Thrombocytopenia as a Strong Indicator of Liver Fibrosis in Chronic Liver Disease Patients from Areas Hyperendemic for Hepatitis B and C Virus Infection

血小板低下可以做為B型與C型肝炎高盛行地區慢性肝炎病患肝臟纖維化之強指標

蘇志盛(Chih-Sheng Su) ； 胡瀞之(Ching-Chih Hu) ； 簡榮南(Rong-Nan Chien) ； 李宗實(Tsung-Shih Lee) ； 嚴卓立(Cho-Li Yen) ； 錢政弘(Cheng-Hung Chien) ； 林志郎(Chih-Lang Lin)

《臺灣消化醫學雜誌》 30卷4期 (2013/12) Pp. 290-299

https://doi.org/10.6557/GJT.201312_30(4).0001

摘要

背景與目的：血小板低下是肝臟纖維化或肝硬化病人身上最常見的血液檢查異常，本研究的目的在探討B型與C型肝炎高盛行地區慢性肝炎病患周邊血液血小板數量與肝臟纖維化程度的相關性。材料與方法：我們研究337位接受過經皮經肝穿刺檢查的病人，分析其臨床表現、實驗室數據與病理報告，且與周邊血液血小板數量做關聯性分析。結果：在肝臟纖維化或肝硬化病人身上血小板低下是常見的，且周邊血液血小板數量會明顯下降，單變項與多變項迴歸分析顯示高的肝臟纖維化分數（風險率-8.983；95%信賴區間-13.641至-4.324）、年紀較大（風險率-1.362；95%信賴區間-2.058至-0.667）、無脂肪肝（風險率6.995；95%信賴區間0.125至13.866）、脾臟腫大（風險率-2.647；95%信賴區間-3.682至-1.613）、與白血球低下皆與周邊血液血小板數量下降獨立相關，其中最特別的是血小板數量與肝臟纖維化程度的反向性相關，因此肝臟纖維化與肝硬化可以使用血小板數量低於189,500與149,500細胞/μL來預測（準確率0.644與0.807）。結論：血小板低下在肝臟纖維化或肝硬化病人身上是常見且嚴重的，所以我們建議應該密切追蹤周邊血液血小板數量來預防出血的風險，尤其是在合併年紀大、無脂肪肝、脾臟腫大與白血球低下的病人。

關鍵字

血小板低下 ； 肝臟纖維化 ； B型肝炎病毒 ； C型肝炎病毒

並列摘要

Background and Aims: Thrombocytopenia is likely the most common hematological abnormality diagnosed in patients with significant liver fibrosis or cirrhosis. The objective of this study was to investigate the relationship between peripheral platelet count and degree of fibrosis in patients with chronic liver disease in a hyperendemic area for hepatitis B and C virus infection.Materials and Methods: We studied 337 consecutive patients who underwent percutaneous liver biopsy. Clinical, laboratory, and histological features were measured and correlated with peripheral platelet counts.Results: Thrombocytopenia was common and peripheral platelet count was significantly decreased in patients with significant liver fibrosis or cirrhosis. Univariate and multivariate regression analyses revealed that a high liver fibrosis score (odds ratio [OR], -8.983; 95% confidence interval [95% CI], -13.641 to -4.324), advanced age (OR, -1.362 ; 95% CI, -2.058 to -0.667), absence of fatty liver (OR, 6.995; 95% CI, 0.125 to 13.866), presence of splenomegaly (OR, -2.647; 95% CI, -3.682 to -1.613), and a low serum WBC count are independently associated with decreased platelet count. Notably, because of a significant inverse correlation between platelet count and stage of liver fibrosis, significant liver fibrosis and cirrhosis could be predicted by a peripheral platelet count below 189,500 and 149,500 cells/μL, with 0.644 and 0.807 accuracy, respectively.Conclusions: Thrombocytopenia is common and severe in patients with significant liver fibrosis or cirrhosis. Therefore, we advocate close monitoring of platelet count to prevent the risk of bleeding, especially in patients with advanced age, without fatty liver, with splenomegaly, and with a low serum WBC count.

並列關鍵字

thrombocytopenia ； liver fibrosis ； HBV ； HCV