Incidence, prevalence, and clinical significance of abnormal hematologic indices in compensated cirrhosis.
Incidence, prevalence, and clinical significance of abnormal hematologic indices in compensated cirrhosis.
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DOI：
10.1016/j.cgh.2009.02.021
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发表时间：
2009-06
期刊：
影响因子：
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通讯作者：
Portal Hypertension Collaborative Group
中科院分区：
文献类型：
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作者：
Qamar AA;Grace ND;Groszmann RJ;Garcia-Tsao G;Bosch J;Burroughs AK;Ripoll C;Maurer R;Planas R;Escorsell A;Garcia-Pagan JC;Patch D;Matloff DS;Makuch R;Rendon G;Portal Hypertension Collaborative Group
肝硬变患者的血液学指标异常是由多种因素引起的，包括脾功能亢进。我们的目的是分析事件的顺序，并确定异常的HI是否具有预后意义。我们分析了213名无食道静脉曲张的代偿性肝硬变患者的数据库。受试者被跟踪了大约9年，直到发生静脉曲张或静脉曲张出血或完成研究；84名受试者发展为静脉曲张。异常HI定义为基线贫血(男性≤为13.5g/dL，女性为11.5g/dL)、白细胞减少(≤4000/mm~3)或血小板减少(≤150,000/mm~3)。主要的终点是死亡或移植手术。大多数受试者在基线时有血小板减少症。Kaplan-Meier分析显示白细胞减少发生在30个月(95%可信区间，18.5-53.6)，贫血发生在39.6个月(95%可信区间，24.1-49.9)。校正基线肝静脉压力梯度(HVPG)和Child-Pugh评分后，基线血小板减少(P=.0191)和白细胞减少(P=.0383)是死亡或移植的预测因素。中位数5年后，基线时白细胞减少合并血小板减少的患者在死亡或移植、死亡率和临床失代偿方面与HI正常的患者相比有显著差异(P<；.0001)。HPVPG与Hb、WBC计数呈正相关(Hb，r=−0.35，P<0.0001；WBC计数，r=−0.31，P<0.0001)。血小板减少是肝硬变患者最常见也是最常见的HI异常，其次是白细胞减少和贫血。基线时白细胞减少和血小板减少的组合预示着发病率和死亡率的增加。
Patients with cirrhosis develop abnormal hematologic indices (HI) from multiple factors, including hypersplenism. We aimed to analyze the sequence of events and determine whether abnormal HI has prognostic significance. We analyzed a database of 213 subjects with compensated cirrhosis without esophageal varices. Subjects were followed for approximately 9 years until the development of varices or variceal bleeding or completion of the study; 84 subjects developed varices. Abnormal HI was defined as anemia at baseline (hemoglobin, ≤13.5 g/dL for men and 11.5 g/dL for women), leukopenia (white blood cell counts, ≤4000/mm3), or thrombocytopenia (platelet counts, ≤150,000/mm3). The primary end points were death or transplant surgery. Most subjects had thrombocytopenia at baseline. Kaplan–Meier analysis showed that leukopenia occurred by 30 months (95% confidence interval, 18.5–53.6), and anemia occurred by 39.6 months (95% confidence interval, 24.1–49.9). Baseline thrombocytopenia (P = .0191) and leukopenia (P = .0383) were predictors of death or transplant, after adjusting for baseline hepatic venous pressure gradient (HVPG), and Child–Pugh scores. After a median of 5 years, a significant difference in death or transplant, mortality, and clinical decompensation was observed in patients who had leukopenia combined with thrombocytopenia at baseline compared with patients with normal HI (P < .0001). HVPG correlated with hemoglobin and white blood cell count (hemoglobin, r = −0.35, P < .0001; white blood cell count, r = −0.31, P < .0001). Thrombocytopenia is the most common and first abnormal HI to occur in patients with cirrhosis, followed by leukopenia and anemia. A combination of leukopenia and thrombocytopenia at baseline predicted increased morbidity and mortality.