Department of Infectious Diseases, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China.
Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
Stem Cells Transl Med. 2023 Jun 15;12(6):325-333. doi: 10.1093/stcltm/szad023.
Previous studies have found that the production of platelets could enhance the therapeutic effects of stem cells. Nevertheless, there are still no articles reporting on the relationship between platelets and the clinical efficacy of umbilical cord mesenchymal stem cells (UCMSCs) for HBV-related acute-on-chronic liver failure (ACLF) and liver cirrhosis (LC).
In this retrospective observational study, patients who met the criteria were included. Patients were divided into subgroups according to the aims of this study. In the first part, the platelet count changes of ACLF and patients with LC after UCMSC therapy were compared and analyzed. Subgroup analysis based on UCMSC infusion times and patient age was also performed. In the second part, patients in the ACLF group and LC group were further divided into subgroups according to their platelet levels. Their clinical characteristics, demographics, and biochemical factors were compared.
This study enrolled 64 patients with ACLF and 59 patients with LC. In both groups, platelet levels declined similarly. Compared with the short-course UCMSC treatment group (≤4 times), patients with ACLF and patients with LC with long-course UCMSC treatment (>4 times) showed an overall increasing trend. Younger patients with LC (<45 years) had significantly higher platelet levels than older patients with LC (≥45 years). However, this age difference was not present in the ACLF group. The median TBIL decrease and cumulative TBIL decrease were not significantly different between patients with high PLT and patients with low PLT after UCMSC transfusions. For patients with ACLF, the cumulative TBIL decrease and the median TBIL decrease were significantly greater than those of patients with LC at the same platelet level after UCMSC treatment. However, this difference was not observed at all time points.
Trend of the platelet levels for HBV-related patients with ACLF and LC after UCMSC treatment did not parallel and varied according to treatment times and patients' age. Platelet levels did not affect the efficacy of MSCs for patients with ACLF or LC.
既往研究发现血小板的产生可增强干细胞的治疗效果。然而，目前尚无文献报道血小板与脐带间充质干细胞（UCMSC）治疗乙型肝炎相关慢加急性肝衰竭（ACLF）和肝硬化（LC）的临床疗效之间的关系。
本回顾性观察性研究纳入符合标准的患者。根据本研究的目的，患者被分为亚组。在第一部分中，比较和分析了 UCMSC 治疗后 ACLF 和 LC 患者的血小板计数变化，并进行了基于 UCMSC 输注次数和患者年龄的亚组分析。在第二部分中，ACLF 组和 LC 组患者根据血小板水平进一步分为亚组，比较其临床特征、人口统计学和生化因素。
本研究纳入了 64 例 ACLF 患者和 59 例 LC 患者。两组患者的血小板水平均呈下降趋势。与短疗程 UCMSC 治疗组（≤4 次）相比，ACLF 和 LC 长疗程 UCMSC 治疗组（>4 次）患者呈整体上升趋势。年轻的 LC 患者（<45 岁）的血小板水平显著高于年长的 LC 患者（≥45 岁）。然而，这种年龄差异在 ACLF 组中并不存在。UCMSC 输注后，血小板水平较高的患者与血小板水平较低的患者的 TBIL 下降中位数和累积 TBIL 下降无显著差异。对于 ACLF 患者，在 UCMSC 治疗后，相同血小板水平下，累积 TBIL 下降和 TBIL 下降中位数均显著大于 LC 患者。然而，在所有时间点均未观察到这种差异。
HBV 相关 ACLF 和 LC 患者 UCMSC 治疗后血小板水平的趋势与治疗次数和患者年龄不一致且存在差异。血小板水平并不影响 MSC 治疗 ACLF 或 LC 患者的疗效。
