应用重组人血小板生成素减少肝硬化患者术前血小板输注疗效初步研究

Administration of recombinant human thrombopoietin before operation in patients with liver cirrhosis and hepatocellular carcinoma and thrombocytopenia

目的以输注血小板改善肝硬化并发血小板减少症患者出血风险的疗效不确切,且可能导致潜在的并发症。本研究的目的是探讨应用重组人血小板生成素注射液(rhTPO)能否减少肝硬化患者术前输注血小板。方法2017年1月~2019年4月在西京医院消化内科住院并进行手术治疗的乙型肝炎肝硬化患者40例和肝细胞癌患者36例,均需行食管静脉曲张套扎和/或胃底静脉曲张组织胶注射术或经肝动脉化疗栓塞术(TACE)治疗。术前给予rhTPO 15000U皮下注射,1次/d,连续应用10 d。结果在76例患者中,血小板计数为40~50×10^9/L组23例,血小板计数<40×10^9/L组53例;两组患者在治疗第8 d时,外周血血小板计数较基线明显升高[>50×10^9/L,分别为(76.0±26.6)×10^9/L和(54.4±24.3)×10^9/L]。在治疗第12 d,两组外周血血小板计数达到高峰[分别为(95±34.8)×10^9/L和(67.9±25.1)×10^9/L],在治疗后第30 d,血小板计数降至基线水平;应用rhTPO治疗后,保证了手术的顺利进行,对血凝功能无明显影响,两组未观察到门静脉血栓形成。结论rhTPO可作为肝硬化并发血小板减少症患者术前血小板输注的替代疗法,能降低术中出血风险,且安全,值得临床进一步验证。

Objective The efficacy of platelet transfusions in increasing platelet counts is variable and may be associated with side effects.The aim of this study was to investigate whether the administration of recombinant human thrombopoietin(rhTPO)could reduce preoperative blood transfusion in patients with liver cirrhosis and hepatocellular carcinoma(HCC)and thrombocytopenia.Methods 40 patients with liver cirrhosis and thrombocytopenia and 36 patients with HCC and thrombocytopenia were recruited in XiJing Hospital From January 2017 through April 2019,and they underwent operations such as esophageal variceal ligation or endoscopic gastric varices tissue adhesive injection for gastroesophageal varices or transcatheter arterial chemoembolization or microwave ablation for cancers.Before operation,the rhTPO was administered once daily for 12 days.Results Of the 76 patients,23 patients had peripheral platelet count at 40-50×10^9/L,and 53 patients had it at<40×10^9/L;the blood platelet counts in the two groups increased significantly on the 8th day of treatment[>50×10^9/L,(76.0±26.6)×10^9/L and(54.4±24.3)×10^9/L,respectively],peaked on the 12th day[(95±34.8)×10^9/L and(67.9±25.1)×10^9/L,respectively],and dropped to the baseline levels at 30 th days[(42.3±5.3)×10^9/L and(23.5±4.6)×10^9/L,respectively];the administration of rhTPO had no side effects on blood coagulation parameters and no portal vein thrombosis was found in the two groups.Conclusion The application of rhTPO could be as an alternative therapy for preoperative platelet transfusion in patients with thrombocytopenia and liver diseases,with the ability to reduce risk of intraoperative bleeding,which needs further study.