慢性乙型肝炎患者外周血小板参数与肝脏组织病理的相关性分析

摘要/Abstract

摘要： 目的探讨外周血小板参数在CHB患者肝脏组织病理无创性评估中的价值。方法前瞻性对787例CHB患者进行血常规检查,记录血小板的相关参数,同时进行肝组织病理学检查。计数资料采用卡方检验;正态分布计量资料采用t检验。两组计量资料之间的相关性分析采用Spearman相关分析,多因素分析采用Logistic逐步回归。结果不同肝脏组织炎症活动度和纤维化程度组在样本量及性别分布上差异均有统计学意义(均P＜0.01);在年龄差异上也有统计学意义(P=0.037、0.01)。不同炎症活动度和纤维化程度组在PLT、MPV、PDW的差异均有统计学意义(t分别为-5.993、3.208、-3.344和-6.955、5.812、-6.503,均P＜0.05)。肝组织炎症活动度与PLT、PCT、PDW呈负相关(r=-0.37、-0.16、-0.25,均P＜0.01),与MPV呈正相关(r=0.22,P<0.01);肝纤维化程度与PLT、PCT、PDW呈负相关(r=-0.37、-0.15、-0.17,均P＜0.01),与MPV呈正相关(r=0.22,P<0.01)。Logistic多元回归分析显示PLT(OR:0.987,P=0.008)、PDW(OR:0.833,P=0.01)为影响肝脏炎症活动度的独立预测因素;年龄(OR:1.017,P=0.049)、PLT(OR:0.989,P<0.01)、PDW(OR:0.801,P<0.01)为影响肝脏纤维化程度的独立预测因素。结论外周血小板参数与CHB患者的肝脏组织炎症、纤维化程度存在一定的相关性,为临床评估肝脏组织炎症、纤维化情况、创建肝脏组织病理评估的无创模型提供了一项简便、有用的观测指标。

关键词: 肝炎,乙型, 血小板, 病理学, 相关因素, 分析

Abstract: Objective To explore the value of platelet parameters in peripheral blood during the noninvasive assessment of liver pathology in patients with CHB. Methods A total of 787 patients with CHB were enrolled in the study. All the patients were undergone blood routine test examination and liver biopsy. The platelet parameters in peripheral blood were recorded at the same time. Apply SPSS 19.0 statistical software for data analysis. Categorical data were analyzed by Chi-square test.Normal distribution measurement data were analyzed by t-test. The relationship between the platelet parameters and the degree of liver pathology was calculated by Spearman correlation analysis and Logistic regression analysis. Results There were significant differences between different genders concerning the degree of liver pathology inflammation and fibrosis (P<0.01); similar difference existed among patients with different age groups (P=0.037, 0.01). Platelet parameters including PLT, MPV, PDW were significantly different among patients with different degree of liver pathology(t=-5.993,3.208,-3.344 and -6.955,5.812,-6.503,P<0.05). PLT, PCT, PDW were negatively related to(r=-0.37, -0.16, -0.25, P<0.01),and MPV was positively related to(r=0.22,P<0.01) the degree of liver inflammation; PLT, PCT, PDW were negatively related to the degree of liver fibrosis (r=-0.37, -0.15, -0.17,P<0.01),while MPV was positively related to it(r=0.22,P<0.01). Logistic multivariate regression analysis indicated that PLT(OR:0.987, P=0.008), PDW(OR:0.833, P=0.01)were independent predictors for the degree of liver inflammation; age (OR:1.017, P=0.049)、PLT(OR:0.989, P<0.01)、PDW(OR:0.801, P<0.01) were independent predictors for the degree of liver fibrosis. Conclusion There is a certain correlation between platelet parameters in peripheral blood and the liver pathology in patients with CHB includingthe degree of inflammation and fibrosis. They can be applied as an easy and useful method to assess the degree of liver pathology.

Key words: Hepatitis B, Platelet, Pathology, Correlation factor, Analysis

欧宏杰, 潘业, 刘家俊, 吴晓鹭. 慢性乙型肝炎患者外周血小板参数与肝脏组织病理的相关性分析[J]. 肝脏, 2016, 21(11): 915-919.

OU Hong-jie, PAN Ye, LIU Jia-jun, WU Xiao-lu. Correlation analysis between parameter of platelet in peripheral blood and liver pathological of patients with chronic hepatitis B[J]. Chinese Hepatolgy, 2016, 21(11): 915-919.

参考文献

[1] 中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2015更新版).肝脏,2015,20:915-932.
[2] Lok AS, McMahon BJ. Chronic hepatitis B: update 2009.Hepatology, 2009, 50: 661-662.
[3] Colloredo G,Guido M,Sonzogni A,et al.Impact of liver biopsy size on histological evaluation of chronic viral hepatitis:the smaller the sample,the milder the disease.J Hepatol,2003,39:239-244.
[4] Ceylan B,Fincanci M,Yardimci C,et al. Can mean platelet volume determine the severity of liver fibrosis or inflammation in patients with chronic hepatitis B.Eur J Gastroenterol Hepatol,2013, 25: 606-612.
[5] 中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2010年版).肝脏,2011,16:2-16.
[6] 朱大年,王庭槐. 生理学. 第8版.北京:人民卫生出版社,2013:68-71.
[7] 中华医学会传染病与寄生虫病学分会,中华医学会肝病学分会.病毒性肝炎防治方案.中华传染病杂志,2001,19:56-62.
[8] Sakaguchi S,Sakaguchi N,Asano M,et al.Immunologic self-tolerance maintained by activated T cells expressing IL-2 receptor alpha-chains(CD25).Breaddown of a single mechanism of self-tolerancecauses various autoimmune diseases.J Immunol,1995,155: 1151-1164.
[9] Fu JL,Xu DP,Zhang P,et al.The characterization of regulatory T cells in peripheral blood of HBV-infected patients.Zhonghua Yi Xue Za Zhi,2006,86: 1522-1525.
[10] 庄鹏,王湘郴,罗国辉,等.慢性乙型肝炎患者外周血CD4⁺CD25⁺ Fox P3⁺ Treg及HBV抗原特异性CTLs检测的分析.中国病理生理杂志, 2011,27:1786-1789.
[11] Franzese O, Kennedy PT, Gehring AJ, et al. Modulation of the CD8+-T-cell response by CD4⁺ CD25⁺ regulatory T cells in patients with hepatitis B virus infection. J Virol, 2005, 79: 3322-3328.
[12] 邓茜,肖影群,邹正宇,等.慢性乙型肝炎患者抗病毒治疗前后CD4⁺CD25⁺ Fox P3⁺调节性T细胞的变化.广东医学,2012,33:2592-2595.
[13] Franzese O,Kenmedy DT,Gehring AJ,et al.Modulation of CD8⁺ T-cell response by CD4⁺ CD25⁺ regulatory T cells in patients with hepatitis B virus infection.J Virol,2005, 79: 3322-3328.
[14] Sakaguchi S.Naturally arising CD4⁺ regulatory T cells for immunologic self-tolerance and negative control of immune responses.Annu Rev Immunol,2004,22:531-562.
[15] 莫莉,许礼发.调节性T细胞与风湿性疾病.中华临床医师杂志(电子版),2011,5:3277-3280.
[16] 贾瑞萍,赵雪芸.自身免疫性血小板减少性紫癜患者外周血中CD4⁺CD25⁺ 调节性T细胞、sFas和sFasL的表达及临床意义.中国实验血液学杂志,2011,19:1264-1267.
[17] Fahin NM,Monir E.Functional role of CD4⁺ CD25⁺ regulatory T cells and transforming growth factor-betal in childhood immune thrombocytopenic purpura.Egypt J Immunol,2006,13:173-187.
[18] Wai CT,Greenson JK,Fontana RJ,et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patient with chronic hepatitis C.Hepatology,2003, 38: 518-526.
[19] Forns X,Ampurdanes S,Llovet J M,et al.Identification of chronic hepatitis C patients without hepatic fibrosis by a simple predictive modle.Hepatology,2002, 36(4 Pt 1): 986-992.
[20] Imbert BF,Ratziv V,Pieroni L,et al. Biochemical markers of liver fibrosis in patientas with hepatitis C virus infection: a prosoective study.Lancet,2001,357: 1069-1075.
[21] Koda M,Matunaga Y,Kawakami M,et al. FibroIndex: a parctical index for predicting significant fibrosis in patients with chronic hepatitis C.Hepatology,2007,45: 297-306.
[22] Lee C M,Leung T K,Wang H J,et al.Evaluation of the effect of partial splentic embolization on platelet values for liver cirrhosis patients with thrombocytopenia.World J Gastroenterol,2007,13: 619-622.
[23] Laffi G,Mana F,Gresele P,et al.Evidence for a storage pool defect in platelets from cirrhotic patients with defective aggregation.Gastroenterology,1992,103: 641-646.