特发性血小板减少性紫癜血小板参数的测定

随着血球分析仪的改进，本院自1998年开展了血小板平均体积(MPV)、血小板压积(PCT)及血小板分布宽度(PDW)等参数的测定，现将本院开展血小板参数测定至今71例特发性血小板减少性紫癜(ITP)患者和50例对照组的血小板计数(Pt)、MPV、PCT及PDW报告如下。     

血小板相关指标对慢性关节假体周围感染诊断价值的研究

目的:探讨血小板计数（PC）、血小板计数/平均血小板体积（PC/MPV）和血小板比容（PCT）对关节置换术后慢性假体周围感染（PJI）的诊断价值。方法:回顾性分析2013年8月至2019年6月在青岛大学附属医院进行人工髋、膝关节翻修术的167例患者的临床资料。其中PJI组51例（膝26例,髋25例）,男性28例,女性2...     

酒精性肝硬化的研究进展

酒精性肝硬化（AC）是长期和过量饮酒导致的一种不可逆的慢性肝脏疾病,是酒精性肝病（ALD）的终末阶段。近年来我国的ALD发病率呈逐年上升趋势,进展为AC的患者也逐年增多,ALD及AC的相关研究受到广泛关注。就AC的发病机制及治疗进展作一综述。     

酒精性肝病肝移植的研究进展

肝移植是酒精性肝病（ALD）相关终末期肝硬化、肝衰竭、肝细胞癌（肝癌）与重症酒精性肝炎患者重要的治疗手段。本文从ALD肝移植的手术指征、受者生存情况、受者饮酒管理、受者全身疾病管理等方面综述最新研究进展,为临床更好管理ALD肝移植受者提供参考。     

Graves病患者血小板参数变化的研究

目的研究Graves病（GD）引起的甲状腺功能亢进症（甲亢）患者血小板参数的变化。方法选取2008年7-12月GD患者共267例,其中甲亢初发患者144例（甲亢初发组）,甲亢缓解患者123例（甲亢缓解组）,选取健康体检者150例作为健康对照组。检测血小板计数（PC）、平均血小板容积（MPV）、血小板分布宽度（PDW）及大血小板比率（P-LCR）。结果甲亢缓解组PC为（250．18±62．13）×10^9／L,健康对照组为（234．21±41．10）×10^9／L,两组比较差异有统计学意义（P〈0．05）。甲亢初发组MPV、PDW和P-LCR分别与甲亢缓解组、健康对照组比较均升高,差异均有统计学意义（P〈0．01）。甲亢缓解组PDW为0．1102±0．0113,健康对照组为0．1136±0．0094,两组比较差异有统计学意义（P〈0．05）。结论PC在甲亢缓解患者中高于健康对照者,甲亢初发患者的MPV、PDW和P—LCR均明显高于甲亢缓解者和健康对照者,治疗后上述指标可逐渐恢复正常。     

低血小板参数与红细胞相关参数对肝硬化出血患者的影响

目的:探讨低血小板与红细胞相关参数对肝硬化患者出血的影响.方法:对60例肝硬变贫血患者PLT、MPV、RDW、HCT、MCV、HRD等参数用AcT-5diff血液分析仪进行检测,30例PLT 60-96×109/L MCV正/RD W正占16.7%;MCV正/RDW↑26.7%:MCV↑/RDW正16 7%;MCV ↑/RDW↑20.0%;%MCV ↓/RDW↓20.0%;30例PLT20-60×109/L MCV正/RD W正占3.3%;MCV正/RDW↑26.6%:MCV↑/RDW正36.7%;MCV ↑/RDW↑16.7%;%MCV ↓/RDW↓16.7%.结论:这些参数能直观地反映肝硬变性贫血的贫血类型,也能直观分析出血原因.     

血小板/脾脏体积比预测肝硬化门静脉高压症的严重程度

目的探讨用简单的、无创的模型(血小板/脾脏体积之比,platelet spleen volume ratio,PSVR)来评估肝硬化门静脉高压症病人门静脉高压症的严重程度。方法连续收集了20例我院因乙型肝炎后肝硬化门静脉高压症行断流术病人的临床资料。根据术中测得的门静脉压力梯度,将病人分为两组,即中度门静脉高压症组(9例)与重度门静脉高压症组(11例)。将两组间的资料进行比较,应用Logistic回归分析建立相关模型来预测门静脉压力的严重程度,并与以往的模型进行比较。结果 20例病人均为最终病理证实肝硬化,中度门静脉高压症组与重度门静脉高压症组相比,γ谷氨酰转移酶(P=0.033)、血小板计数(platelet count,PLT,P=0.005)、脾脏体积(P=0.001)、100×PLT/脾脏体积(PSVR,P=0.006),两组间差异均有统计学意义。单因素Logistic回归分析表明,PLT、脾脏体积、PSVR差异具有统计学意义。进一步多因素Logistic回归分析证实PSVR是预测中度与重度门静脉高压症的独立因素。利用ROC曲线分析PSVR最佳截断值5.08,曲线下面积、敏感度、特异度、阳性预测值、阴性预测值分别为0.929、72.7%、100%、75%、100%。应用同样的方法,分析了PLT、脾脏体积、天冬氨酸转氨酶/丙氨酸转氨酶之比(AST/ALT ratio,AAR)、AST/PLT之比(AST to platelet ratio index,APRI)、FIB-4{[年龄(岁)×AST(U/L)]/[PLT(×10~9/L)×ALT(U/L)~(1/2)]}来预测重度和中度门静脉高压症,结果显示PSVR均优于上述指标。结论血小板和脾脏体积之比能准确地预测肝硬化中度及重度门静脉高压症。应用这一指标有望减少有创的肝静脉压力梯度的测量,有助于外科医生对肝硬化门静脉高压症病人进行术前评估。     

早期糖尿病肾病患者血小板相关参数测定的临床意义

目的 探究早期糖尿病肾病患者(diabetic nephropathy,DN)平均血小板体积(mean platelet volume,MPV),大血小板比率(platelet-large cell ratio,P-LCR),血小板分布宽度(platelet distribution width,PDW),中性粒细胞/...     

肝硬化食管静脉曲张无创性预测指标的探讨

目的 回顾性分析外周血血小板计数与脾脏长径比值对不同病因肝硬化合并食管静脉曲张的预测作用.方法 收集我院肝硬化住院病例共107例,其中乙肝肝硬化59例,酒精性肝硬化32例,原发性胆汁性肝硬化16例;有食管静脉曲张73例,无食管静脉曲张者34例.记录外周血血小板计数、B超下脾脏最长径值、血清白蛋白、转氨酶及凝血酶原时间等各项指标.应用Ginanni等研究发现的909作为血小板计数与脾脏长径比值阈值进行评估分析. 结果 有食管静脉曲张的患者与无食管静脉曲张患者的凝血酶原时间[(13.0±1.5)s比(15.7±3.1)s]、脾脏长径值[(128±23)mm比(148±41)mm]、白蛋白[(36.0±5.4)g/L比(31.0±2.6)g/L]、血小板计数[(9±6)×109/L比(5±3)×109/L]、血小板计数和脾脏长径比值[(760±529)比(438±317)]相比差异均有统计学意义.909作为血小板计数与脾脏长径比值阈值适合于国人,其预测食管静脉曲张存在的敏感性达到91.8%,特异性为71.3%.结论血小板计数/脾脏长径比值可以作为非侵入性方法进行食管静脉曲张存在的评估,且909可以作为阈值对我国肝硬化人群是否合并食管静脉衄张进行预测.     

The predictive value of the platelet volume parameters in evaluation of varicocelectomy outcome in infertile patients

The aim of this study was to evaluate the role of platelet count (PLT) and platelet volume indices (PVI) such as mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (PCT) as a clinical biomarker in 64 infertile males with varicocele and 45 controls. In addition, semen parameters, serum total testosterone, FSH and testicular volume were measured before and at 6 months after varicocelectomy. The mean PLT, MPV, PDW and PCT were 231 ± 42 × 103/µl, 9.6 ± 1.8 fl, 16.2 ± 2.5 fl and 0.18% in the patient group respectively. When the patient and control groups were compared, there was a significant increase in mean MPV, PDW and PCT (p < .0001), while platelet count was lower in patients than control group, but with no significant relationship. MPV had a significant negative correlation with total testosterone (p < .03). No significant correlations were found between PVI and testicular volume. After follow-up of 37.1 ± 1.9 months, a significant negative correlation was found between the preoperative MPV and varicocelectomy outcome in terms of semen values (p < .007). So, the increase in MPV and low total testosterone in men with varicocele may be a feature of high risk of infertility.     

脓毒症患者血小板计数及体积变化趋势的临床意义

目的观察脓毒症患者血小板计数（PC）、血小板体积（MPV）的变化趋势,探讨两者相关性及其临床意义。方法应用HEMACELL Plus全自动22项5类血细胞分析仪,通过阻抗法检测40例脓毒症患者发病后1d、3d、7d、10d的PC、MPV,并回顾性将脓毒症患者分为死亡组和存活组,分析其PC、MPV变化趋势,并进行两者相关性分析。结果①入院时存活组和死亡组患者PC均低于正常生理范罔,死亡组PC在各时相点均低于存活组（1d、3dP〉0．05,7d、10dP〈0．01）。存活组血小板在入ICU第3天明显下降（P〈0．01）,继之于第7天、10天持续上升（P均〈0．01）。死亡组PC则呈持续下降趋势（P均〈0．01）。②入院时存活组和死亡组患者MPV均基本上处于正常生理范围,但是死亡组MPV值比存活组患者高（P均〈0．05）,病程中存活组患者MPV呈进行性下降趋势,而死亡组患者MPV呈进行性上升趋势（P均〈0．01）。③PC与MPV呈显著负相关。结论PC、MPV的变化可能成为脓毒症患者血小板生成和活性紊乱以及骨髓反应的间接标志,常规检测脓毒症患者的PC、MPV变化趋势,尤其早期检测MPV,可能成为评价脓毒症病情及骨髓反应情况的一种快速、可信的手段。     

Evaluation of blood platelet count and function in patients with erectile dysfunction

We evaluated and compared blood total platelet count, mean platelet volume (MPV) and platelet distribution width (PDW) values of patients with erectile dysfunction (ED) and control subjects. A total 57 male patients (mean age 49.7 ± 12 years) with ED and 59 control men (mean age 49.7 ± 10.7 years) were included in the study. All patients were evaluated using medical history with International Index of Erectile Function (IIEF) scores, physical examination and routine blood analysis. Total blood count, including white blood cell (WBC), total platelet counts, MPV and PDW parameters, were recorded in both groups. MPV values were detected to be significantly higher in patients with ED than control group: 10.7 ± 1 and 9.72 ± 1.5, respectively (P = 0.001). Similarly, PDW values were significantly higher in patients with ED than control group: 14.6 ± 2.8 and 12.9 ± 1.9, respectively (P = 0.001). However, mean platelet and mean WBC counts were similar in both groups (P = 0.45). We demonstrated that MPV and PDW values significantly increased in patients with ED compared with the control group. According to these findings, platelet function might play an important role in patients with ED that warrants further research.     

Chances and limitations of non‐invasive tests in the assessment of liver fibrosis in liver transplant patients

Kamphues C, Lotz K, Röcken C, Berg T, Eurich D, Pratschke J, Neuhaus P, Neumann UP. Chances and limitations of non‐invasive tests in the assessment of liver fibrosis in liver transplant patients.
Clin Transplant 2009 DOI:10.1111/j.1399‐0012.2009.01152.x
© 2009 John Wiley & Sons A/S. Abstract: Because fibrosis progression resulting in liver cirrhosis represents the main reason for graft lost in patients after liver transplantation, an early detection of liver fibrosis is crucial. In recent years, several non‐invasive tests for the assessment of liver fibrosis have been developed. We prospectively assessed the stage of liver fibrosis of 135 liver transplant patients (94 hepatitis C virus [HCV], 41 alcoholic cirrhosis) using liver biopsy, transient elastography, and serum markers. In the HCV group, the area under the receiver operating characteristic curve (AUROC) for diagnosis of significant fibrosis (F ≥ 2) and cirrhosis (F = 4) was 0.81 (negative predictive value [NPV] = 0.58, positive predictive value [PPV] = 0.9) and 0.87 (NPV = 0.94, PPV = 0.56), respectively. In the alcoholic cirrhosis group, significant fibrosis (F ≥ 2) was diagnosed with an AUROC of 0.83 (NPV = 1.00, PPV = 0.23). In both groups, higher AUROC values were reached in patients with a body mass index of <25 kg/m², and both serum markers showed no significant correlation to liver fibrosis. The transient elastography is a reliable test for exclusion of liver cirrhosis in HCV transplant and significant liver fibrosis in alcoholic transplant patients. For the diagnosis of significant liver fibrosis in HCV transplant patients, the transient elastography reaches good results but cannot replace liver biopsy. Both serum markers AST‐to‐platelet ratio index and FIB‐4 are not feasible to assess liver fibrosis in liver transplant patients.     

四因素综合法制备大鼠肝硬化模型的评价

目的评价四因素综合法[苯巴比妥钠诱导;四氯化碳（CCl4）诱导肝损伤;食用白酒为惟一饮用水;饮用水中添加甜味剂]制备大鼠肝硬化模型的方法。方法健康雄性SD大鼠140只,体重180～220 g,随机分为5组,腹腔注射生理盐水（NS）对照组（Ⅰ组,n=10）、皮下注射NS对照组（Ⅱ组,n=10）、腹腔注射CCl4组（Ⅲ组,n=40）、皮下注射CCl4无甜味剂组（Ⅳ组,n=40）、皮下注射CCl4甜味剂组（Ⅴ组,n=40）。模型制备9周末左心室抽血9～13 ml,测定血常规和血生化指标,并记录9周末大鼠生存情况、模型制备成功情况。结果与Ⅰ组和Ⅱ组比较,Ⅲ组、Ⅳ组、Ⅴ组的生存率降低,白细胞计数、血红蛋白、血小板计数、血清总蛋白、红细胞计数、白蛋白降低,球蛋白、谷丙转氨酶、谷草转氨酶、总胆红素、直接胆红素、碱性磷酸酶升高（P〈0.01）;与Ⅲ组比较,Ⅳ组、Ⅴ组的生存率升高（P〈0.01）;与Ⅳ组比较,Ⅴ组生存率升高（P〈0.01）。Ⅲ组、Ⅳ组、Ⅴ组的成模率差异无统计学意义（P〈0.05）。结论采用苯巴比妥钠诱导、皮下注射CCl4诱导肝损伤、食用白酒为惟一饮用水、饮用水中添加甜味剂的四因素综合法制备大鼠肝硬化模型可明显提高动物生存率,有助于节约实验动物,降低实验成本。     

Nutritional status of patients with alcoholic cirrhosis undergoing liver transplantation: time trends and impact on survival

Alcoholic cirrhotics evaluated for liver transplantation are frequently malnourished or obese. We analyzed alcoholic cirrhotics undergoing transplantation to examine time trends of nutrition/weight, transplant outcome, and effects of concomitant hepatitis C virus (HCV) and/or hepatocellular carcinoma (HCC). Nutrition and transplant outcomes were reviewed for alcoholic cirrhosis with/without HCV/HCC. Malnutrition was defined by subjective global assessment. Body mass index (BMI) classified obesity. A total of 261 patients receiving transplants were separated (1988–2000, 2001–2006, and 2007–2011) to generate similar size cohorts. Mean BMI for the whole cohort was 28 ± 6 with 68% classified as overweight/obese. Mean BMI did not vary among cohorts and was not affected by HCV/HCC. While prevalence of malnutrition did not vary among cohorts, it was lower in patients with HCV/HCC (P < 0.01). One‐year graft/patient survival was 90% and not impacted by time period, HCV/HCC, or malnutrition after adjusting for demographics and model end‐stage liver disease (MELD). Alcoholic cirrhotics undergoing transplantation are malnourished yet frequently overweight/obese. Among patients selected for transplantation, 1‐year post‐transplant graft/patient survival is excellent, have not changed over time, and do not vary by nutrition/BMI. Our findings support feasibility of liver transplantation for alcoholic cirrhotics with obesity and malnutrition.     

平均血小板体积联合Gensini评分预测ST段抬高型心肌梗死患者急诊经皮冠状动脉介入术近期预后

目的探讨平均血小板体积(MPV)联合Gensini评分预测急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入术(PCI)近期预后的价值。方法对186例接受急诊PCI治疗的STEMI患者,术前完善相关实验室检查、检测MPV,并根据冠状动脉造影检查结果进行Gensini评分;术后随访记录主要不良心血管事件(MACE)发生情况,并进行统计学分析。结果 186例中,PCI术后36例发生MACE(MACE组),150例未发生MACE(非MACE组)。2组间总胆固醇(TC)、血小板计数(Plt)、D-二聚体、N末端脑钠肽前体(NT-proBNP)、MPV、Gensini评分及病变累及冠状动脉3支血管的比例差异均有统计学意义(P均0.05)。MPV、Gensini评分、Plt、NT-proBNP及病变累及冠状动脉3支血管是STEMI患者PCI术后发生MACE的独立危险因素(P均0.05)。以MPV(阈值0.86 fl)联合Gensini评分(阈值82.17分)预测STEMI患者急诊PCI术后发生MACE的ROC曲线AUC为0.92[95%CI(0.87,0.98)],敏感度为92.70%,特异度为83.33%。结论 STEMI患者急诊PCI术后近期MACE的发生与术前MPV及Gensini评分有关;MPV联合Gensini评分可用于筛查PCI术后高危患者。     

Role of preoperative platelet level in clinical and pathological outcomes after surgery for renal cortical malignancies

Study Type – Therapy (case series)
Level of Evidence 4 What's known on the subject? and What does the study add? Preoperative platelet count (PLT), which reflects the systemic inflammatory response, has been previously identified in several small studies as useful prognostic factor in a number of cancers including renal cell carcinoma. This study is the largest study to our knowledge to investigate the relationship between platelets and surgical outcomes in patients with renal cell carcinoma. Thrombocytosis (PLT > 400) was associated with and was an independent predictor of decreased overall and disease‐specific survival in patients undergoing extirpative renal surgery, and was associated with larger tumour size, and higher TNM stage at surgery. OBJECTIVE ? To investigate preoperative platelet level (PLT) as a prognostic factor for pathologic and clinical outcomes following surgery for renal cortical malignancy. PATIENTS AND METHODS ? 1422 patients underwent radical or partial nephrectomy at our institution from 1988–2009 for renal cortical lesions. ? The cohort with available PLT values was divided into group 1 (PLT ≤ 400 × 10⁹) and (PLT > 400 × 10⁹) based on institutional laboratory upper threshold (400 × 10⁹ cells/liter). RESULTS ? 961 patients were divided into groups 1 (n = 870) and 2 (n = 91), with mean age at surgery of 61 and 60 years, 70.6% and 50.6% males (P ≤ 0.0001), 56% undergoing radical nephrectomy in each group, 39.1% vs. 22% undergoing partial nephrectomy (P = 0.001) respectively. ? Groups differed significantly inmedian tumour size (5.06 vs. 7.28 cm) (P ≤ 0.001), pathologic T stage (P = 0.002), and metastases (P ≤ 0.0001). No significant difference existed regarding histologic findings at surgery. ? With median follow‐up of 24 months, PLT > 400 × 10⁹ cells/liter was associated with decreased overall (OS) and disease‐specific survival (DSS) using log rank test (P ≤ 0.0001). ? On multivariate analysis, controlling for TNM stage, histology, and tumour diameter, PLT > 400 × 10⁹cells/liter independently predicted decreased OS (HR 1.67, P = 0.007) and DSS (HR 2.39, P = 0.001). As a continuous variable, PLT predicted OS (HR 1.002, P = 0.005) and DSS (HR 1.003, P =  0.004). ? With metastatic patients excluded, PLT was significantly associated with OS and DSS, but was not an independent predictor. CONCLUSION ? PLT is a clinically significant independent predictor of OS and DSS in continuous and categorical analyses in patients undergoing renal cortical malignancy surgery. PLT may be clinically useful for risk stratifying patients undergoing surgery for renal cancer, especially for prognosis assessment of patients with renal cortical malignancy and micrometastatic disease at surgery.