Quan Xin, Ye Xiuling, Qian Shuaijie, Wei Bo, Tong Huan, Wang Zhidong, Tai Yang, Guo Xu, Gao Jinhang, Wu Hao
Department of Gastroenterology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, China.
Department of Gastroenterology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, China; Lab of Gastroenterology and Hepatology, West China Hospital, Sichuan University, NO. 1, 4th Keyuan Road, Chengdu, China.
Dig Liver Dis. 2023 May;55(5):629-636. doi: 10.1016/j.dld.2022.09.019. Epub 2022 Oct 22.
Alteration of platelet status associates with decompensation and death in cirrhosis, while its effect on portal vein thrombosis (PVT) remains unclear. We aimed to retrospectively investigate whether PVT associates with platelet-fibrin clot strength and platelet activation in decompensated cirrhosis.
Platelet-fibrin clot strength (G) was measured by thromboelastography (TEG). Platelet activation was reflected by plasma concentrations of soluble p-selectin (sPs) and a platelet aggregation test adjusted for platelet counts.
Among 166 patients, 45 had PVT. The platelet count was significantly lower in PVT. While the G value was positively correlated with platelet count (ρ = 0.74, P < 0.01), increased G was associated with PVT after adjusting for platelet count in the logistic regression (P = 0.04). The normalized G value according to the linear relation with platelet count was calculated as follows: G = [(G - 2622)/platelet count]. This coefficient had no correlation with platelet count and was an independent risk factor of PVT (OR = 1.03, CI: 1.01-1.05, P = 0.012). In two subanalyses, the collagen-induced platelet aggregation (n = 37, P = 0.029) and plasma concentration of sPs (n = 56, P = 0.001) adjusted for platelet count were significantly higher in PVT.
This study showed a positive correlation of high platelet-fibrin clot strength detected via TEG and platelet activation with PVT in decompensated cirrhosis.
血小板状态改变与肝硬化失代偿及死亡相关，但其对门静脉血栓形成（PVT）的影响尚不清楚。我们旨在回顾性研究失代偿期肝硬化患者中PVT是否与血小板 - 纤维蛋白凝块强度及血小板活化相关。
通过血栓弹力图（TEG）测量血小板 - 纤维蛋白凝块强度（G）。血小板活化通过可溶性P - 选择素（sPs）的血浆浓度及针对血小板计数调整后的血小板聚集试验反映。
166例患者中，45例有PVT。PVT患者的血小板计数显著更低。虽然G值与血小板计数呈正相关（ρ = 0.74，P < 0.01），但在逻辑回归中调整血小板计数后，G值升高与PVT相关（P = 0.04）。根据与血小板计数的线性关系计算的标准化G值如下：G = [（G - 2622）/血小板计数]。该系数与血小板计数无相关性，是PVT的独立危险因素（OR = 1.03，CI：1.01 - 1.05，P = 0.012）。在两项亚分析中，调整血小板计数后的胶原诱导血小板聚集（n = 37，P = 0.029）和sPs血浆浓度（n = 56，P = 0.001）在PVT患者中显著更高。
本研究表明，通过TEG检测到的高血小板 - 纤维蛋白凝块强度及血小板活化与失代偿期肝硬化患者的PVT呈正相关。
