背景：慢性丙肝患者的血小板减少可能源于以下几个因素：骨髓抑制、肝脏TPO的减少，自身免疫机制。而年龄、性别、肝病严重程度、病毒血症级别等临床变量也可以对血小板减少的严重程度造成影响。本研究的目的是确定慢性丙肝患者血小板减少的主要机制以及可预测其严重性的临床指标。方法：本研究包括81名慢性丙肝伴血小板减少的患者，实验采用髂嵴处的骨髓活检明确病毒的骨髓抑制作用，用ELISA方法检测抗血小板抗体的形成。研究中的临床预测指标包括：年龄、性别、ALT水平、肝纤维化分期以及HCV RNA。结果：绝大部分（93.3%）的重度血小板减少患者以及大部（61.53%）的中度患者中央和外周机制共同起作用，85%的轻度患者，自身免疫破坏是唯一的作用机制。另外，血小板减少与ALT值、病毒载量以及纤维化分期密切相关。结论：资料表明慢性丙肝与血小板减少的程度相关，随着疾病进展，血小板数量减少，而且，大部分都是上述两个机制共同起作用。而纤维化的分期是血小板减少的主要决定因素之一。BACKGROUND AND AIMS: Thrombocytopenia in patients with chronic hepatitis C may be the result of several factors: bone marrow inhibition, the decrease of liver thrombopoietin production and an autoimmune mechanism. Clinical variables such as age, gender, severity of liver disease and degree of viremia could influence the severity of platelet reduction. The goal of this study is to determine the prevalent mechanism of thrombocytopenia in patients with chronic hepatitis C and the clinical predictors of its severity.
METHODS: Eighty-one patients with chronic hepatitis C and thrombocytopenia were included. The viral inhibition on the bone marrow (central mechanism) was studied by performing bone marrow biopsy from the iliac crest. The presence of antiplatelet antibodies by ELISA assessed the peripheral mechanism. The clinical predictors included in the analysis were: age, gender, ALT level, liver fibrosis stage and HCV RNA.
RESULTS: Coexistence of a central and peripheral mechanism was found in the vast majority (93.3%) of patients with severe thrombocytopenia (< 100,000/microL) and in most patients (61.53%) with moderate thrombocytopenia (100,000- 125,000/microL). In patients with less severe thrombocytopenia (126,000-149,000/microL), autoimmune destruction was the sole mechanism (85%). Thrombocytopenia was significantly associated with ALT values, viral load and stage of fibrosis.
CONCLUSIONS: Our data demonstrates that chronic hepatitis C is associated with a variable degree of thrombocytopenia. As the disease advances, the platelet count decreases and, in most cases, both mechanisms are involved. The stage of fibrosis is one of the major determinants of thrombocytopenia.
吉林大学第一医院肝胆胰内科 李银萍 摘译
本文首次发表于[J Gastrointestin Liver Dis. 2010 ,19(4):381-385]
Thrombocytopenia in chronic hepatitis C
Abstract
