肝炎肝硬化合并免疫性血小板减少症临床特点分析(附8例报道)

张世斌; 王征; 米军; 吴燕京; 金瑞

肝炎肝硬化合并免疫性血小板减少症临床特点分析(附8例报道)

首都医科大学附属北京佑安医院

详细信息

中图分类号: R575.2
计量
- 文章访问数: 260
- HTML全文浏览量: 15
- PDF下载量: 123
- 被引次数: 0
出版历程
- 出版日期: 2011-08-20

The analysis of the clinical characteristics of patients with liver cirrhosis and immune thrombocytopenia

摘要

摘要: 目的总结分析肝炎肝硬化血小板明显下降患者的临床表现及其原因,藉此探讨和交流诊治经验。方法对8例肝炎肝硬化合并进行性血小板下降的患者,回顾分析其肝功能指标、凝血指标及免疫学指标以及各指标之间的相关性。结果 8例患者血小板进行性下降与其肝硬化严重程度不成比例,并能够除外严重感染、弥漫性血管内凝血、再生障碍性贫血、淋巴瘤、血栓性血小板减少性紫癜等血液系统疾病,抗血小板抗体阳性,诊断为免疫性血小板减少症,应用丙种球蛋白、激素治疗后血小板明显升高。结论肝炎肝硬化患者血小板短期内明显下降时,应考虑合并免疫性血小板减少症,并予以相应的治疗。
- 血小板减少 /
- 自身免疫疾病 /
- 肝炎,病毒性,人 /
- 肝硬化
Abstract: Objective To summarize and analyze the clinical manifestations of cirrhotic patients with severe thrombocytopenia and its underlying etiology.Methods Eight patients of post-hepatitic cirrhosis with progressive thrombocytopenia were involved in our study and their liver function indexes, prothrombin activity, antiplatelet antibody and bone marrow biopsy results were retrospectively analyzed.Results The decrease of the platelet number was not in proportion to the degree of cirrhosis in the eight patients with cirrhosis developed thrombocytopenia, out of proportion to their liver disease.They were diagnosed as immune thrombocytopenia (ITP) based on positive anti-platelet antibody and exclusion of severe infection, disseminated intravascular coagulation, aplastic anemia, lymphoma, thrombotic thrombocytopenic purpura et al.The number of platelet obviously increased with the treatment of immunoglobulin and corticosteroids.Conclusion Immune thrombocytopenia must be considered and treated in the post-hepatitic cirrhosis patients when the platelets decreased markedly in a short-term.
- thrombocytopenia /
- autoimmune diseases /
- hepatitis /
- viral

HTML全文

参考文献(15)

[1]Poordad F.Review article:thrombocytopenia in chronic liver disease[J].Aliment Pharmacol Ther, 2007, 26 (Suppl 1) :5-11.

[2]Afdhal N, McHutchison J, Brown R, et al.Thrombocytopenia asso-ciated with chronic liver disease[J].J Hepatol, 2008, 48 (6) :1000-1007.

[3]Rodeghiero F, Stasi R, Gernsheimer T, et al.Standardization of ter-minology, definitions and outcome criteria in immune thrombocytope-nic purpura of adults and children:report from an international work-ing group0[J].Blood, 2009, 113 (11) :2386-2393.

[4]Toghill PJ, Green S, Ferguson F.Platelet dynamics in chronic liverdisease with special reference to the role of the spleen[J].J ClinPatho, 1977, 30 (4) :367-371.

[5]Aster RH.Pooling of platelets in the spleen:role in the pathogenesiso‘fhypersplenic’thrombocytopenia[J].J Clin Invest, 1966, 45 (5) :645-657.

[6]Kajihara M, Okazaki Y, Kato S, et al.Evaluation of platelet kineticsin patients with liver cirrhosis:Similarity to idiopathic thrombocyto-penic purpura[J].J Gastroenterol Hepatol, 2007, 22 (1) :112-118.

[7]Blonski W, Siropaides T, Reddy KR.Coagulopathy in liver disease[J].Curr Treat Options Gastroenterol, 2007, 10 (6) :464-473.

[8]Giannini EG.Review article:thrombocytopenia in chronic liver dis-ease and pharmacologic treatment options[J].Aliment Pharmacol T-her, 2006, 23 (8) :1055-1065.

[9]Eissa LA, Gad LS, Rabie AM, et al.Thrombopoietin level inpatients with chronic liver diseases[J].Ann Hepatol, 2008, 7 (3) :235-244.

[10]Giannini EG, Savarino V.Thrombocytopenia in liver disease[J].CurrOpin Hematol, 2008, 15 (5) :473-480.

[11]Pereira J, Accatino L, Alfaro J, et al.Platelet autoantibodies in pa-tients with chronic liver disease[J].Am J hematol, 1995, 50 (3) :173-178.

[12]Pockros PJ, Duchini A, McMillan R, et al.Immune thrombocytope-nic purpura in patients with chronic hepatitis C virus infection[J].JGastroenterol, 2002, 97 (8) :2040-2045.

[13]王兆钺.免疫性血小板减少性紫癜的发病机制与临床研究进展[J].中国免疫学杂志, 2009, 25 (12) :1141-1144.

[14]Sekiguchi T, Nagamine T, Takagi H, et al.Autoimmune thrombocyto-penia in response to splenectomy in cirrhotic patients with accompanyinghepatitis C[J].World J Gastroenterol, 2006, 12 (8) :1205-1210.

[15]Aref S, Sleem T, El Menshawy N, et al.Antiplatelet antibodiescontribute to thrombocytopenia associated with chronic hepatitis C vi-rus infection[J].Hepatology, 2009, 14 (5) :277-281.

施引文献

资源附件(0)

访问统计