慢性乙型病毒性肝炎合并血小板减少47例患者骨髓象改变及其临床意义

Analyse platelet counts decreasing reason in 47 chronic hepatitis B patients with marrow information

目的:分析慢性乙型病毒性肝炎合并血小板减少患者骨髓象改变,探讨引起血小板减少的骨髓因素以及临床对策。方法:收集47例有骨髓标本的慢性乙型病毒肝炎患者临床资料,根据病情将患者分为慢性活动性肝炎组26例(A组)及慢性重型肝炎组21例(B组)。结果:入院时两组患者PLT、骨髓巨核细胞数量有统计学意义(t=2.853,P=0.027;t=3.587,P=0.000);两组患者骨髓均表现为增生活跃,巨核细胞成熟障碍分别占62%、67%。A组患者均康复出院,出院时血小板计数与入院时无明显差异;B组患者4例死亡,其余17例肝功能明显好转出院,出院时血小板计数与入院时比较有统计学意义(t=2.973,P=0.007)。结论:慢性乙型病毒性肝炎患者,随着肝功能进行性恶化,骨髓巨核细胞逐渐减少,伴随成熟障碍,从而导致血小板数进行性下降。动态观察患者骨髓像可以了解肝脏储备功能,预测血小板减少的发展趋势。

Objective:To study platelet counts decreasing reason in 47 chronic hepatitis B patients wih marrow information.Methods:Clincial and laboratory features of 47 chronic hepatitis B patients were Studied retrospectively.patients were classified into two groups according to their condition(26 patients in group A with chronic active hepatitis B,and 21 patients in group B with chronic severe hepatitis B).Results:platelet counts and bone marrow megakaryocyte counts of group B were significantly lower than that of patients in group A(t=2.853,P=0.027;t=3.587,P=0.000);marrow showed active proliferation in both groups;Patients with maturation arrest of megakaryocyte are 62% in group A and 67% in group B.All the patients in group A were discharged in recovery,and the platelet counts were similar between admission and discharge;There were 4 patients died in group B,the rest 17 patients were discharged in recovery,among which the platelet counts were significant different from admission to discharge(t=2.973,P=0.007).Conclusion:There are different principal factors causing decreasing of platelet counts in different stage of chronic hepatitis B patients.While Liver function get worse,bone marrow megakaryocyte counts will drop,followed with maturation arrest,thus causing decreasing of platelet counts.Persistent observation of patients' marrow information may get the message of liver reserve function,and predict thrombocytopenic tendency.