基线血小板生成素水平与慢性丙型肝炎血小板减少症患者成功接受直接作用抗病毒药物治疗后的血小板计数改善相关。
Baseline thrombopoietin level is associated with platelet count improvement in thrombocytopenic chronic hepatitis C patients after successful direct-acting antiviral agent therapy.
机构信息
Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan No 2, Ming-Shen Road, Dalin Town, Chia-Yi County, 622, Taiwan.
School of Medicine, Tzu Chi University, Hualien, Taiwan.
出版信息
BMC Gastroenterol. 2021 Jan 21;21(1):30. doi: 10.1186/s12876-021-01606-x.
BACKGROUND
Thrombocytopenia can rapidly improve in chronic hepatitis C (CHC) patients receiving direct-acting antiviral agents (DAA). The role of baseline (BL) thrombopoietin (TPO) in this phenomenon is unclear.
METHODS
From June 2016 to February 2019, a total of 104 CHC patients receiving DAA, with a sustained virologic response and BL thrombocytopenia, at Dalin Tzu Chi Hospital, were enrolled in this retrospective study. Significant platelet count improvement and platelet count improvement ratio were analyzed for correlation with BL TPO.
RESULTS
This cohort included 40 men (38.5%). Seventy-two (69.2%) patients had advanced fibrosis. The platelet count [median (range)] increased from 110.5 (32-149) × 10/µL at BL to 116.5 (40-196) and 118.0 (35-275) × 10/µL at end of treatment (EOT) and 12 weeks after EOT (P12), respectively, (EOT vs. BL, P < 0.001; P12 vs. BL, P < 0.001). BL TPO was positively correlated with significant platelet count improvement (P < 0.001), platelet count improvement ratio at EOT (P = 0.004), and P12 (P < 0.001). The area under the receiver operating characteristic curve and optimal cutoffs (pg/ml) were 0.77 (95% confidence interval, 0.67-0.86) and 120, respectively, for significant platelet count improvement prediction. The sensitivity, specificity, and accuracy were 88.6%, 71.7%, and 78.8%, respectively.
CONCLUSIONS
BL TPO level might be a useful marker for predicting significant platelet count improvement in thrombocytopenic patients after successful DAA therapy.
背景
接受直接作用抗病毒药物（DAA）治疗的慢性丙型肝炎（CHC）患者的血小板减少症可迅速改善。基线（BL）促血小板生成素（TPO）在此现象中的作用尚不清楚。
方法
本回顾性研究于 2016 年 6 月至 2019 年 2 月期间共纳入 104 例在大林慈济医院接受 DAA 治疗且获得持续病毒学应答和 BL 血小板减少症的 CHC 患者。分析 BL TPO 与显著血小板计数改善和血小板计数改善率的相关性。
结果
本队列包括 40 名男性（38.5%）。72 例（69.2%）患者存在晚期纤维化。血小板计数[中位数（范围）]从 BL 时的 110.5（32-149）×10/µL 增加到 EOT 时的 116.5（40-196）和 EOT 后 12 周（P12）时的 118.0（35-275）×10/µL（EOT 与 BL 相比，P<0.001；P12 与 BL 相比，P<0.001）。BL TPO 与显著血小板计数改善（P<0.001）、EOT 时的血小板计数改善率（P=0.004）和 P12 时的血小板计数改善率（P<0.001）呈正相关。预测显著血小板计数改善的受试者工作特征曲线下面积和最佳截断值（pg/ml）分别为 0.77（95%置信区间，0.67-0.86）和 120。灵敏度、特异性和准确性分别为 88.6%、71.7%和 78.8%。
结论
BL TPO 水平可能是预测 DAA 治疗成功后血小板减少症患者血小板计数显著改善的有用标志物。
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