He M, Fan Y N, Ba Z Q, Ji T T, Zhang D M, Yu Y Y, Xu X Y, Xu J H
Department of Infectious Diseases, Peking University First Hospital, Beijing 100034, China.
Department of Critical Care Medicine, Peking University First Hospital, Beijing 100034, China.
Zhonghua Gan Zang Bing Za Zhi. 2024 Jun 20;32(6):508-516. doi: 10.3760/cma.j.cn501113-20240408-00183.
To explore the related factors of thrombocytopenia (TCP) occurrence in patients with cirrhosis. A cross-sectional study was conducted. Inpatients with an initial diagnosis of cirrhosis at Peking University First Hospital from January 1, 2010 to December 31, 2020 were included. Clinical data such as demographic characteristics, etiology of cirrhosis, complications of cirrhosis, laboratory indicators, Child-Pugh grade, invasive procedures, and mortality during hospitalization were collected. A logistic regression model was used to explore the related factors of TCP occurrence in patients with cirrhosis. Categorical variables were compared by the (2) test. The inter-group comparison was performed using continuous variables, a -test, one-way analysis of variance (ANOVA), or a nonparametric test. There were a total of 2 592 cases of cirrhosis. 75 cases with incomplete clinical data were excluded. 2 517 cases were included for analysis. The median age was 58 (50, 67) years. Males accounted for 64%. 1 435 cases (57.0%) developed TCP, and 434 cases (17.2%) had grade 3-4 TCP. Gender, primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), and concomitant esophagogastric varices (EGV) were the major factors associated with TCP. Females were more prone to combine with TCP (=1.32, 95%: 1.12-1.56, =0.001). Patients combined with EGV (=3.09, 95%: 2.63-3.65, <0.001) were more prone to develop TCP, which was associated with the increased incidence of hypersplenism (<0.001). Patients with PBC (=0.64, 95%: 0.50-0.82, <0.001) and PSC (=0.23, 95%: 0.06-0.65, =0.010) were less prone to develop TCP, which was due to the shorter prothrombin time and better coagulation function of PBC patients (<0.001), and the lower proportion of hypersplenism in combined PSC patients (=0.004). Patients with TCP and grade 3-4 TCP had a higher rate of hemostatic procedures (<0.05), but a lower rate of liver biopsy (<0.05). Patients with grade 3-4 TCP had a higher nosocomial mortality rate compared to those without (=0.004). TCP is common in patients with cirrhosis. However, TCP occurrence is higher in female patients with EGV and lower in patients combined with PBC and PSC. TCP affects invasive procedures and is associated with adverse outcomes.
探讨肝硬化患者血小板减少症（TCP）发生的相关因素。进行了一项横断面研究。纳入2010年1月1日至2020年12月31日在北京大学第一医院初诊为肝硬化的住院患者。收集人口统计学特征、肝硬化病因、肝硬化并发症、实验室指标、Child-Pugh分级、侵入性操作及住院期间死亡率等临床资料。采用逻辑回归模型探讨肝硬化患者TCP发生的相关因素。分类变量采用χ²检验进行比较。连续变量采用t检验、单因素方差分析（ANOVA）或非参数检验进行组间比较。共有2592例肝硬化病例。排除75例临床资料不完整的病例。纳入2517例进行分析。中位年龄为58（50，67）岁。男性占64%。1435例（57.0%）发生TCP，434例（17.2%）为3-4级TCP。性别、原发性胆汁性胆管炎（PBC）、原发性硬化性胆管炎（PSC）及合并食管胃静脉曲张（EGV）是与TCP相关的主要因素。女性更易合并TCP（比值比=1.32，95%可信区间：1.12-1.56，P=0.001）。合并EGV的患者更易发生TCP（比值比=3.09，95%可信区间：2.63-3.65，P<0.001），这与脾功能亢进发生率增加有关（P<0.001）。PBC患者（比值比=0.64，95%可信区间：0.50-0.82，P<0.001）和PSC患者（比值比=0.23，95%可信区间：0.06-0.65，P=0.010）不易发生TCP，这是由于PBC患者凝血酶原时间较短且凝血功能较好（P<0.001），以及合并PSC患者脾功能亢进比例较低（P=0.004）。发生TCP及3-4级TCP的患者止血操作率较高（P<0.05），但肝活检率较低（P<0.05）。与未发生3-4级TCP的患者相比，发生3-4级TCP的患者院内死亡率较高（P=0.004）。TCP在肝硬化患者中常见。然而，合并EGV的女性患者TCP发生率较高，而合并PBC和PSC的患者发生率较低。TCP影响侵入性操作并与不良结局相关。
