Liver Center, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA.
Transpl Int. 2013 Apr;26(4):435-42. doi: 10.1111/tri.12064. Epub 2013 Jan 29.
Several studies have shown a direct role of liver atrophy in the pathogenesis of thrombocytopenia of cirrhosis via reduced production of thrombopoeitin. About 181 patients listed for liver transplantation at a single transplant center were evaluated at the time of listing with laboratory tests and volumetric liver measurements using computed tomography. Expected normal liver volume was calculated using the Heinemann formula. Liver volume ratio (LVR) was calculated as actual liver volume over expected liver volume. Patients were predominantly male (70.7%), with viral hepatitis (60.2%), had a mean age of 51.8 years (SD 8.7), model for end stage liver disease (MELD) of 14 (SD 6.4), LVR of 0.95 (SD 0.3), and platelet count of 105,000/mcL (SD 66,000). Platelet count (P < 0.0001) correlated more strongly with LVR than MELD, MELD components (P = 0.27) or serum albumin (P = 0.003). Platelet count (HR 0.987, 95% CI 0.979-0.994, P = 0.001) was a strong independent predictor of mortality. Patients with platelet count < 100,000/mcL had a shorter survival (935 vs. 1396 days, P = 0.002) and higher death rate (42.2% vs. 23.6%, P = 0.01), but no different transplantation rate (36.7% vs. 33.3%, P = 0.64) compared to those with platelet count ≥ 100,000/mcL. Low platelet count corresponds to higher waiting list mortality and is a sign of advanced liver atrophy.
几项研究表明，通过减少血小板生成素的产生，肝萎缩在肝硬化血小板减少症的发病机制中起着直接作用。在单一移植中心，对 181 名等待肝移植的患者进行了评估，评估时进行了实验室检查和使用计算机断层扫描进行容积肝脏测量。使用 Heinemann 公式计算预期正常肝体积。肝体积比 (LVR) 计算为实际肝体积与预期肝体积之比。患者主要为男性 (70.7%)，病毒性肝炎 (60.2%)，平均年龄为 51.8 岁 (标准差 8.7)，终末期肝病模型 (MELD) 为 14 (标准差 6.4)，LVR 为 0.95 (标准差 0.3)，血小板计数为 105,000/mcL(标准差 66,000)。血小板计数 (P < 0.0001) 与 LVR 的相关性强于 MELD、MELD 成分 (P = 0.27) 或血清白蛋白 (P = 0.003)。血小板计数 (HR 0.987，95%CI 0.979-0.994，P = 0.001) 是死亡率的独立强预测因素。血小板计数 < 100,000/mcL 的患者存活率更短 (935 天与 1396 天，P = 0.002)，死亡率更高 (42.2%与 23.6%，P = 0.01)，但与血小板计数≥100,000/mcL 的患者相比，移植率无差异 (36.7%与 33.3%，P = 0.64)。血小板计数低对应较高的等待名单死亡率，是肝萎缩严重的标志。
