Varma Subhash, Kumar Shiv, Garg Ashish, Malhotra Pankaj, Das Ashim, Sharma Arpita, Chawla Yogesh K, Dhiman Radha K
Departments of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh - 160012, India.
Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh - 160012, India.
J Clin Exp Hepatol. 2011 Sep;1(2):68-72. doi: 10.1016/S0973-6883(11)60124-2. Epub 2011 Nov 9.
Hepatitis C virus (HCV) has been reported to be associated with the occurrence of autoimmune disorders, including immune thrombocytopenic purpura (ITP). This has suggested that HCV could be responsible for thrombocytopenia in these patients. This study was performed to estimate the frequency of HCV infection in patients of chronic ITP (cITP), and to find the frequency of thrombocytopenia in chronic HCV infection.
A total of 150 subjects were included in the study. Fifty consecutive adult patients with cITP (< 6 months' duration) and 50 age-matched patients with chronic HCV were included for comparison of platelet counts in two groups. Fifty age-matched healthy subjects were also included in the control group. All patients' sera were tested for the presence or absence of HCV-RNA. Anti-HCV antibodies were tested in patients as well as in controls. Complete blood count and examination of peripheral blood smear were done followed by bone-marrow aspiration to confirm the diagnosis of ITP.
Three patients (6%) were tested positive for anti-HCV antibodies while no subject was positive in control group (P=0.24). The prevalence of severe thrombocytopenia (platelet counts <50,000/mL) was significantly higher in ITP patients compared with that in chronic HCV patients (P=0.0001). Thrombocytopenia occurred more frequently in patient with moderate to severe than mild stage of fibrosis (P=0.001).
In conclusion, thrombocytopenia in ITP patients was not associated with HCV infection. The prevalence of thrombocytopenia was more common and more severe in ITP patients when compared with that in patients with chronic HCV. Thrombocytopenia in chronic HCV patients was related to the stage of fibrosis and to the duration of HCV infection.
据报道，丙型肝炎病毒（HCV）与自身免疫性疾病的发生有关，包括免疫性血小板减少性紫癜（ITP）。这表明HCV可能是这些患者血小板减少的原因。本研究旨在评估慢性ITP（cITP）患者中HCV感染的频率，并找出慢性HCV感染中血小板减少的频率。
本研究共纳入150名受试者。连续纳入50例成年cITP患者（病程<6个月）和50例年龄匹配的慢性HCV患者，比较两组的血小板计数。对照组还纳入了50例年龄匹配的健康受试者。检测所有患者血清中HCV-RNA的有无。对患者和对照组均检测抗-HCV抗体。进行全血细胞计数和外周血涂片检查，随后进行骨髓穿刺以确诊ITP。
3例患者（6%）抗-HCV抗体检测呈阳性，而对照组无受试者呈阳性（P=0.24）。ITP患者中重度血小板减少（血小板计数<50,000/mL）的患病率显著高于慢性HCV患者（P=0.0001）。血小板减少在纤维化中度至重度患者中比轻度患者更常见（P=0.001）。
总之，ITP患者的血小板减少与HCV感染无关。与慢性HCV患者相比，ITP患者中血小板减少的患病率更高且更严重。慢性HCV患者的血小板减少与纤维化阶段和HCV感染持续时间有关。
