乙型肝炎肝硬化患者血清中血小板生成素的测定及临床意义

Detection on serum thrombopoietin levels in patients with Hepatitis B cirrhosis and it′s clinic significance

目的探讨血小板生成素(TPO)在乙型肝炎肝硬化患者血清中的水平变化,以明确肝硬化患者血小板计数(PLT)减少的原因。方法选取40例乙型肝炎肝硬化患者(Child-Pugh A级15例、Child-Pugh B级15例、Child-Pugh C级10例),另选取20例年龄和性别与肝硬化组相匹配的健康人作为对照组。入院后空腹采血,离心分离血清;用酶联免疫吸附试验(ELISA)检测血清TPO含量;同时检测血常规、白蛋白(ALB)、总胆红素(TBIL)及凝血酶原活动度(PTA)水平;脾脏B型超声由同一医师在相同条件下由同一超声仪测量。结果肝硬化组PLT低于健康对照组,脾脏厚度高于健康对照组,差异均有统计学意义(P<0.05)。肝硬化组TPO水平与健康对照组比较差异无统计学意义(P>0.05)。Child-Pugh分级A、B、C级组PLT均低于健康对照组,脾脏厚度均高于健康对照组,B、C级组TPO均低于A级组、健康对照组;A级组TPO、PLT均高于B、C级组,脾脏厚度均低于B、C级组,差异均有统计学意义(P<0.05)。总体上,随着肝功能的下降,TPO与PLT、ALB、PTA呈正相关(r值分别为0.498、0.619、0.766,P<0.01),TPO与TBIL呈负相关(r=-0.641,P<0.01),脾脏厚度与PLT呈负相关(r=-0.587,P<0.01)。结论血清TPO水平下降和脾脏肿大可能是血小板减少的主要原因。血清TPO水平可以作为反映肝功能的指标。

Objective To assess the change of serum thrombopoietin（TPO） level in patients with Hepatitis B cirrhosis.In order to make clear the reason ofplatelet decreaced in patients with Hepatitis B cirrhosi.Methods Selected 40 cases of Hepatitis B cirrhosis patients（Chi1d-Pugh A,15cases;Child-Pugh B,15 cases;Child-Pugh C,10 cases） as experimental group and 20 healthy volunteers as control group.Serum TPO level was detected by ELISA（enzyme linked immunosorbent assay）.Meanwhile,routine blood tests,serum levels of ALB,TBIL and PTA were tested.Spleen color Doppler ultrasound was measured by the same doctor under the same conditions.Results In cirrhosis group PLT was lower than that of healthy controls,while the spleen thickness was higher than those in the control group,the differences were statistically significant（P0.05）.No significant difference was noted in serum TPO level between the control group and the cirrhosis group（P0.05）.The PLT of class A,B,C groups were lower than those of healthy controls.The spleen thickness of class A were higher than those in the control group.The serum TPO levels of class B and C were lower than those of class A and the healthy control group.The TPO and PLT of the class A were higher than those of class B,C.The spleen thickness of class A was lower than those of class B,C,all differences were statistically significant（P0.05）.Overall,TPO and PLT,ALB,PTA was positively correlated with the decline in liver function（r=0.498,0.619,0.766,P0.01）.TPO was negatively correlated with TBIL.Spleen thickness was negatively correlated with PLT（r=-0.587,P0.05）.Conclusion Reduction in the level of serum TPO and spleen enlargement may be the main reason for thrombocytopenia.Serum TPO can be used as parameters for evaluation of liver function.