Lv Yunfu, Yee Lau Wan, Wu Hongfei, Han XiaoYu, Gong Xiaoguang, Liu Ning, Yue Jie, Li Qingqing, Li YeJuan, Deng Jie
1 Department of Emergency Surgery, Hainan Province People's Hospital, Haikou 570311, China.
2 Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
Exp Biol Med (Maywood). 2017 Apr;242(7):744-749. doi: 10.1177/1535370217693113. Epub 2017 Jan 1.
The clinical data of 183 patients with hepatitic cirrhosis and portal hypertensive splenomegaly complicated by peripheral cytopenia were retrospectively analyzed to investigate the causes of peripheral cytopenia, as well as the proportion of the causes in these patients. All patients underwent splenectomy. Before operation, these patients had one or more types of peripheral cytopenia (cumulative cytopenia: 390 patient-times). After splenectomy, blood counts in 79.2% (309/390) returned to normal, while in 15.9% (62/390) they increased but failed to reach to normal levels, and in 4.9% (19/390) they became lower than before the operations. For the last group of patients ( n = 19), long-term follow-up showed that blood counts returned to normal in five patients. In other words, in 80.5% [(309 + 5)/390 or 314/390] of patient-times, the peripheral cytopenia was due to hypersplenism, in 15.9% it was due to a combination of factors, and in 3.6% [14/390] it had nothing to do with the hypersplenism. Thus, hypersplenism is a major cause, but not the only cause, of peripheral cytopenia in patients with hepatic cirrhosis and portal hypertensive splenomegaly, and splenectormy is an effective treatment for these patients. Impact statement For a long time, the development of peripheral cytopenias as a complication to cirrhotic portal hypertension has been attributed to hypersplenism; however, this has never been fully demonstrated. Dameshek summarized that hypersplenism should be diagnosed by the presence of four conditions: (a) mono- or multi-lineage peripheral cytopenias; (b) compensatory hyperplasia of bone marrow; (c) splenomegaly; and (d) correction of cytopenias after splenectomy. We retrospectively analyzed the clinical data from 183 surgical patients, and found that 80.5% of peripheral cytopenias was caused by hypersplenism, 16% by a combination of factors, and 3.5% by other factors unrelated to hypersplenism. As the first quantitative findings in this field, our results verify that hypersplenism is a major, but not exclusive, cause of peripheral cytopenias, and provides important clinical evidence for investigating the cause of peripheral cytopenias.
回顾性分析183例肝炎肝硬化门静脉高压脾肿大合并外周血细胞减少患者的临床资料，以探讨外周血细胞减少的原因及其在这些患者中的构成比例。所有患者均接受了脾切除术。术前，这些患者存在一种或多种外周血细胞减少（累计血细胞减少：390例次）。脾切除术后，79.2%（309/390）的患者血细胞计数恢复正常，15.9%（62/390）的患者血细胞计数升高但未达到正常水平，4.9%（19/390）的患者血细胞计数低于术前。对于最后一组患者（n = 19），长期随访显示其中5例患者的血细胞计数恢复正常。也就是说，在80.5%[（309 + 5）/390或314/390]的例次中，外周血细胞减少是由脾功能亢进引起的，15.9%是由多种因素共同作用引起的，3.6%[14/390]与脾功能亢进无关。因此，脾功能亢进是肝炎肝硬化门静脉高压脾肿大患者外周血细胞减少的主要原因，但不是唯一原因，脾切除术是治疗这些患者的有效方法。影响声明长期以来，外周血细胞减少作为肝硬化门静脉高压的并发症，其发生一直被归因于脾功能亢进；然而，这从未得到充分证实。达梅谢克总结认为，脾功能亢进应通过以下四个条件来诊断：（a）单系或多系外周血细胞减少；（b）骨髓代偿性增生；（c）脾肿大；（d）脾切除术后血细胞减少得到纠正。我们回顾性分析了183例手术患者的临床资料，发现80.5%的外周血细胞减少是由脾功能亢进引起的，16%是由多种因素共同作用引起的，3.5%是由与脾功能亢进无关的其他因素引起的。作为该领域的首个定量研究结果，我们的研究结果证实脾功能亢进是外周血细胞减少的主要但非唯一原因，并为探究外周血细胞减少的原因提供了重要的临床证据。
