慢性乙肝肝硬化血小板减少与疾病相关性的研究

Correlation between thrombocytopenia in chronic hepatitis B and chronic hepatitis B with liver cirrhosis

目的探讨慢性乙肝肝硬化血小板减少与血清血小板生成素(thrombopoietin,TPO)浓度及HBV-DNA载量之间的关系。方法测定26例血小板减少的慢性乙肝肝硬化肝功能代偿期患者、73例血小板减少的慢性乙肝肝硬化肝功能失代偿期患者、26例血小板正常的慢性乙肝肝硬化患者及25例健康对照的血小板参数;用酶联免疫吸附法(ELISA)测定血清TPO浓度;荧光定量PCR法测定99例血小板减少的慢性乙肝肝硬化患者的HBV-DNA水平。结果与健康对照组相比,血小板减少的慢性乙肝肝硬化肝功能代偿期组及慢性乙肝肝硬化肝功能失代偿期组的血小板显著降低(P<0.01),血小板减少的慢性乙肝肝硬化肝功能失代偿期组的血清TPO浓度显著升高(P<0.05),而血小板减少的慢性乙肝肝硬化肝功能代偿期组与血小板正常的慢性乙肝肝硬化组及健康对照组的血清TPO浓度相比均无统计学差异(P>0.05)。血小板减少的慢性乙肝肝硬化肝功能代偿期组、失代偿期组的血清TPO浓度与外周血小板计数之间均无相关性(P>0.05)。与HBV-DNA水平小于103IU/mL的血小板减少的慢性乙肝肝硬化患者组比较,HBV-DNA水平在103～106IU/mL及HBV-DNA水平大于106IU/mL的血小板均显著降低(P<0.05)。结论血小板减少可以作为评价慢性乙肝肝硬化的指标,但不能区别肝硬化肝功能处于代偿期还是失代偿期。慢性乙肝肝硬化血小板减少是多因素影响的,血清TPO水平在慢性乙肝肝硬化中增高,其对血小板减少的影响不大,而乙肝病毒载量高低对血小板减少的影响较大。

Objective To investigate the relationship of thrombocytopenia with the serum concentration of thrombopoietin（TPO） and HBV-DNA load in chronic hepatitis B（CHB） patients with liver cirrhosis.Methods The values of platelets of 26 patients with CHB with liver cirrhosis,thrombocytopenia and compensated liver function,73 patients with the same disease but with decompensated liver function,26 CHB-liver cirrhosis patients with normal platelets,and 25 healthy controls were detected.The serum concentration of TPO was detected by ELISA and HBV-DNA load of 99 CHB patients with liver cirrhosis and thrombocytopenia was detected by PQ-PCR.Results Compared with that in the healthy control group,the value of platelets was significantly lower in the group of CHB patients with cirrhosis,thrombocytopenia and compensated liver function and the group of patients with decompensated liver function（P0.01）.The serum concentration of TPO in CHB patients with liver cirrhosis of thrombocytopenia and decompensated liver function increased significantly（P0.05）,while in the patients with decompensated liver function and the CHB patients with liver cirrhosis of normal platelets it increased but with no significant difference（P0.05）.The serum concentration of TPO in CHB patients with liver cirrhosis of thrombocytopenia including compensated and decompensated liver functions had no correlation with the platelet count of peripheral blood（P0.05）.Compared with the patients with HBV-DNA load less than 103 IU/mL,the number of platelets decreased significantly in the patients with HBV-DNA load of 103-106 IU/mL and above 106 IU/mL（P0.05）.Conclusion Thrombocytopenia parameters can be used as indicators to evaluate HBV cirrhosis,but cannot be used to differentiate stages of liver function in HBV cirrhosis.Multiple factors may affect thrombocytopenia in CHB with liver cirrhosis.The serum concentration of thrombopoietin increases in CHB patients with liver cirrhosis,but has no significant effect on platelet decrease,while the load of HBV-DNA significantly affects the decrease of platelets.