肝胆管结石病人血小板量及聚集性改变的临床研究

Clinical researches on changes in amount and aggregation of platelets in patients with hepatolithiasis

目的 探讨血小板在肝胆管结石病人中的病理作用及临床意义。方法 采用血小板聚集仪测定 40例肝胆管结石病人血小板量、血小板聚集率 (AGG) ,同时行肝活检术。结果 有胆道感染病史组血小板为 (6 4± 12 )× 10 9/L ,AGG为 (40 .8± 16 .4) % ,明显低于无胆道感染病史组 [分别为(2 17± 72 )× 10 9/L ,(76 .7± 17.2 ) % ,均P <0 .0 1]和正常对照组 [分别为 (2 39± 42 )× 10 9/L ,(77 8±13 0 ) % ,均P <0 0 1]。肝活检发现有胆道感染病史组有微聚物沉积于肝窦 ,部分肝细胞变性。结论 肝胆管结石病人血小板量及聚集性下降 ,可能与肝脏微聚物形成有关 ;临床测定血小板量及AGG对手术决策 ,预后估价具有重要的参考意义。

Objective To explore the pathologic role and clinical significance of platelets in patients with cholelithiasis. Methods The amounts and aggregation of platelets in venous blood were measured in 40 patients with hepatolithiasis by PPP automatic platelet aggregometer and liver biopsies were also made. Results Platelet amount was (64±12)×10 9/L and platelet aggregation rate (AGG) was (40 8±16 4)% in patients with a history of cholangitis which were remarkably lower than those in patients of the group without the history(217±72)×10 9/L and (76 7±17 2)%, respectively(all P<0 01), and of the normal control group (239±42)×10 9/L and (77 8±13 0)%, respectively (also P<0 01). It was found by liver biopsy that there were a large amount of microaggregates of platelets in liver sinusoids and a part of livers cells were degenerated. Conclusion The formation of microaggregates of platelets in liver sinusoids may be the cause for the decreasing platelet amount and AGG in patients with hepatolithiasis having a histoy of cholangitis. Clinical measurement of platelet amount and AGG plays an important reference role in operation determination and prognosis evaluation.