traumatic splenic rupture， among which secondary hypersplenism is frequently observed in DLC. However， after splenectomy， some patients have no improvement and experience a series of complications. It has long been assumed that hemogram changes in DLC patients are mainly associated with hypersplenism， while myelogram changes are not taken seriously and are often neglected. Identifying the cause of hemogram changes in such patients is the key to the selection of treatment methods. Therefore， by summarizing the association between the hemogram and myelogram of patients with DLC， this article points out the drawbacks of performing splenectomy at random， so as to provide correct knowledge and guidance for the treatment of patients with DLC and hypersplenism.
- Liver Cirrhosis /
- Hypersplenism /
- Splenectomy

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表 1 DLC血常规变化

Table 1. hematologic changes in decompensated cirrhosis

项目	红细胞	血小板	白细胞
介绍	主要通过血红蛋白运输氧气和二氧化碳，且参与对血液中的酸、碱物质的缓冲及免疫复合物的清除	骨髓巨核细胞脱落下来的胞质小块，其生理特性有黏附，释放，聚集，收缩，吸附	主要在机体内发挥免疫和防御功能，其总数的变化主要与中性粒细胞有关
生成减少	LC时，肝脏细胞长期受到损伤，导致肝功能异常，造血因子储备不足，造血系统受到破坏
破坏增加	脾肿大时单核－巨噬细胞会过度合成如抗红细胞抗体等各种自身抗体，导致从循环中免疫去除红细胞增多，外周血红细胞减少。脾脏滤血功能异常，血液瘀滞，血细胞破裂

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