肝硬化中的血小板变化机制及影响

doi:10.3969/j.issn.1009-976X.2022.06.015

摘要/Abstract

摘要： 肝硬化可引起血小板数量和功能的变化。血小板变化,尤其是血小板数量的减少可引起肝硬化患者出血风险增加并与侵入性手术后的出血密切相关,治疗血小板减少对改善肝硬化患者的预后至关重要。本文对肝硬化中血小板的减少机制及影响作一综述,为此类患者的临床诊疗和病情评估提供依据。

关键词: 肝硬化, 血小板变化, 侵入性手术, 影响

Abstract: Liver cirrhosis can cause changes in the number and function of platelets. Platelet changes, especially the decrease of platelet number, can increase the risk of bleeding in patients with liver cirrhosis. Thrombocytopenia is closely related to bleeding after invasive procedures. Treatment of thrombocytopenia is essential to improve the prognosis of patients. This article reviews the mechanism and influence of thrombocytopenia in liver cirrhosis, providing basis for clinical diagnosis and treatment and disease evaluation of such patients.

Key words: liver cirrhosis, platelet changes, invasive procedures, effects

中图分类号:

R657.3

廖小慧, 杨长青, 魏子白. 肝硬化中的血小板变化机制及影响[J]. 岭南现代临床外科, 2022, 22(06): 600-605.

LIAO Xiao-hui, YANG Chang-qing, WEI Zi-bai. Mechanisms and effects of platelet changes in liver cirrhosis[J]. Lingnan Modern Clinics In Surgery, 2022, 22(06): 600-605.

参考文献

[1] Lisman T, Caldwell SH, Intagliata NM.Haemostatic alterations and management of haemostasis in patients with cirrhosis[J]. J Hepatol, 2022, 76(6): 1291-1305.
[2] Wang L, Wang B, You H, et al.Platelets′increase is associated with improvement of liver fibrosis in entecavirtreated chronic hepatitis B patients with significant liver fibrosis[J]. Hepatol Int, 2018,12(3):237-243.
[3] Basili S, Raparelli V, Napoleone L, et al.Platelet Count Does Not Predict Bleeding in Cirrhotic Patients: Results from the PRO-LIVER Study[J]. Am J Gastroenterol, 2018,113(3):368-375.
[4] Peck-Radosavljevic M.Thrombocytopenia in chronic liver disease[J]. Liver Int, 2017,37(6):778-793.
[5] Rawi S, Wu GY.Pathogenesis of Thrombocytopenia in Chronic HCV Infection: A Review[J]. J Clin Transl Hepatol, 2020,8(2):184-191.
[6] 王兆钺. 病毒性肝炎血小板减少的发病机制与治疗进展[J]. 中华血液学杂志, 2014, 35(7): 667-669.
[7] Huang CE, Chang JJ, Wu YY, et al.Different impacts of common risk factors associated with thrombocytopenia in patients with hepatitis B virus and hepatitis C virus infection[J]. Biomed J, 2022, 45(5): 788-797.
[8] Latorre R, Vaquero J, Rincón D, et al.Determinants of platelet count are different in patients with compensated and decompensated cirrhosis[J]. Liver Int, 2016,36(2):232-239.
[9] Neuenfeldt FS, Weigand MA, Fischer D.Coagulopathies in Intensive Care Medicine: Balancing Act between Thrombosis and Bleeding[J]. J Clin Med, 2021, 10(22): 5369.
[10] Drolz A, Horvatits T, Roedl K, et al.Coagulation parameters and major bleeding in critically ill patients with cirrhosis[J]. Hepatology, 2016, 64(2):556-568.
[11] Witters P, Freson K, Verslype C, et al.Review article: blood platelet number and function in chronic liver disease and cirrhosis[J]. Aliment Pharmacol Ther, 2008, 27(11):1017-1029.
[12] Zanetto A, Campello E, Bulato C, et al.More Pronounced Hypercoagulable State and Hypofibrinolysis in Patients With Cirrhosis With Versus Without HCC[J]. Hepatol Commun, 2021, 5(12): 1987-2000.
[13] Rogalski P, Rogalska-Plonska M, Wroblewski E, et al.Blood platelet function abnormalities in cirrhotic patients with esophageal varices in relation to the variceal bleeding history[J]. Scand J Gastroenterol, 2019, 54(3): 311-318.
[14] de Oliveira Souza E, D′Amico ÉA, Flores da Rocha TR, et al. Preservation of platelet function in patients with cirrhosis and thrombocytopenia undergoing esophageal variceal ligation[J]. Hepatobiliary Pancreat Dis Int, 2020, 19(6): 555-560.
[15] Potze W, Siddiqui MS, Boyett SL, et al.Preserved hemostatic status in patients with non-alcoholic fatty liver disease[J]. J Hepatol, 2016, 65(5):980-987.
[16] Lisman T, Bongers TN, Adelmeijer J, et al.Elevated levels of von Willebrand Factor in cirrhosis support platelet adhesion despite reduced functional capacity[J]. Hepatology, 2006, 44:53-61.
[17] Driever EG, Stravitz RT, Zhang J, et al.VWF/ADAMTS13 Imbalance, But Not Global Coagulation or Fibrinolysis, Is Associated With Outcome and Bleeding in Acute Liver Failure[J]. Hepatology, 2021, 73(5): 1882-1891.
[18] Napolitano G, Iacobellis A, Merla A, et al.Bleeding after invasive procedures is rare and unpredicted by platelet counts in cirrhotic patients with thrombocytopenia[J]. Eur J Intern Med, 2017, 38:79-82.
[19] von Meijenfeldt FA, van den Boom BP, Adelmeijer J, et al. Prophylactic fresh frozen plasma and platelet transfusion have a prothrombotic effect in patients with liver disease[J]. J Thromb Haemost, 2021, 19(3): 664-676.
[20] Peck-Radosavljevic M.Thrombocytopenia in chronic liver disease[J]. Liver Int, 2017, 37(6): 778-793.
[21] Rowley MW, Agarwal S, Seetharam AB, Hirsch KS.Real-time ultrasound-guided paracentesis by radiologists: near zero risk of hemorrhage without correction of coagulopathy[J]. J Vasc Interv Radiol, 2019, 30(2): 259-264.
[22] O′Leary JG, Greenberg CS, Patton HM, Caldwell SH. AGA Clinical Practice Update: Coagulation in Cirrhosis[J]. Gastroenterology, 2019, 157(1): 34-43.e1.
[23] Alvaro D, Caporaso N, Giannini EG, et al.Procedure-related bleeding risk in patients with cirrhosis and severe thrombocytopenia[J]. Eur J Clin Invest, 2021,51(6):e13508.
[24] De Gottardi A, Thévenot T, Spahr L, et al.Risk of complications after abdominal paracentesis in cirrhotic patients: a prospective study[J]. Clin Gastroenterol Hepatol, 2009, 7(8): 906-909.
[25] Takyar V, Etzion O, Heller T, et al.Complications of percutaneous liver biopsy with Klatskin needles: a 36-year single-centre experience[J]. Aliment Pharmacol Ther, 2017, 45(5): 744-753.
[26] Potretzke TA, Saling LJ, Middleton WD, Robinson KA.Bleeding complications after percutaneous liver biopsy: do subcapsular lesions pose a higher risk?[J]. Am J Roentgenol, 2018, 211(1): 204-210.
[27] Mammen T, Keshava SN, Eapen CE, et al.Transjugular liver biopsy: a retrospective analysis of 601 cases[J]. J Vasc Interv Radiol, 2008, 19(3): 351-358.
[28] Procopet B, Bureau C, Métivier S, et al.Tolerance of liver biopsy in a tertiary care center: comparison of the percutaneous and the transvenous route in 143 prospectively followed patients[J]. Eur J Gastroenterol Hepatol, 2012, 24(10): 1209-1213.
[29] Vanbiervliet G, Giudicelli-Bornard S, Piche T, et al.Predictive factors of bleeding related to post-banding ulcer following endoscopic variceal ligation in cirrhotic patients: a case-control study[J]. Aliment Pharmacol Ther, 2010,32(2):225-232.
[30] Vieira da Rocha EC, D′Amico EA, Caldwell SH, et al. A prospective study of conventional and expanded coagulation indices in predicting ulcer bleeding after variceal band ligation[J]. Clin Gastroenterol Hepatol, 2009,7(9):988-993.
[31] Soh H, Chun J, Hong SW, et al.Child-Pugh B or C cirrhosis increases the risk for bleeding following colonoscopic polypectomy[J]. Gut Liv, 2020, 14(6): 755-764.
[32] Lee S, Park SJ, Cheon JH, et al.Child-Pugh score is an independent risk factor for immediate bleeding after colonoscopic polypectomy in liver cirrhosis[J]. Yonsei Med J, 2014, 55(5): 1281-1288.
[33] Park JG, Park SY, Tak WY, et al. Early complications after percutaneous radiofrequency ablation for hepatocellular carcinoma: an analysis of 1,843 ablations in 1,211 patients in a single centre: experience over 10 years[J]. Clin Radiol, 2017, 72(8): 692.e9-692. e15.
[34] Goto E, Tateishi R, Shiina S, et al.Hemorrhagic complications of percutaneous radiofrequency ablation for liver tumors[J]. J Clin Gastroenterol, 2010, 44(5): 374-380.
[35] Maegawa FB, Shehorn L, Aziz H, et al.Association Between Noninvasive Fibrosis Markers and Postoperative Mortality After Hepatectomy for Hepatocellular Carcinoma[J]. JAMA Netw Open, 2019, 2(1): e187142.
[36] Alvaro D, Caporaso N, Giannini EG, et al.Procedure-related bleeding risk in patients with cirrhosis and severe thrombocytopenia[J]. Eur J Clin Invest, 2021, 51(6): e13508.
[37] Cocero N, Bezzi M, Martini S, Carossa S.Oral surgical treatment of patients with chronic liver disease: assessments of bleeding and its relationship with thrombocytopenia and blood coagulation parameters[J]. J Oral Maxillofac Surg, 2017, 75(1): 28-34.
[38] Vuyyuru SK, Singh AD, Gamanagatti SR, et al.A randomized control trial of thromboelastography-guided transfusion in cirrhosis for high-risk invasive liver-related procedures[J]. Dig Dis Sci, 2020, 65(7): 2104-2111.
[39] Shah A, Amarapurkar D, Dharod M, et al.Coagulopathy in cirrhosis: a prospective study to correlate conventional tests of coagulation and bleeding following invasive procedures in cirrhotics[J]. Indian J Gastroenterol, 2015, 34(5): 359-364.
[40] Stroncek DF, Rebulla P.Platelet transfusions[J]. Lancet, 2007, 370(9585): 427-438.
[41] Yuan S, Otrock ZK.Platelet Transfusion: An Update on Indications and Guidelines[J]. Clin Lab Med, 2021, 41(4): 621-634.
[42] Liu P, Hum J, Jou J, et al.Transfusion strategies in patients with cirrhosis[J]. Eur J Haematol, 2020, 104(1): 15-25.
[43] O′Leary JG, Greenberg CS, Patton HM, Caldwell SH. AGA Clinical Practice Update: Coagulation in Cirrhosis [J]. Gastroenterology, 2019, 157(1): 34-43.e1.
[44] Blumberg N, Heal JM, Phillips GL.Platelet transfusions: trigger, dose, benefits, and risks[J]. F1000 Med Rep, 2010, 2: 5.
[45] Flisiak R, Antonov K, Drastich P, et al.Practice Guidelines of the Central European Hepatologic Collaboration (CEHC) on the Use of Thrombopoietin Receptor Agonists in Patients with Chronic Liver Disease Undergoing Invasive Procedures[J]. J Clin Med, 2021,10(22):5419.
[46] de Franchis R, Bosch J, Garcia-Tsao G, et al. Baveno VII - Renewing consensus in portal hypertension[J]. J Hepatol, 2022, 76(4): 959-974.
[47] Quach ME, Chen W, Li R.Mechanisms of platelet clearance and translation to improve platelet storage[J]. Blood, 2018, 131(14): 1512-1521.
[48] Podda GM, Pugliano M, Casazza G, et al.Measurement of platelet count with different anticoagulants in thrombocytopenic patients and healthy subjects: Accuracy and stability over time[J]. Haematologica, 2019, 104: e570-e572.
[49] Belluco C, Forlin M, Delrio P, et al.Elevated platelet count is a negative predictive and prognostic marker in locally advanced rectal cancer undergoing neoadjuvant chemoradiation: A retrospective multi-institutional study on 965 patients[J]. BMC Cancer, 2018, 18: 1094.