慢性肝炎外周血细胞计数影响因素的探讨

Analyses of the factors of influencing peripheral blood cells count in patients with chronic hepatitis

目的探讨慢性肝炎外周血细胞计数变化的影响因素，筛选对肝纤维化程度有诊断价值的血细胞。方法慢性肝炎61例。肝活检标本的病理分级和分期参照2000年全国病毒性肝炎及肝病学术会议修订的标准，外周血细胞计数采用Coulter Ac·T diff血细胞分析仪测定。统计分析采用SPSS11．5软件，采用Spearman相关和协方差分析分析影响外周血细胞计数变化的因素。结果血小板计数与病理分期呈显著负相关（P=0．000），粒细胞计数与病理分级和分期均呈显著负相关（P=0．004和0．008）；其余各系血细胞计数与病理分级和分期均无显著相关性（P〉0．05）。白细胞计数与脾脏长径和脾脏厚度呈显著负相关（P=0．000和0．003），血小板计数与门脉内径、脾脏长径和脾脏厚度呈显著负相关（P=0．002、0．000和0．000），粒细胞计数与脾脏长径呈显著负相关（P=0．031），淋巴细胞和中间细胞与门脉内径、脾脏长径、脾脏厚度呈显著负相关（P=0．034和0．024、0．002和0．012、0．012和0．018）；红细胞计数与门脉内径、脾脏长径和脾脏厚度无显著相关性（P〉0．05）。各系血细胞计数与右肝斜径和左肝长径均无显著相关性（P〉0．05）。根据协方差分析，病理分期是影响血小板计数的主要因素（P=0．000，偏Eta平方=0．226）。结论脾脏增大是慢性肝炎外周血细胞计数减少的主要原因，血小板计数有预测肝纤维化程度的价值。

Objective To explore the influencing factors of peripheral blood cells count changes in patients with chronic hepatitis, and to screen out the blood cells with diagnostic value for fibrotic grading. Methods 61 patients with chronic hepatitis were enrolled into present study. The pathological grading and staging of the liver biopsy samples were diagnosed according to the national standard revised in 2000. Peripheral blood cells were measured with Coulter Ac.T diff Hematology Analyzer. SPSS11.5 software was used for statistical analyses. The influencing factors of peripheral blood cells count were analyzed by Spearman correlation and covariance analysis. Results Blood platelet count was negatively correlated to pathological staging significantly （P=0.000）, and granulocyte count was negatively correlated to pathological grading and staging significantly （P=0.004 and 0.008）; and the other lines of blood cells count was not correlated to pathological grading and staging significantly （P〉0.05）. White blood cell count was negatively correlated to spleen longitudinal diameter and spleen vertical diameter significantly （P=0.000 and 0.003）; and blood platelet count was negatively correlated to portal vein diameter, spleen longitudinal diameter and spleen vertical diameter significantly （P=0.002, 0.000 and 0.000）; and granulocyte count was negatively correlated to spleen longitudinal diameter significantly （P=0.031）; and lymphocyte count and mid cell count were negatively correlated to portal vein diameter, spleen longitudinal diameter, spleen vertical diameter significantly （P=0.034 and 0.024, 0.002 and 0.012, 0.012 and 0.018）; and red blood cell count was not correlated to portal vein diameter, spleen longitudinal diameter and spleen vertical diameter significantly （P〉0.05）. Every line of blood cell count was not correlated to maximum oblique diameter of right liver and longitudinal diameter of left liver （P〉0.05）. According to the covariance analysis, pathological staging was the leading factor of influencing blood platelet count （P=0.000, partial eta squared=0.226）. Conclusions Splenomegaly is the leading factor of peripheral blood cells decrease in patients with chronic hepatitis, and blood platelet count is valuable for predicting fibrotic degree.