Ng Y Y, Lin C C, Wu S C, Hwang S J, Ho C H, Yang W C, Lee S D
Department of Medicine, Taipei Veterans General Hospital, Taiwan, Republic of China.
Clin Nephrol. 2002 Apr;57(4):289-95. doi: 10.5414/cnp57289.
To investigate the relation of leukopenia and thrombocytopenia in hemodialysis (HD) patients with hepatitis C virus (HCV) infection.
The study included 86 HD patients with hepatitis B surface antigen-negative and hepatitis C antibody-negative, 28 HD patients with hepatitis C antibody-positive, 22 HD patients with hepatitis B surface antigen-positive, 78 non-HD patients with hepatitis B-induced liver cirrhosis and 38 non-hemodialysis patients with hepatitis C-induced liver cirrhosis. The following parameters were checked: anti-HCV, hepatitis B surface antigen, hemoglobin, hematocrit, white blood cells, platelets, calcium, phosphate, iron, ferritin, albumin, globulin, aspartate transaminase (AST), alanine transaminase (ALT) and C-reactive protein. The history of blood transfusions, medications, erythropoietin doses and adequate dialysis (KTNV) for 6 consecutive months was also recorded from charts.
The HD patients with positive serum anti-HCV and non-HD patients with hepatitis B- or C-induced liver cirrhosis had higher prevalences of leukopenia (39.3%, 43.6% and 50% vs. 15.1%; p < 0.001) and thrombocytopenia (67.9%, 89.7% and 81.6% vs. 34.9%: p < 0.001) than HD patients with serum anti-HCV(-)HbsAg(-). The WBC (4,432 +/- 1,394, 4,792 +/- 2,263 and 4,624 2,446 vs. 5,590 +/- 1,500/mm3; p < 0.001) and platelet counts (140 +/- 45, 80 +/- 50 and 89 +/- 65 vs. 186 +/- 62 x 10(3)/mm3; p < 0.001) of HD patients with positive serum anti-HCV and non-HD patients with hepatitis B- or C-induced cirrhosis were also lower than HD patients without anti-HCV antibody. The liver cirrhosis patients had more thrombocytopenia than the HD patients with anti-HCV(+). The WBC and platelet counts did not vary between HD patients with HbsAg(+) and HD patients with anti-HCV(-)HBsAg(-). The durations of HD, hepatitis and liver cirrhosis were not related to the leukopenia or thrombocytopenia (p > 0.05).
HCV infection associated with leukopenia and/or thrombocytopenia in HD patients is as common as in non-HD patients with liver cirrhosis. This may be due to the direct effect of hemopoiesis rather than the hyperspleenism of liver cirrhosis patients. There is a need for further prospective investigation to ascertain the clinical significance of leukopenia and thrombocytopenia in HD patients with anti-HCV(+). The prevalence of leukopenia and thrombocytopenia was higher in HD patients with hepatitis C than in HD patients with hepatitis B and HD patient without hepatitis.
研究丙型肝炎病毒（HCV）感染的血液透析（HD）患者白细胞减少和血小板减少之间的关系。
本研究纳入86例乙肝表面抗原阴性且丙肝抗体阴性的HD患者、28例丙肝抗体阳性的HD患者、22例乙肝表面抗原阳性的HD患者、78例乙型肝炎所致肝硬化的非HD患者以及38例丙型肝炎所致肝硬化的非血液透析患者。检查以下参数：抗HCV、乙肝表面抗原、血红蛋白、血细胞比容、白细胞、血小板、钙、磷、铁、铁蛋白、白蛋白、球蛋白、天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）和C反应蛋白。还从病历中记录输血史、用药情况、促红细胞生成素剂量以及连续6个月的充分透析（KTNV）情况。
血清抗HCV阳性的HD患者以及乙型或丙型肝炎所致肝硬化的非HD患者白细胞减少（分别为39.3%、43.6%和50%，对比15.1%；p<0.001）和血小板减少（分别为67.9%、89.7%和81.6%，对比34.9%：p<0.001）的患病率高于血清抗HCV（-）乙肝表面抗原（-）的HD患者。血清抗HCV阳性的HD患者以及乙型或丙型肝炎所致肝硬化的非HD患者的白细胞计数（分别为4432±1394、4792±2263和4624±2446，对比5590±1500/mm³；p<0.001）和血小板计数（分别为140±45、80±50和89±65，对比186±62×10³/mm³；p<0.001）也低于无抗HCV抗体的HD患者。肝硬化患者的血小板减少比抗HCV（+）的HD患者更常见。乙肝表面抗原（+）的HD患者和抗HCV（-）乙肝表面抗原（-）的HD患者之间白细胞和血小板计数没有差异。HD、肝炎和肝硬化的病程与白细胞减少或血小板减少无关（p>0.05）。
HD患者中与白细胞减少和/或血小板减少相关的HCV感染与肝硬化的非HD患者一样常见。这可能是由于造血的直接作用而非肝硬化患者的脾功能亢进。需要进一步进行前瞻性研究以确定抗HCV（+）的HD患者白细胞减少和血小板减少的临床意义。丙型肝炎的HD患者白细胞减少和血小板减少的患病率高于乙型肝炎的HD患者和无肝炎的HD患者。
