Portal hypertension and hypersplenism in extrahepatic portal venous obstruction: Are they related?
Portal hypertension and hypersplenism in extrahepatic portal venous obstruction: Are they related?
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DOI：
10.1007/s12664-018-0864-7
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发表时间：
2018-05
影响因子：
2
通讯作者：
R. Kilambi;A. Singh;K. Madhusudhan;S. Pal;R. Saxena;Shalimar;N. Dash;P. Sahni
中科院分区：
文献类型：
--
作者：
R. Kilambi;A. Singh;K. Madhusudhan;S. Pal;R. Saxena;Shalimar;N. Dash;P. Sahni
背景和目的肝外门静脉阻塞（EHPVO）引起的门静脉高压（PHT）在发展中国家很常见。脾功能亢进是EHPVO的一个几乎恒定的特征，但与糖尿病不同，其意义尚不清楚。我们的目的是研究脾功能亢进和PHT的严重程度与EHPVO.MethodsThis前瞻性研究的患者之间的关系进行了三级护理中心从2014年1月至2015年8月。所有接受脾切除术和分流术或断流术的EHPVO患者均纳入研究。记录有关临床特征、术前参数和术中详细信息的数据。脾功能亢进和术中测得的门静脉压力和标志物PHT.ResultsOf 40例研究（平均[SD]年龄22.4 [8.4]岁），血液学脾功能亢进之间的相关性进行了研究，存在于39（97.5%）。平均（SD）血红蛋白、总白细胞计数（TLC）和血小板计数分别为9.9（2.4）g/dL、2971（1239）个细胞/mm 3和66，400（32047）个细胞/mm 3。平均（SD）超声脾体积（SV）、脾重量和术中门静脉压分别为1084.7（553.9）cm 3、1088.7（454.7）g和35.6（5.1）mmHg。TLC和血小板计数与门静脉压力呈负相关。此外，血小板计数与根除静脉曲张状态、SV和体重呈负相关;血红蛋白与SV和体重呈负相关; TLC与SV呈负相关。多因素分析显示血小板计数是门静脉压力的独立预测因子，血小板计数≤ 53,500 cells/mm 3提示门静脉压力显著升高。血小板计数≤ 53，500个细胞/mm 3可预测血压显著升高。
Background and AimsPortal hypertension (PHT) due to extrahepatic portal venous obstruction (EHPVO) is common in developing countries. Hypersplenism is a near-constant feature of EHPVO, but its significance, unlike in cirrhotics, is unknown. We aimed to study the relationship between hypersplenism and the severity of PHT in patients with EHPVO.MethodsThis prospective study was done at a tertiary care center from January 2014 to August 2015. All patients with EHPVO who underwent a splenectomy and a shunt or devascularization were included. Data regarding clinical profile, preoperative parameters, and intraoperative details were recorded. The correlation was studied between hypersplenism and the intraoperatively measured portal pressures and markers of PHT.ResultsOf the 40 patients studied (mean [SD] age 22.4 [8.4] years), hematological hypersplenism was present in 39 (97.5%). The mean (SD) hemoglobin, total leukocyte counts (TLC), and platelet counts were 9.9 (2.4) g/dL, 2971 (1239) cells/mm3, and 66,400 (32047) cells/mm3, respectively. The mean (SD) sonographic spleen volume (SV), splenic weight, and intraoperative portal pressure were 1084.7 (553.9) cm3, 1088.7 (454.7) g, and 35.6 (5.1) mmHg, respectively. The TLC and platelet counts correlated inversely with the portal pressure. Additionally, the platelet counts correlated negatively with eradicated variceal status, SV, and weight; hemoglobin with SV and weight; and TLC with SV. Multivariate analysis showed the platelet counts were an independent predictor of portal pressures and platelet counts ≤ 53,500 cells/mm3indicated significantly high portal pressures.ConclusionsThe platelet counts showed a significant inverse correlation with portal pressures in patients with EHPVO and may be used as surrogate markers of PHT. A platelet count ≤ 53,500 cells/mm3is predictive of significantly high pressures.