肝炎肝硬化血细胞减少与骨髓病态造血及脾功能相关性研究

摘要

目的：探讨肝炎肝硬化血细胞减少与骨髓病态造血及脾功能亢进的相关性，以及乳酸脱氢酶活性检查对预后判断的临床意义。方法：选取320例代偿期及失代偿期肝炎肝硬化患者，根据脾脏肿大情况将其分为脾大组及无脾大组，每组160例；另选同期健康献血者40名作为对照组，进行外周血及血清乳酸脱氢酶(LDH)活性检测。并随机选取失代偿期肝炎肝硬化脾大组及无脾大组各30例患者，进行骨髓祖细胞体外培养及骨髓血细胞形态学观察，其结果进行统计学分析。结果：代偿期肝硬化脾大组与无脾大组的血红蛋白、中性粒细胞、血小板及LDH活性值相比，均无差异(t=0.017，t=0.019，t=0.015，t=0.014；P＞0.05)；失代偿期肝硬化脾大组的血红蛋白、中性粒细胞、血小板及LDH活性值降低明显高于无脾大组，其差异显著(t=8.364， t=2.442，t=3.542，t=4.542；P＜0.05)。失代偿期肝硬化脾大组与无脾大组骨髓祖细胞不良生长率及骨髓血细胞病态造血率相比均无差异(t=0.798，t=1.754，t=0.618，t=1.575， t=0.302，t=0.881，t=1.060；P＞0.05)。相关性分析结果显示，三系血细胞减少与骨髓病态造血程度呈显著正相关(r=0.355，P＜0.05)，而三系血细胞减少与脾功能亢进程度呈显著负相关(r=-0.521，P＜0.05)。结论：肝炎肝硬化外周血细胞减少与骨髓病态造血及脾功能亢进具有相关性，系由血细胞生成减少、成熟障碍以及破坏增多所致，而血细胞减少可作为预后判断的重要指标，且三系血细胞减少提示预后较差。%Objective: To investigate the correlation between the blood cell reduction of hepatitis cirrhosis and the relationship between the pathological hematopoiesis of bone marrow and spleen function, and the clinical significance of the activity of lactate dehydrogenase in the prognosis of the patients. Methods: 320 cases with compensated and decompensated cirrhosis splenomegaly were selected and divided into splenomegaly group and non splenomegaly group with 160 patients in each group. At the same time, 40 cases of healthy blood donors were taken as the control group, detected LDH activity in peripheral blood and serum. And 30 patients were randomly selected in decompensated liver cirrhosis splenomegaly group and without splenomegaly, treated with in vitro culture of bone marrow progenitor cells and morphological observation of bone marrow blood cells. And the results were statistically analyzed. Results:The difference was not statistically significant about hemoglobin, neutrophil and platelet activity and LDH value in compensated cirrhosis splenomegaly group and non splenomegaly group (t=0.017, t=0.019, t=0.015, t=0.014;P>0.05). The hemoglobin, neutrophil, platelet count and LDH activity in decompensated cirrhosis splenomegaly group significantly higher than those in non splenomegaly group. The difference was statistically significant(t=8.364, t=2.442, t=3.542, t=4.542; P<0.05). The difference was not statistically significant about adverse growth rate of bone marrow progenitor cells and abnormal hematopoietic rate of bone marrow hematopoietic cells in the two groups(t=0.798, t=1.754, t=0.618, t=1.575, t=0.302, t=0.881, t=1.060; P>0.05). Correlation analysis showed that the reduction of the three series of blood cells was positively correlated with the degree of pathological hematopoietic(r=0.355, P<0.05), and the three series of blood cells decreased with the degree of spleen function is significantly negatively related to the degree of hyperthyroidism(r=-0.521, P<0.05). Conclusion: The decrease of peripheral blood cells in patients with hepatitis cirrhosis is related to the pathological hematopoiesis of bone marrow and spleen. The blood cell formation is reduced, and mature disorders, damage caused by increased blood cells can be used as an important indicator of prognosis. The three series of blood cells reducing shows that prognosis is poor.