Ding Jing-Nuo, Feng Ting-Ting, Sun Wei, Cai Xin-Yi, Zhang Yun, Zhao Wei-Feng
Department of Infectious Diseases, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China.
World J Gastrointest Surg. 2022 Nov 27;14(11):1260-1271. doi: 10.4240/wjgs.v14.i11.1260.
Chronic liver disease (CLD) related thrombocytopenia increases the risk of bleeding and poor prognosis. Many liver disease patients require invasive procedures or surgeries, such as liver biopsy or endoscopic variceal ligation, and most of them have lower platelet counts, which could aggravate the risk of bleeding due to liver dysfunction and coagulation disorders. Unfortunately, there is no defined treatment modality for CLD-induced thrombocytopenia. Recombinant human thrombopoietin (rhTPO) is commonly used to treat primary immune thrombocytopenic purpura and thrombocytopenia caused by solid tumor chemotherapy; however, there are few reports on the use of rhTPO in the treatment of CLD-related thrombocytopenia.
To evaluate the efficacy of rhTPO in the treatment of patients with CLD-associated thrombocytopenia undergoing invasive procedures.
All analyses were based on the retrospective collection of clinical data of patients with CLD who were treated in the Department of Infectious Diseases at The First Affiliated Hospital of Soochow University between June 2020 and December 2021. Fifty-nine male and 41 female patients with liver disease were enrolled in this study to assess the changes in platelet counts and parameters before and after the use of rhTPO for thrombocytopenia. Adverse events related to treatment, such as bleeding, thrombosis, and disseminated intravascular coagulation, were also investigated.
Among the enrolled patients, 78 (78%) showed a platelet count increase after rhTPO use, while 22 (22%) showed no significant change in platelet count. The mean platelet count after rhTPO treatment in all patients was 101.53 ± 81.81 × 10/L, which was significantly improved compared to that at baseline (42.88 ± 16.72 × 10/L), and this difference was statistically significant ( < 0.001). In addition, patients were further divided into three subgroups according to their baseline platelet counts (< 30 × 10/L, 30-50 × 10/L, > 50 × 10/L). Subgroup analyses showed that the median platelet counts after treatment were significantly higher ( < 0.001, all). Ninety (90%) patients did not require platelet transfusion partially due to an increase in platelet count after treatment with rhTPO. No serious adverse events related to rhTPO treatment were observed. Overall, rhTPO demonstrated good clinical efficacy for treating CLD-associated thrombocytopenia.
rhTPO can improve platelet count, reduce the risk of bleeding, and decrease the platelet transfusion rate, which may promote the safety of invasive procedures and improve overall survival of patients with CLD.
慢性肝病（CLD）相关的血小板减少会增加出血风险及预后不良。许多肝病患者需要进行侵入性操作或手术，如肝活检或内镜下静脉曲张结扎术，而他们中的大多数血小板计数较低，这可能会因肝功能障碍和凝血紊乱而加重出血风险。不幸的是，目前尚无针对CLD所致血小板减少的明确治疗方式。重组人血小板生成素（rhTPO）常用于治疗原发性免疫性血小板减少症和实体瘤化疗引起的血小板减少症；然而，关于rhTPO用于治疗CLD相关血小板减少症的报道较少。
评估rhTPO在治疗接受侵入性操作的CLD相关性血小板减少症患者中的疗效。
所有分析均基于苏州大学附属第一医院感染科2020年6月至2021年12月期间治疗的CLD患者临床数据的回顾性收集。本研究纳入了59例男性和41例女性肝病患者，以评估使用rhTPO治疗血小板减少症前后血小板计数及参数的变化。还调查了与治疗相关的不良事件，如出血、血栓形成和弥散性血管内凝血。
在纳入的患者中，78例（78%）在使用rhTPO后血小板计数升高，而22例（22%）血小板计数无显著变化。所有患者rhTPO治疗后的平均血小板计数为101.53±81.81×10⁹/L，与基线时（42.88±16.72×10⁹/L）相比有显著改善，且差异具有统计学意义（P<0.001）。此外，根据患者的基线血小板计数（<30×10⁹/L、30 - 50×10⁹/L、>50×10⁹/L）将患者进一步分为三个亚组。亚组分析显示治疗后的血小板中位数计数均显著更高（P<0.001）。90例（90%）患者部分由于rhTPO治疗后血小板计数增加而无需输注血小板。未观察到与rhTPO治疗相关的严重不良事件。总体而言，rhTPO在治疗CLD相关血小板减少症方面显示出良好的临床疗效。
rhTPO可提高血小板计数，降低出血风险，减少血小板输注率，这可能会促进侵入性操作的安全性并改善CLD患者的总体生存率。
