肝硬化并发肝癌患者介入术前预防性输注血小板阈值探讨

Investigation on threshold of prophylactic platelet transfusion in patients with hepatic cirrhosis and hepatocarcinoma before interventional operation

目的探讨肝硬化并发肝癌患者介入术前血小板输注的阈值及输注量。方法回顾性分析我院2013年1月1日至2015年12月31日期间因肝癌介入术预防性输注血小板患者的临床资料,比较不同阈值[(10~20)×10~9/L(A组)、(20~30)×10~9/L(B组)、(30~40)×10~9/L(C组)、(40~50)×10~9/L(D组)]四组患者输注不同剂量血小板(1 U、2 U)后介入术后的血小板(PLT)计数、凝血功能、肝功能的差异。结果不同输注阈值的患者输注1 U血小板后术后1 d和3 d的PLT计数比较差异均有统计学意义(P<0.05),而凝血功能中的凝血酶原时间(PT)、凝血酶原活动度(PTA)、部分凝血酶原时间(APTT)、凝血酶时间(TT)、国际标准化比值(INR)和纤维蛋白原(FIG)比较差异均无统计学意义(P>0.05);不同阈值的患者输注2 U血小板后术后1 d、3 d PLT计数和PTA、INR比较差异均无统计学意义(P>0.05),但术后1 d PT、APTT、TT比较差异均有统计学意义(P<0.05),术后3 d PT、FIG、TT比较差异均有统计学意义;相同阈值输注2 U血小板后术后1 d、3 d PLT计数比输注1 U血小板的患者明显提高,差异均有统计学意义(P<0.05),PTA和INR仅在阈值为(10-20)×10~9/L时差异有统计学意义(P<0.05)。结论肝硬化并发肝癌患者介入术前预防性输注血小板阈值建议是<20×10~9/L,且输注量为2 U;当输注阈值>20×10~9/L时输注1 U或者不输注。

Objective To study the thresholds and volume of platelet transfusion before interventional operation for patients suffering from hepatic cirrhosis combined with hepatocarcinoma. Methods The clinical data of patients who had received prophylactic platelet transfusion due to intervention from January 1, 2013 to December 31, 2015 were collected and retrospectively analyzed. Then, platelet count（PLT）, coagulation tests and liver function after different platelet transfusion（1 U, 2 U） in patients with four different infusion thresholds,（10-20） ×10^9L（A group）,（20-30）×10^9L（B group）,（30-40）×10^9L（C group）,（40-50） ×10^9L（D group）, were compared. Results There were significant differences in PLT counts at day 1 and day 3 after 1 U platelet transfusion in patients with different infusion thresholds（P〈0.05）; however, there was no difference in blood coagulation tests of prothrombin time（PT）, prothrombin activity（PTA）, activated partial thromboplastin time（APTT）, thrombin time（TT）, in-ternational normalized ratio（INR）, fibrinogen（FIB）（P〈0.05）. For patients who have received transfusion 2 U with different thresholds, no variation was observed in PLT count, PTA and INR at 1 d or 3 d after the operation（P〈0.05）; but significant differences could be observed in PT, TT and APTT at 1 day after operation, and in PT, TT and FIB of 3 days after operation（P〈0.05）; Compared with that of patients who had received 2 U platelet transfusion, the PLT count was significantly higher in patients with 1 U platelet transfusion（P〈0.05）, but only for patients with threshold（10-20） × 10^9/L, the differences were significant in PTA and INR（P〈0.05）. Conclusion For patients with hepatic cirrhosis combined with hepatocarcinoma, if they want to receive interventional operation, the threshold of PLT transfusion should be20×10^9L, and the amount of infusion is 2U; when PLT count20×10^9L, the amount of infusion is 1U or zero.