血小板减少是急性胆管炎的危险信号

Thrombocytopenia is a danger signal of acute cholangitis

目的探讨血小板减少在急性胆管炎患者中的提示意义。方法回顾性分析2020年6月至2021年6月于首都医科大学附属北京友谊医院急诊科收治的77例急性胆管炎患者的临床资料。77例急性胆管炎患者根据血小板指标是否≥125×10^(9)/L分为两组,即血小板正常组(≥125×10^(9)/L)患者59例和血小板减少组(<125×10^(9)/L)患者18例。观察两组患者血象指标(包括白细胞计数、中性粒细胞绝对值、血红蛋白计数、血小板计数)、生化指标[包括天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、总胆红素、直接胆红素、间接胆红素、乳酸脱氢酶、淀粉酶)]、感染指标(包括C-反应蛋白、降钙素原)、是否存在休克、是否应用血管活性药物治疗、是否存在精神神经症状、住院天数等指标。结果血小板减少组患者在白细胞升高(33.33%vs.20.34%)、中性粒细胞升高(38.89%vs.37.29%)、血红蛋白减低(33.33%vs.23.73%)、ALT升高(88.89%vs.81.36%)、总胆红素升高(94.44%vs.76.27%)、直接胆红素升高(100.0%vs.77.97%)、间接胆红素升高(83.33%vs.72.88%)、C-反应蛋白升高(94.44%vs.79.66%)、降钙素原升高(73.33%vs.57.69%)、乳酸脱氢酶升高(38.89%vs.25.42%)、淀粉酶升高(44.44%vs.29.31%)、存在精神神经症状(5.56%vs.1.69%)等方面的比率高于血小板正常组患者,但差异无统计学意义(P>0.05);血小板减少组患者在AST升高(94.44%vs.66.10%)、出现休克(33.33%vs.1.69%)、应用血管活性药物治疗(22.22%vs.1.69%)等的比率均高于血小板正常组患者,差异均有统计学意义(P<0.05)。血小板减少组患者AST、C-反应蛋白及降钙素原高于血小板正常组患者(170.65U/Lvs.49.00U/L、111.67±85.19mg/Lvs.68.70±68.93mg/L、3.18ng/mLvs.0.65 ng/mL),差异均有统计学意义(P<0.05)。结论对于急性胆管炎患者,出现血小板减少时,需要警惕存在感染的可能。血小板减少也提示着疾病可能更加凶险。

Objective To explore the significance of thrombocytopenia in patients with acute cholangitis.Methods The clinical information of 77 patients with acute cholangitis treated in the Department of Emergency,Beijing Friendship Hospital,Capital Medical University from June 2020 to June 2021 were analyzed retrospectively.According to whether platelet index≥125×10^(9)/L in 77 patients with acute cholangitis was divided into two groups,normal platelet group(≥125×10^(9)/L)59 patients and thrombocytopenia group(<125×10^(9)/L)18 patients.The observation indexes included hemogram indexes(including leukocyte count,absolute value of neutrophils,hemoglobin count and platelet count),biochemical indexes(including aspartate aminotransferase(AST),alanine aminotransferase(ALT),total bilirubin,direct bilirubin,indirect bilirubin,lactate dehydrogenase and amylase),infection indexes(including C-reactive protein and procalcitonin),whether there is shock,whether vasoactive drugs are used,whether there are psychoneurological symptoms,length of hospital stay and other indicators.Results The proportion elevated leukocytes(33.33%vs.20.34%),elevated neutrophils(38.89%vs.37.29%),decreased hemoglobin(33.33%vs.23.73%),elevated alanine aminotransferase(88.89%vs.81.36%),elevated total bilirubin(94.44%vs.76.27%),elevated direct bilirubin(100.0%vs.77.97%),elevated indirect bilirubin(83.33%vs.72.88%),elevated C-reactive protein(94.44%vs.79.66%),elevated procalcitonin(73.33%vs.57.69%),elevated lactate dehydrogenase(38.89%vs.25.42%),elevated amylase(44.44%vs.29.31%),psychoneurological symptoms(5.56%vs.1.69%)of patients in thrombocytopenia group were higher than those in the normal platelet group,but the difference was not statistically significant(P>0.05);the proportion of patients in thrombocytopenia group was higher than those of patients with normal platelet in the following aspects:elevated aspartate aminotransferase(94.44%vs.66.10%),shock(33.33%vs.1.69%),treatment with vasoactive drugs(22.22%vs.1.69%),were higher than those in the normal platelet group,and the differences were statistically significant(P<0.05).The levels of AST,C-reactive protein and procalcitonin in the thrombocytopenia group were higher than those in the normal platelet group(170.65 U/L vs.49.00 U/L,111.67±85.19 mg/L vs.68.70±68.93 mg/L,3.18 ng/mL vs.0.65 ng/mL),the difference was statistically significant(P<0.05).Conclusion For patients with acute cholangitis,when thrombocytopenia occurs,we need to be alert to the possibility of infection.Thrombocytopenia also suggests that the disease may be more dangerous.