Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy.
Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
Semin Thromb Hemost. 2015 Jul;41(5):455-61. doi: 10.1055/s-0035-1550432. Epub 2015 Jun 6.
Thrombocytopenia is a common hematological abnormality in patients with chronic liver disease, and its prevalence is higher in patients with liver failure. Although the presence of thrombocytopenia has historically been associated with portal hypertension, the characterization of thrombopoietin has improved our understanding of the determinants of platelet count in patients with liver disease. In particular, the association between thrombopoietin levels and residual liver function helped disclose the multifaceted pathophysiology of thrombocytopenia in patients with chronic liver failure. In this regard, important results were provided by studies performed in patients with chronic viral hepatitis that assessed the complex interplay between thrombocytopenia induced by the myelosuppressive effect of interferon-based treatment and thrombopoietin pathophysiology. These studies showed that successful antiviral therapy is accompanied by improved hepatic thrombopoietin production. Moreover, studies that evaluated thrombopoietin and platelet count dynamics before and after liver transplantation were instrumental in describing how restoration of liver function determines a normalization of the thrombopoietin-platelet count feedback that is deranged in patients with end-stage liver disease.
血小板减少症是慢性肝病患者常见的血液学异常，肝功能衰竭患者的发病率更高。尽管血小板减少症的存在历来与门静脉高压有关，但对促血小板生成素的特征描述提高了我们对肝病患者血小板计数决定因素的认识。特别是，促血小板生成素水平与残余肝功能之间的关联有助于揭示慢性肝功能衰竭患者血小板减少症的多方面病理生理学。在这方面，在慢性病毒性肝炎患者中进行的研究提供了重要结果，这些研究评估了基于干扰素的治疗的骨髓抑制作用引起的血小板减少症与促血小板生成素病理生理学之间的复杂相互作用。这些研究表明，成功的抗病毒治疗伴随着肝促血小板生成素产生的改善。此外，评估肝移植前后促血小板生成素和血小板计数动态的研究有助于描述肝功能恢复如何决定终末期肝病患者中失调的促血小板生成素-血小板计数反馈的正常化。
