Hayashi Hiromitsu, Beppu Toru, Shirabe Ken, Maehara Yoshihiko, Baba Hideo
Hiromitsu Hayashi, Toru Beppu, Hideo Baba, Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan.
World J Gastroenterol. 2014 Mar 14;20(10):2595-605. doi: 10.3748/wjg.v20.i10.2595.
Thrombocytopenia is a common complication in liver disease and can adversely affect the treatment of liver cirrhosis, limiting the ability to administer therapy and delaying planned surgical/diagnostic procedures because of an increased risk of bleeding. Multiple factors, including splenic sequestration, reduced activity of the hematopoietic growth factor thrombopoietin, bone marrow suppression by chronic hepatitis C virus infection and anti-cancer agents, and antiviral treatment with interferon-based therapy, can contribute to the development of thrombocytopenia in cirrhotic patients. Of these factors, the major mechanisms for thrombocytopenia in liver cirrhosis are (1) platelet sequestration in the spleen; and (2) decreased production of thrombopoietin in the liver. Several treatment options, including platelet transfusion, interventional partial splenic embolization, and surgical splenectomy, are now available for severe thrombocytopenia in cirrhotic patients. Although thrombopoietin agonists and targeted agents are alternative tools for noninvasively treating thrombocytopenia due to liver cirrhosis, their ability to improve thrombocytopenia in cirrhotic patients is under investigation in clinical trials. In this review, we propose a treatment approach to thrombocytopenia according to our novel concept of splenic volume, and we describe the current management of thrombocytopenia due to liver cirrhosis.
血小板减少症是肝病中的常见并发症，会对肝硬化的治疗产生不利影响，由于出血风险增加，限制了治疗的实施能力，并延误了计划中的手术/诊断程序。多种因素，包括脾内扣押、造血生长因子血小板生成素活性降低、慢性丙型肝炎病毒感染和抗癌药物导致的骨髓抑制，以及基于干扰素的抗病毒治疗，都可能导致肝硬化患者发生血小板减少症。在这些因素中，肝硬化患者血小板减少症的主要机制是：（1）血小板在脾脏内扣押；（2）肝脏中血小板生成素产生减少。目前有多种治疗方案可供肝硬化患者严重血小板减少症使用，包括血小板输注、介入性部分脾栓塞和手术脾切除术。尽管血小板生成素激动剂和靶向药物是非侵入性治疗肝硬化所致血小板减少症的替代工具，但它们改善肝硬化患者血小板减少症的能力正在临床试验中进行研究。在本综述中，我们根据脾脏容积的新概念提出了一种血小板减少症的治疗方法，并描述了目前肝硬化所致血小板减少症的管理方法。
