脾切除术治疗Wilson病合并脾亢患者的血液学改变及临床疗效

Hematological changes and clinical efficacy of splenectomy in treatment of Wilson's disease with hypersplenism

目的探索Wilson病(WD)合并脾功能亢进患者血液肝功能等指标与其脾脏大小相关性,及脾脏切除的临床疗效。方法回顾性分析2018年1月至2021年12月在安徽中医药大学神经病学研究所附属医院住院的63例行脾切除术的WD患者的临床资料,并收集行脾切除术前、后的病例资料,采用Spearman相关性分析脾切除前后血液肝功能等指标与脾脏大小相关性。结果采用Spearman相关性分析法得出脾脏厚度与PLT(r=-0.54,P<0.001)呈负相关,与PT(r=0.28,P=0.026)、SOD(r=0.28,P=0.028)、TBA(r=0.30,P=0.017)、TBIL(r=0.36,P=0.004)呈正相关。脾脏长度与PLT(r=-0.37,P=0.003)呈负相关、与TBA(r=0.28,P=0.025)呈正相关。WD患者脾切除后SOD、ALB、PLT水平较术前升高,PT以及TBIL水平较术前下降,差异有统计学意义(P<0.05)。结论脾切除术对WD合并脾亢患者的PLT下降具有改善作用,可部分改善肝脏的解毒、代谢、合成等功能指标,并对改善凝血功能具有积极影响。

Objective To explore the correlation between blood liver function and spleen size in patients with Wilson′s disease(WD)and hypersplenism,and to analyze the changes before and after splenectomy.Methods A retrospective analysis was performed in 63 WD patients who underwent splenectomy in the Affiliated Hospital of the Institute of Neurology,Anhui University of Traditional Chinese Medicine from January 2018 to December 2021,and case data before and after splenectomy were collected to observe and compare the correlation between blood liver function and spleen size before and after splenectomy using Spearman correlation analysis.Results It was found that spleen thickness was negatively correlated with PLT(r=-0.550,P<0.001),and positively correlated with PT(r=0.270,P=0.032),SOD(r=0.280,P=0.029),TBA(r=0.300,P=0.017),and TBIL(r=0.350,P=0.005).The length of the spleen was negatively correlated with PLT(r=-0.370,P=0.003)and positively correlated with TBA(r=0.290,P=0.024).After splenectomy,the levels of SOD,ALB,and PLT in WD patients increased compared to those before surgery,while the levels of PT and TBIL decreased compared to those before surgery,with statistically significant differences(P<0.05).Conclusion Splenectomy has an ameliorating effect on the decrease of PLT in WD patients with hypersplenism,partially improving liver detoxification,metabolism,synthesis and other functional indicators,and has a positive impact on improving coagulation function.