Karasu Zeki, Tekin Fatih, Ersoz Galip, Gunsar Fulya, Batur Yucel, Ilter Tankut, Akarca Ulus S
Department of Gastroenterology, Ege University Medical School, Izmir, Turkey.
Dig Dis Sci. 2007 Jun;52(6):1535-9. doi: 10.1007/s10620-006-9144-y. Epub 2007 Apr 27.
Thrombocytopenia is a common complication of chronic liver diseases, but its pathogenesis is not clear. Although generally attributed to hypersplenism, other factors should also be considered. We investigated the relationship between the peripheral platelet count and the degree of fibrosis in patients with chronic viral hepatitis. In an effort to avoid the effects of hypersplenism, we excluded patients with splenomegaly and/or bi- or pan-cytopenia. Seven hundred eighty-four patients (265 chronic viral hepatitis C and 519 chronic viral hepatitis B) were included in the study. Univariate analysis showed that the peripheral platelet count had a negative correlation with fibrosis score, necroinflammatory activity, and age in both groups. In multivariate analysis, the peripheral platelet count had a similar correlation with the fibrosis score and age, but not with necroinflammatory activity, in both groups. The peripheral platelet count decreased more significantly in females with chronic hepatitis C but not in the chronic hepatitis B group. In conclusion, a decrease in peripheral platelet count may be a sign of an increase in the degree of fibrosis during the course of chronic viral hepatitis B and C and factors other than hypersplenism may play a role in this decrease in the peripheral platelet count.
血小板减少症是慢性肝病的常见并发症，但其发病机制尚不清楚。虽然通常归因于脾功能亢进，但也应考虑其他因素。我们研究了慢性病毒性肝炎患者外周血小板计数与纤维化程度之间的关系。为避免脾功能亢进的影响，我们排除了脾肿大和/或全血细胞减少或两系血细胞减少的患者。784例患者（265例慢性丙型病毒性肝炎和519例慢性乙型病毒性肝炎）纳入本研究。单因素分析显示，两组患者外周血小板计数与纤维化评分、坏死性炎症活动及年龄均呈负相关。多因素分析显示，两组患者外周血小板计数与纤维化评分及年龄的相关性相似，但与坏死性炎症活动无关。慢性丙型肝炎女性患者外周血小板计数下降更为显著，而慢性乙型肝炎组则不然。总之，外周血小板计数下降可能是慢性乙型和丙型病毒性肝炎病程中纤维化程度增加的一个迹象，脾功能亢进以外的因素可能在这种外周血小板计数下降中起作用。
