肝硬化患者的未成熟血小板分数和血小板生成素：一项队列研究。
Immature platelet fraction and thrombopoietin in patients with liver cirrhosis: A cohort study.
作者信息
Rauber Philip, Lammert Frank, Grotemeyer Katharina, Appenrodt Beate
机构信息
Department of Neurology, Saarland University Medical Center, Homburg/Saar, Germany.
Department of Medicine II, Saarland University Medical Center, Homburg/Saar, Germany.
出版信息
PLoS One. 2018 Feb 13;13(2):e0192271. doi: 10.1371/journal.pone.0192271. eCollection 2018.
BACKGROUND AND AIMS
Thrombocytopenia occurs frequently in patients with cirrhosis. The immature platelet fraction (IPF%) is measured to differentiate the causes of thrombocytopenia. To date the relevance of thrombopoietin (TPO) in the context of cirrhosis is unknown. The aim of our study was to investigate the cause of thrombocytopenia in patients with liver cirrhosis by measuring IPF%, TPO and spleen size. In addition we examined the use of IPF% to evaluate the severity of cirrhosis and its complications.
METHODS
Overall, we included 88 in-patients with cirrhosis in our study. The collected data comprises current health status, blood parameters, severity of cirrhosis evaluated by Child-Pugh score and MELD score, spleen diameter, ascites and esophageal varices. The IPF% was measured using an automatic hematology analyzer. TPO was measured with ELISA.
RESULTS
IPF% (p = 0.003) and spleen diameter (p = 0.001) were significantly higher in patients with thrombocytopenia. There was no significant difference in TPO between patients with and without thrombocytopenia. The mean values of IPF% varied significantly (p = 0.044) in Child-Pugh stages. IPF% was significantly (p = 0.005) elevated in patients with esophageal varices. Moreover, IPF% higher than 3.85% displayed sensitivity of 76.6% and specificity of 52.4% with an area under receiver operating curve characteristics of 0.669 for the presence of esophageal varices.
CONCLUSION
On closer examination of the three compartments known to have an influence on platelet count splenomegaly seems to be the major cause of thrombocytopenia in patients with cirrhosis according to current knowledge. Higher IPF% in patients with thrombocytopenia indicates peripheral consumption of platelets. The relation between spleen diameter and platelet count indicates the spleen to be the major place of platelets' consumption. TPO did not differ between patients with and without thrombocytopenia. Furthermore, we cannot exclude an influence of impaired thrombopoietin synthesis on platelet counts. The association between IPF% and platelet count suggests that there is physiological regulation of platelets in patients with cirrhosis. In our study IPF% is associated with esophageal varices and the stage of cirrhosis. Further studies are needed to confirm these results.
背景与目的
血小板减少症在肝硬化患者中频繁发生。通过检测未成熟血小板比例（IPF%）来鉴别血小板减少症的病因。迄今为止，血小板生成素（TPO）在肝硬化背景下的相关性尚不清楚。我们研究的目的是通过检测IPF%、TPO和脾脏大小来探究肝硬化患者血小板减少症的病因。此外，我们还研究了利用IPF%评估肝硬化及其并发症的严重程度。
方法
我们的研究共纳入了88例肝硬化住院患者。收集的数据包括当前健康状况、血液参数、通过Child-Pugh评分和MELD评分评估的肝硬化严重程度、脾脏直径、腹水和食管静脉曲张情况。使用自动血液分析仪检测IPF%。采用酶联免疫吸附测定法检测TPO。
结果
血小板减少症患者的IPF%（p = 0.003）和脾脏直径（p = 0.001）显著更高。血小板减少症患者与非血小板减少症患者的TPO无显著差异。Child-Pugh分期中IPF%的平均值有显著差异（p = 0.044）。食管静脉曲张患者的IPF%显著升高（p = 0.005）。此外，IPF%高于3.85%时，对于食管静脉曲张存在情况的受试者工作特征曲线下面积为0.669，其敏感性为76.6%，特异性为52.4%。
结论
根据目前的认识，在仔细研究已知对血小板计数有影响的三个因素后，脾肿大似乎是肝硬化患者血小板减少症的主要原因。血小板减少症患者较高的IPF%表明血小板外周消耗。脾脏直径与血小板计数之间的关系表明脾脏是血小板消耗的主要部位。血小板减少症患者与非血小板减少症患者的TPO无差异。此外，我们不能排除血小板生成素合成受损对血小板计数的影响。IPF%与血小板计数之间的关联表明肝硬化患者存在血小板的生理调节。在我们的研究中，IPF%与食管静脉曲张和肝硬化分期相关。需要进一步研究来证实这些结果。
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