Impaired liver function and retroviral activity factors contributing to HIV-associated thrombocytopenia
Impaired liver function and retroviral activity factors contributing to HIV-associated thrombocytopenia
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DOI：
10.1097/00002030-199910010-00014
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发表时间：
1999-10-01
期刊：
影响因子：
3.8
通讯作者：
Weber, R
中科院分区：
文献类型：
--
作者：
Ciernik, IF;Cone, RW;Weber, R
目的：探讨血小板生成素（TPO）水平与hiv相关血小板减少症的关系。设计和方法：研究TPO水平与hiv相关血小板减少严重程度之间的关系。38例患者(30 ~ 96 × 10（9)血小板/l 19例，< 10 × 10(9)血小板/l 19例）与38例hiv阳性非血小板减少患者（150 × 10(9)血小板/l）配对。结果：血小板计数正常的hiv阳性患者血清中位TPO水平为137 pg/ml。30-96 × 10(9)个血小板/l的患者TPO水平降低，中位值为90 pg/ml (P = 0.016)，更有可能出现血清天冬氨酸转移酶水平升高（P < 0.001）和触诊或超声成像肝肿大（P = 0.005）。严重血小板减少的hiv感染者血清TPO中位水平为110 pg/ml（无统计学意义）。所有患有严重血小板减少症的患者对乙型肝炎病毒核心抗原抗体均呈阳性，而在没有血小板减少症的hiv感染者中，这一比例为80%。与血小板计数正常的患者相比，严重血小板减少患者更有可能具有高HIV复制（P = 0.02），血浆HIV-1 RNA水平的降低与血小板计数的增加有关。严重的血小板减少症与肝脏疾病无关。结论：肝脏疾病易导致低TPO血清水平和轻度血小板减少症。高逆转录病毒活性易导致严重的免疫性血小板减少性紫癜样血小板减少症。至少存在两种不同类型的严重hiv相关血小板减少症，一种对抗逆转录病毒治疗有反应，另一种对抗逆转录病毒治疗无反应。(C) 1999 Lippincott Williams & Wilkins。
Objective: To investigate the relationship between thrombopoetin (TPO) serum levels and HIV-associated thrombocytopenia.Design and methods: The relationship between TPO levels and severity of HIV-associated thrombocytopenia was investigated. Thirty-eight patients (19 patients with 30-96 x 10(9) platelets/l and 19 patients with < 10 x 10(9) platelets/l) were matched with 38 HIV-positive non-thrombocytopenic patients (> 150 x 10(9) platelets/l).Results: HIV-positive patients with normal platelet counts had a median TPO serum level of 137 pg/ml. Patients with 30-96 x 10(9) platelets/l had decreased TPO levels with a median of 90 pg/ml (P = 0.016), and were more likely to have elevated serum aspartate-transferase levels (P < 0.001) and hepatomegaly by palpation or ultrasound imaging (P = 0.005). The median TPO serum level of HIV-infected patients with severe thrombocytopenia was 110 pg/ml (non-significant). All patients with severe thrombocytopenia were positive for antibodies against hepatitis B virus core antigen, compared with 80% of HIV-infected persons without thrombocytopenia. Patients with severe thrombocytopenia were more likely to have high HIV replication compared to patients with normal platelet counts (P = 0.02), and reduction of plasma HIV-1 RNA levels was associated with increasing platelet counts. Severe thrombocytopenia was not associated with liver disease.Conclusions: Liver disease predisposes for low TPO serum levels and mild thrombocytopenia. High retroviral activity predisposes for severe, immune thrombocytopenic purpura-like thrombocytopenia. At least two distinct categories of severe HIV-associated thrombocytopenia exist, one responsive to antiretroviral treatment and one non-responsive to antiretroviral treatment. (C) 1999 Lippincott Williams & Wilkins.