Blood Bank Service, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Trieste, Trieste, Italy.
J Hepatol. 2011 May;54(5):894-900. doi: 10.1016/j.jhep.2010.08.018. Epub 2010 Dec 22.
BACKGROUND & AIMS: Thrombocytopenia is common in liver cirrhosis (LC) but the mechanisms are not fully understood. The purpose of our work was to evaluate platelet kinetics in LC with different etiologies by examining platelet production and destruction.
Ninety-one consecutive LC patients (36 HCV, 49 alcoholics, 15 HBV) were enrolled. As controls, 25 subjects with idiopathic thrombocytopenic purpura, 10 subjects with aplastic anemia, and 40 healthy blood donors were studied. Plasma thrombopoietin (TPO) was measured by ELISA. Reticulated platelets (RP) were determined using the Thiazole Orange method. Plasma glycocalicin (GC) was measured using monoclonal antibodies. Platelet associated and serum antiplatelet antibodies were detected by flow cytometry. B-cell monoclonality in PBMC was assessed by immunoglobulin fingerprinting.
Serum TPO was significantly lower in LC (29.9±18.1 pg/ml) compared to controls (82.3±47.6 pg/ml). The GC levels were higher in LC (any etiology) than in healthy cases. Conversely, the absolute levels of RP were lower in LC (any etiology) than in healthy controls. The platelet-associated and serum anti-platelet antibodies were higher in HCV+ LC compared to healthy subjects (p<0.0064), alcoholic LC (p<0.018), and HBV+ LC (p<0.0001). B-cell monoclonality was found in 27% of the HCV+LC, while it was not found in HBV+ or alcoholic LC.
Patients with LC present decreased plasma TPO, accelerated platelet turnover, and reduced platelet production. This indicates that LC thrombocytopenia is a multifactorial condition involving both increased platelet clearance and impaired thrombopoiesis.
血小板减少症在肝硬化（LC）中很常见，但发病机制尚不完全清楚。我们的工作目的是通过检查血小板的生成和破坏来评估不同病因的 LC 患者的血小板动力学。
共纳入 91 例连续的 LC 患者（36 例 HCV、49 例酒精性、15 例 HBV）。作为对照，研究了 25 例特发性血小板减少性紫癜患者、10 例再生障碍性贫血患者和 40 名健康献血者。采用 ELISA 法检测血浆血小板生成素（TPO）。采用噻唑橙法测定网织血小板（RP）。采用单克隆抗体测定血浆糖蛋白（GC）。采用流式细胞术检测血小板相关和血清抗血小板抗体。通过免疫球蛋白指纹分析评估 PBMC 中的 B 细胞单克隆性。
与对照组（82.3±47.6pg/ml）相比，LC 患者（任何病因）的血清 TPO 明显降低（29.9±18.1pg/ml）。LC（任何病因）患者的 GC 水平高于健康对照组。相反，LC（任何病因）患者的 RP 绝对值低于健康对照组。与健康对照组（p<0.0064）、酒精性 LC（p<0.018）和 HBV+ LC（p<0.0001）相比，HCV+ LC 患者的血小板相关和血清抗血小板抗体更高。在 27%的 HCV+LC 中发现了 B 细胞单克隆性，而在 HBV+或酒精性 LC 中未发现。
LC 患者的血浆 TPO 降低，血小板周转率加快，血小板生成减少。这表明 LC 血小板减少症是一种涉及血小板清除增加和血小板生成受损的多因素疾病。
