Lu Sheng-Nan, Wang Jing-Houng, Liu Shiann-Long, Hung Chao-Hung, Chen Chien-Hung, Tung Hung-Da, Chen Tsung-Ming, Huang Wu-Shiung, Lee Chuan-Mo, Chen Chia-Cheng, Changchien Chi-Sin
Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Cancer. 2006 Nov 1;107(9):2212-22. doi: 10.1002/cncr.22242.
The objective of this study was to examine the usefulness of platelet counts in the diagnosis of cirrhosis and for identifying high-risk individuals in a community-based hepatocellular carcinoma (HCC) screening program.
Pilot Study 1 determined the correlation between platelet counts and pathologic hepatic fibrosis scores among individuals with chronic hepatitis B virus (HBV) infection (n = 122 patients) and hepatitis C virus (HCV) infection (n = 244 patients). Pilot Study 2 investigated proportions of individuals with thrombocytopenia (<150 x 10(3)/mm(3)) among patients with HCC (n = 4042 patients). Pilot Study 3 demonstrated the correlation between platelet counts and ultrasonographic (US) parenchyma scores among anti-HCV-positive individuals (n = 75 patients). The core study was a 2-stage, community-based screening for HCC among residents age 40 years or older in townships with a high prevalence of anti-HCV (n = 4616 individuals) and in townships with a low prevalence of anti-HCV (n = 1694 individuals). Patients with thrombocytopenia were identified for US and alpha-fetoprotein screening.
Among the individuals who were positive for anti-HCV, platelet counts decreased according to increased pathologic fibrosis scores or US scores for liver parenchyma disease: The best cutoff platelet count was 150 x 10(3)/mm(3) for a diagnosis of cirrhosis. The sensitivity and specificity were 68.2% and 76.4%, respectively, for pathologic cirrhosis and 76.2% and 87.8%, respectively, for US cirrhosis. Forty-eight percent of patients with HCC were thrombocytopenic. The proportion of thrombocytopenia was significantly greater in patients with HCV-related HCC (63%) than in patients with HBV-related HCC (42%). In the townships with high and low anti-HCV prevalence, the prevalence of thrombocytopenia was 17.9% and 6.1%, respectively, (P < .001), respectively. Twenty-five patients were diagnosed with HCC, and all of those patients resided in the high-prevalence township.
Thrombocytopenia was a valid surrogate of cirrhosis and a valid marker for the identification of individuals at high-risk for HCC, especially in areas that had a high prevalence of HCV.
本研究的目的是检验血小板计数在肝硬化诊断以及在基于社区的肝细胞癌（HCC）筛查项目中识别高危个体方面的实用性。
试点研究1确定了慢性乙型肝炎病毒（HBV）感染患者（n = 122例）和丙型肝炎病毒（HCV）感染患者（n = 244例）的血小板计数与病理性肝纤维化评分之间的相关性。试点研究2调查了HCC患者（n = 4042例）中血小板减少症（<150×10³/mm³）患者的比例。试点研究3证明了抗HCV阳性个体（n = 75例）的血小板计数与超声（US）实质评分之间的相关性。核心研究是在抗HCV高流行率乡镇（n = 4616例）和抗HCV低流行率乡镇（n = 1694例）中对40岁及以上居民进行的两阶段基于社区的HCC筛查。识别出血小板减少症患者进行超声和甲胎蛋白筛查。
在抗HCV阳性个体中，血小板计数随着病理性纤维化评分或肝脏实质疾病的超声评分增加而降低：诊断肝硬化的最佳血小板计数临界值为150×10³/mm³。病理性肝硬化的敏感性和特异性分别为68.2%和76.4%；超声诊断肝硬化的敏感性和特异性分别为76.2%和87.8%。48%的HCC患者有血小板减少症。HCV相关HCC患者（63%）的血小板减少症比例显著高于HBV相关HCC患者（42%）。在抗HCV高流行率和低流行率乡镇中，血小板减少症的患病率分别为17.9%和6.1%（P <.001）。25例患者被诊断为HCC，所有这些患者都居住在高流行率乡镇。
血小板减少症是肝硬化的有效替代指标，也是识别HCC高危个体的有效标志物，尤其是在HCV高流行地区。
