普萘洛尔治疗肝硬化血小板减少症的临床意义

The clinical significance of propranolol in the treatment of thrombocytopenia in patients with cirrhosis

目的探讨普萘洛尔治疗肝硬化血小板减少症的临床意义。方法21例肝硬化血小板减少症患者纳入本研究,所有患者均于清晨空腹使用彩色多谱勒血流显像(CDFI)及多普勒能量图(CDE)测脾内、外动脉搏动指数,同时用全自动血细胞分析仪测定血小板计数、酶联免疫吸附实验测定血小板相关性免疫球蛋白G(PAIgG)及放射免疫分析法测定血小板生成素(TPO)。随机分为两组,实验组给予普萘洛尔治疗一周后,重复上述检查。结果普萘洛尔治疗前后外周血血小板计数值分别为47±5×109/L和63±8×109/L;血小板计数变化值与脾内、外动脉搏动指数变化值存在正相关,r分别为0.78和0.74,P<0.05;治疗前后PAIgG、TPO与对照组比无明显差异(P>0.05)。结论普萘洛尔可能通过改变脾脏的血流动力学而改善肝硬化患者血小板减少症。

Objective To explore the clinical significance of propranolol in the treatment of thrombocytopenia in patients with cirrhosis. Methods 21 patients with cirrhosis and thrombocytopenia （fewer than 70× 10^9/L） were included. All of them were studied in the morning after an overnight fast. The pulsatility index of intrasplenic and extrasplenic artery were measured by Doppler uhrasonography. Platelet counts were determined by auto blood cell analyzer and platelet -associated immunoglobulin G and thrombopoietin levels were detected by ELISA and RIA, respectively. Then, the subjects were divided into 2 groups randomly. Propranolol was administrated to experiment group. The measurements were repeated after 1 week. Results Propranolol administration significantly increased the platelet count （from 47±5×10^9/L to 63 ±8 ×10^9/L, p〈0.05） and the change in platelet count was significantly correlated with either the change in intrasplenic artery pulsatility index （r=0. 78, p〈0. 05） or the change in extrasplenic artery pulsatility index （r= 0. 74, p〈 0. 05）. Platelet-associated immunoglobulin G and thrombopoietin levels were not modified in either of the 2 groups （p〉0. 05）. Conclusions Propranolol can ameliorate thrombocytopenia in patients with cirrhosis. This effect may be due mainly to hemodynamic changes in the spleen.