Department of Infectious Diseases, Tropical Medicine and AIDS, G2-105, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
Eur J Clin Microbiol Infect Dis. 2010 Dec;29(12):1465-73. doi: 10.1007/s10096-010-1049-1. Epub 2010 Sep 19.
Hyposplenic patients are at risk of overwhelming post-splenectomy infection (OPSI), which carries mortality of up to 70%. Therefore, preventive measures are warranted. However, patients with diminished splenic function are difficult to identify. In this review we discuss immunological, haematological and scintigraphic parameters that can be used to measure splenic function. IgM memory B cells are a potential parameter for assessing splenic function; however, more studies are necessary for its validation. Detection of Howell-Jolly bodies does not reflect splenic function accurately, whereas determining the percentage of pitted erythrocytes is a well-evaluated method and seems a good first-line investigation for assessing splenic function. When assessing spleen function, (99m)Tc-labelled, heat-altered, autologous erythrocyte scintigraphy with multimodality single photon emission computed tomography (SPECT)-CT technology is the best approach, as all facets of splenic function are evaluated. In conclusion, although scintigraphic methods are most reliable, they are not suitable for screening large populations. We therefore recommend using the percentage of pitted erythrocytes, albeit suboptimal, as a first-line investigation and subsequently confirming abnormal readings by means of scintigraphy. More studies evaluating the value of potentially new markers are needed.
脾功能低下的患者有发生感染性并发症（OPSI）的风险，其死亡率高达 70%。因此，需要采取预防措施。但是，脾功能低下的患者很难识别。在这篇综述中，我们讨论了可用于评估脾功能的免疫学、血液学和闪烁扫描参数。IgM 记忆 B 细胞是评估脾功能的一个潜在参数；但是，还需要更多的研究来验证其准确性。Howell-Jolly 小体的检测不能准确反映脾功能，而确定有核红细胞的比例是一种经过良好评估的方法，似乎是评估脾功能的良好一线检查。在评估脾功能时，（99m）Tc 标记的、热变性的、自体红细胞闪烁扫描结合多模态单光子发射计算机断层扫描（SPECT）-CT 技术是最佳方法，因为可以评估脾功能的各个方面。总之，尽管闪烁扫描方法最可靠，但它们不适合用于筛查大量人群。因此，我们建议使用有核红细胞的比例作为一线检查，尽管不太理想，但随后通过闪烁扫描来确认异常读数。需要更多的研究来评估潜在的新标志物的价值。
