慢性乙型肝炎病毒感染患者的血小板计数与肝损伤的严重程

StephenW

Platelet Count Is Closely Associated With the Severity of Liver Injury in Patients With Chronic Hepatitis B Virus Infection: A Cross-Sectional Study
Ya-Ting Yang  1   2 , Li-Li Wang  3 , Li-Ting Yan  1   2 , Li-Ting Zhang  1 , Wei Zhou  2 , Qing-Feng Chen  1 , Yu Chen  4 , Su-Jun Zheng  4 , Zhong-Ping Duan  4 , Jun-Feng Li  1   2
Affiliations

    PMID: 32550883 PMCID: PMC7296297 DOI: 10.3892/etm.2020.8703

Abstract

Although the platelet count may provide clues regarding the severity of liver disease, there are currently no available data supporting the utility of the platelet count to evaluate the degree of liver injury in patients with chronic hepatitis B virus (HBV) infection. The present study aimed to determine the association between the platelet count and the severity of liver injury in patients with chronic HBV infection. A total of 941 patients were included and were stratified into a Child-Turcotte-Pugh (CTP) class A group and a CTP class B/C group using the CTP scoring system. A total of 53 patients underwent liver biopsy. The pathological stage F4 was defined as cirrhosis based on the METAVIR scoring system. Compared with that in patients with CTP class A, the platelet count in patients with CTP class B/C was lower (P<0.001). Similarly, for patients with normal alanine aminotransferase (ALT) levels, the platelet count was significantly different between the CTP class B/C and A groups (P<0.001). The platelet count was inversely correlated with the CTP score (r=-0.420, P<0.001) and independently associated with CTP grade B/C [odds ratio (OR), 0.994; 95% CI, 0.990-0.999; P=0.009]. The area under the receiver operating characteristic curve (AUC) of the platelet count to distinguish CTP grade B/C from A was 0.712 and 0.791, respectively, in all patients with HBV infection and the subset with normal ALT levels. In addition, compared to patients with chronic hepatitis B, patients with cirrhosis had a lower platelet count and higher aspartate transaminase-to-platelet ratio index (APRI) and fibrosis index based on four factors (FIB-4) (P<0.001). The platelet count was inversely correlated with FIB-4 (r=-0.855, P<0.001) and APRI (r=-0.741, P<0.001). The AUC for the platelet count to distinguish cirrhosis from chronic hepatitis B was 0.927 (sensitivity, 78.76%; specificity, 92.22%). Among patients who underwent liver biopsy, the platelet count in those with F4 was lower compared with that in patients with ≤F3 (P=0.013). The platelet count was inversely correlated with the pathological stage (r=-0.295, P=0.032) and was independently associated with F4 (OR, 0.978; 95% CI, 0.960-0.997; P=0.026). The AUC of the platelet count to distinguish F4 from patients with ≤F3 was 0.761. In conclusion, the platelet count may be used as a non-invasive marker to assess the severity of liver injury and of liver fibrosis in patients with chronic HBV infection.

Keywords: chronic hepatitis B virus infection; liver fibrosis; liver injury; platelet count.

StephenW

慢性乙型肝炎病毒感染患者的血小板计数与肝损伤的严重程度密切相关：一项跨领域研究
杨亚婷1 2，王丽丽3，严丽婷1 2，张丽婷1，周伟2，陈庆丰1，陈宇4，郑素君4，段仲平4，李俊峰1 2
隶属关系

    PMID：32550883 PMCID：PMC7296297 DOI：10.3892 / etm.2020.8703

抽象

尽管血小板计数可以提供有关肝病严重程度的线索，但目前尚无可用数据支持血小板计数在评估慢性乙型肝炎病毒（HBV）感染患者肝损伤程度方面的实用性。本研究旨在确定慢性HBV感染患者血小板计数与肝损伤严重程度之间的关系。总共纳入了941名患者，并使用CTP评分系统将其分为Child-Turcotte-Pugh（CTP）A组和CTP B / C C组。共有53例患者进行了肝活检。根据METAVIR评分系统，将病理分期F4定义为肝硬化。与CTP A级患者相比，CTP B / C级患者的血小板计数更低（P <0.001）。同样，对于丙氨酸氨基转移酶（ALT）水平正常的患者，CTP B / C级和A组之间的血小板计数显着不同（P <0.001）。血小板计数与CTP评分呈负相关（r = -0.420，P <0.001），与CTP B / C级无关[比值比（OR）为0.994； 95％CI，0.990-0.999; P = 0.009]。在所有患有HBV感染的患者和ALT水平正常的患者中，血小板计数的接收者工作特征曲线（AUC）下用于区分CTP级B / C与A的面积分别为0.712和0.791。此外，与慢性乙型肝炎患者相比，肝硬化患者的血小板计数更低，而基于四个因素（FIB-4）的天冬氨酸转氨酶与血小板之比指数（APRI）和纤维化指数更高（P <0.001）。血小板计数与FIB-4（r = -0.855，P <0.001）和APRI（r = -0.741，P <0.001）呈负相关。用于区分肝硬化和慢性乙型肝炎的血小板计数的AUC为0.927（敏感性为78.76％；特异性为92.22％）。在接受肝活检的患者中，F4患者的血小板计数低于≤F3患者（P = 0.013）。血小板计数与病理分期呈负相关（r = -0.295，P = 0.032），并与F4独立相关（OR为0.978； 95％CI为0.960-0.997； P = 0.026）。区分F4和≤F3患者的血小板计数的AUC为0.761。总之，血小板计数可用作非侵入性标志物，以评估慢性HBV感染患者肝损伤和肝纤维化的严重程度。

关键词：慢性乙型肝炎病毒感染；肝纤维化肝损伤血小板计数。

StephenW

www.spandidos-publications.com/10.3892/etm.2020.8703/download

jinpaimanman

回复 StephenW 的帖子

血小板250~260 ，肝硬化的可能性高吗？

StephenW

回复 jinpaimanman 的帖子

以上文件仅建立"血小板计数可以提供有关肝病严重程度的线索", 没有具体提及如何使用血小板计数来确定纤维化阶段.

文件提到:
来自活检:
纤维化 <= F3   血小板 = 152.83±58.78
纤维化 <= F4   血小板 = 103.15±42.97
F4 = 肝硬化(cirrhosis)

Therefore, it may be speculated that patients with chronic HBV infection with platelet counts of <117x109/l were likely to already have early‑stage cirrhosis based on the results
因此，根据研究结果，可以推测血小板计数<117x109 / l的慢性HBV感染患者可能已经患有早期肝硬化.