TIPS对肝硬化门脉高压患者血小板去唾液酸化及活化的影响

发布时间：2018-10-08 14:17

【摘要】：背景经颈静脉肝内门体分流术(TIPS)是门脉高压相关并发症的主要治疗方法之一。随着严重门脉高压并发症得到控制,肝衰竭成为终末期肝硬化患者死亡的主要原因。研究显示血小板计数是TIPS术后肝衰、总生存期的独立影响因素。肝硬化患者血小板计数减少同时伴有血小板生成减少及血小板清除增加。肝细胞、巨噬细胞吞噬去唾液酸化的血小板、血小板活化聚集是血小板的主要清除机制。目前关于TIPS术后血小板变化的研究局限于血小板计数,且结论尚不统。目的分析TIPS对血小板活化、血小板去脱唾液酸化的影响,探讨TIPS对肝硬化门脉高压患者血小板清除、血小板计数的影响。材料与方法2015年01月至2016年06月共31例患者纳入本研究。于TIPS术前(t1)、术后1周(t2)、术后3～6月(t3),空腹采外周静脉血。采用流式细胞仪检测脱唾液酸率(RCA-1、sWAG表达率),检测血小板PAC-1表达率及血浆血小板微粒(PMPs)水平评估血小板活化程度。使用ELISA法检测TIPS前后血浆内毒素(LPS)水平。同时收集各时间点血小板计数(PLT)、平均血小板体积(MPV)、血小板压积(PCT)、血小板分布宽度(PDW)及大型血小板比率(PLCR)等数据进行分析。结果1.血浆LPS TIPS 术后血浆 LPS 水平显著下降(43.0±17.9pg/ml VS 29.3±13.9pg/ml,P0.01)。LPS水平与门脉压力梯度(PPG)正相关(r=0.63,p0.01)。2.血小板计数、MPV、PCT、PDW、PLCRt1、t2、t3血小板计数分别为97.0±86.3×109/L、87.2±50.6×109/L、95.9±52.3×109/L,差异无统计学意义(P=0.38)。t1、t2、t3PCT 分别为 1.1±1.0ml/L、0.9±0.6 ml/L、1.0±0.6 ml/L,差异无统计学意义(P=0.20)。t1、t2、t3PDW 分别为 14.6±2.2f1、13.4±2.1f1、13.5±2.7f1,t1 显著高于 t2 及 t3(P=0.01)。t1、t2、t3MPV 分别为 11.7±0.9fL、11.1±0.9fL、11.0±0.9fL,t1 显著高于 t2 及 t3(P0.01)。t1、t2、t3 PLCR 分别为 38.6±6.8%、33.2±7.0%、33.0±7.5%,t1 显著高于 t2 及 t3(P0.01)。3.血小板活化t1、t2、t3 PAC-1 表达率分别为 37.1±25.3%、19.4±17.5%、14.8±14.8%,对应的血浆PMPs水平分别为14.6±10.4×105/ml、8.0±6.3×105/ml、5.6±3.2X 105/ml,差异均有统计学意义(P0.01)。PAC-1表达率与LPS正相关(r=0.51,p0.01),与血小板计数负相关(r=-0.27,P=0.01),与MPV正相关(r=0.41,P0.01)。4.血小板去唾液酸化t1、t2、t3 RCA-1 表达率分别为 8.5±8.2%、13.9±14.6%、9.6±9.9%,t2 显著高于 t1 及 t3(P=0.01)。t1、t2、t3 sWAG 表达率分别为 11.5±12.7%、14.6±14.5%、11.6±8.0%,差异无统计学意义(P=0.40)。结论TIPS降低肝硬化门脉高压患者血浆内毒素浓度,减轻血小板活化,对血小板去唾液酸化则无显著影响。虽然TIPS对血小板计数无显著影响,但可一定程度降低硬化患者血小板清除率,延长循环血小板寿命。
[Abstract]:Background Transjugular intrahepatic portosystemic shunt (TIPS) is one of the main treatments for portal hypertension related complications. With severe portal hypertension complications under control, liver failure is the leading cause of death in patients with end-stage cirrhosis. Studies have shown that platelet count is an independent factor in the overall survival of liver failure after TIPS. Thrombocytopenia is associated with thrombocytopenia and increased platelet clearance in cirrhotic patients. Hepatocytes, macrophages, phagocytosis of salivary acidified platelets, platelet activation and aggregation is the main clearance mechanism of platelets. At present, the study of platelet changes after TIPS is limited to platelet count, and the conclusion is not uniform. Objective to investigate the effects of TIPS on platelet activation and platelet desalivation in patients with portal hypertension. Materials and methods from January 2015 to June 2016, 31 patients were included in this study. Peripheral venous blood was collected before TIPS (T1), 1 week postoperatively (T2), and 3 ~ 6 months postoperatively (T3). The desialic acid rate (RCA-1,sWAG expression rate), platelet PAC-1 expression rate and plasma platelet particulate (PMPs) level were measured by flow cytometry to evaluate platelet activation. Plasma endotoxin (LPS) levels were measured by ELISA before and after TIPS. At the same time, the data of (PLT), mean platelet volume (MPV), (PCT), platelet distribution width (PDW) and large platelet ratio (PLCR) were collected and analyzed. Result 1. The plasma LPS level decreased significantly after LPS TIPS (43.0 卤17.9pg/ml VS 29.3 卤13.9 PG / ml P0.01). There was a positive correlation between LPS level and portal pressure gradient (PPG) (r 0.63% P 0.01) .2. 琛，

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