Noguchi H, Hirai K, Aoki Y, Sakata K, Tanikawa K
Second Department of Medicine, Kurume University School of Medicine, Japan.
Hepatology. 1995 Dec;22(6):1682-8.
We performed a partial splenic arterial embolization in 22 patients with cirrhosis associated with thrombocytopenia and then evaluated the changes in platelet kinetics after undergoing the procedure using 111In-tropolone-labeled platelets. The controls consisted of eight chronic hepatitis patients who showed a normal platelet count and normal spleen size. The mean splenic infarction ratio after the procedure was 54.9%. A platelet kinetics study was performed before and 2 months after the procedure. Before the procedure, the cirrhotic patients showed increases in the splenic volume and the spleen/liver uptake ratio of the 111In-labeled platelets on both the third and seventh days, and a decrease in the platelet recovery compared with the controls, which suggested an increased platelet pool in the spleen. In addition, the platelet survival time in cirrhotic patients was shortened, whereas the platelet-associated immunoglobulin G (PA-IgG) was higher than that of the controls, which suggested the involvement of immunologic mechanisms in the thrombocytopenia. With an increase of the platelet count after a partial splenic arterial embolization, the spleen/liver uptake ratio of the 111In-labeled platelets decreased, whereas the platelet recovery increased. Furthermore, the platelet survival time was prolonged, whereas the PA-IgG decreased. The platelet count showed a positive correlation with the platelet survival time and a negative correlation with PA-IgG before and after the procedure. These results suggest that a transcatheter splenic arterial embolization not only may reduce the increased platelet pool in the spleen but also may improve the thrombocytopenia induced by immunologic mechanisms in patients with cirrhosis.
我们对22例肝硬化合并血小板减少症患者进行了部分脾动脉栓塞术，然后使用111In-托酚酮标记的血小板评估了术后血小板动力学的变化。对照组由8例血小板计数正常且脾脏大小正常的慢性肝炎患者组成。术后平均脾梗死率为54.9%。在术前和术后2个月进行了血小板动力学研究。术前，肝硬化患者在第3天和第7天脾脏体积以及111In标记血小板的脾/肝摄取率均增加，与对照组相比血小板回收率降低，这提示脾脏中血小板池增加。此外，肝硬化患者的血小板存活时间缩短，而血小板相关免疫球蛋白G（PA-IgG）高于对照组，这提示免疫机制参与了血小板减少症。随着部分脾动脉栓塞术后血小板计数增加，111In标记血小板的脾/肝摄取率降低，而血小板回收率增加。此外，血小板存活时间延长，而PA-IgG降低。术前和术后血小板计数与血小板存活时间呈正相关，与PA-IgG呈负相关。这些结果表明，经导管脾动脉栓塞术不仅可能减少脾脏中增加的血小板池，而且可能改善肝硬化患者免疫机制所致的血小板减少症。
