平均血小板体积与血小板计数比率与HCV感染相关肝纤维化的相关性分析  

Correlation analysis between the mean platelet volume to platelet count ratio and HCV-related liver fibrosis

作　　者：李映春[1] 陈继梅[2] 沈弢 LI Ying-chun;CHEN Ji-mei;SHEN Tao(Department of Oncology and Gastroenterology,The Fifth People's Hospital of Wuhu ,Wuhu ,Anhui 241000,China)

机构地区：[1]安徽省芜湖市第五人民医院肿瘤消化内科,安徽芜湖241000 [2]安徽省芜湖市第三人民医院检验科,安徽芜湖241000 [3]北京大学医学部基础医学院病原生物学系暨感染病研究中心,北京100191

出　　处：《中国病毒病杂志》2019年第1期6-11,共6页Chinese Journal of Viral Diseases

基　　金：国家"十三五"科技重大专项(2017ZX10202101);国家自然科学基金(81271826)

摘　　要：目的探讨外周血平均血小板体积和血小板计数比率(mean platelet volume to platelet count ratio,MPR)与丙型肝炎(丙肝)肝纤维化进展之间的关联性。方法 2009年在河南上蔡调查既往献血人群中慢性丙型肝炎病毒(HCV)单感染者(HCVc)103例,HCV急性自发清除者(HCVr)41例,以及健康对照者(HCs)26例。另有丙肝肝硬化患者(HCV-Cirr)20例样本由临床医院提供。在2017年对其中慢性HCV感染者56例和HCV自发清除者33例成功进行了随访。在HCV-Cirr、HCVc、HCVr以及HCs人群横断面分析MPR的基础上,再对2009-2017年HCVc患者MPR变化趋势与肝脏纤维化指标谷草转氨酶/血小板比值指数(AST to platelet ratio index,APRI)和基于4因子的纤维化指数(fibrosis-4score,FIB-4)进行了纵向分析。此外,还对2017年随访HCVc患者的MPR与FibroTouch肝硬度值相关性进行了分析。结果 2009年横断面比较显示,HCV-Cirr组MPR显著高于HCVc、HCVr和HCs组(P<0.001),HCVc组MPR也显著高于HCVr (P=0.009)和HCs组(P=0.002)。HCVc组的MPR与APRI (r=0.731 2,P<0.000 1)和FIB-4 (r=0.745 5,P<0.000 1)之间均呈显著正相关。与2009年相配对比较,HCVc组2017年MPR (P<0.01)显著升高,MPR2017/MPR2009比值与APRI2017/APRI2009比值(r=0.564 9,P<0.000 1)以及FIB-42017/FIB-42009比值(r=0.780 8,P<0.000 1)之间均呈显著正相关。进一步分析显示,2017年随访HCVc患者的MPR比率与FibroTouch肝硬度值之间也呈显著正相关(r=0.581 4,P<0.000 1)。结论外周血平均血小板体积和血小板计数比率MPR在丙肝肝硬化和慢性HCV感染者人群里显著升高,且与肝脏纤维化进程具有一定的关联性,可作为反映肝纤维化程度的辅助指标。Objective To study the association between the mean platelet volume to platelet count ratio(MPR)and HCV-related liver fibrosis status. Methods Study subjects are as follows:(1)Our initial survey of anti-HCV positive individuals during the year 2009 in Shangcai county of Henan province.This group included chronic HCV-infected patients(HCVc,n=103),HCV spontaneous resolvers(HCVr,n=41)and healthy controls(HCs,n=26).(2)Twenty HCV-related cirrhosis patients(HCV-cirr)were recruited from two clinical hospitals of Anhui province.(3)In 2017,we successfully followed up 56 HCVc and 33 HCVr individuals.Comparison of MPR levels among HCV-cirr,HCVc,HCVr and HCs,and longitudinal comparison of MPR changes from 2009 to 2017in HCVc group were analyzed to study the correlations of MPR and changes of fibrosis indicators. Results Horizontal comparison of MPR levels in 2009 indicated that the MPR values in HCV-cirr group were significantly higher than that of HCVc,HCVr and HCs(P<0.000 1).In addition,HCVc presented higher MPR values than HCVr(P=0.009)and HCs(P=0.002).MPR values were shown to be positively correlated with AST to platelet ratio index(APRI,r=0.731 2,P<0.000 1)and fibrosis-4score(FIB-4,r=0.745 5,P<0.000 1)in HCVc group.Furthermore,comparing to the year 2009,MPR values increased significantly in 2017(P<0.000 1).The ratios of MPR2017/MPR2009 were positively associated with APRI2017/APRI2009(r=0.564 9,P <0.000 1)and FIB-42017/FIB-42009(r=0.780 8,P <0.000 1),respectively.Further analysis indicated that MPR values in HCVc group were positively associated(r=0.581 4,P<0.000 1)with the liver hardness values detected by FibroTouch instantaneous elasticity detector in the 2017follow-up. Conclusions The peripheral mean platelet volume to platelet count ratio(MPR)was found higher in HCV-related cirrhosis and chronically HCV-infected patients,and associated with the degree of liver fibrosis.It suggested that MPR could be a simple auxiliary indicator in monitoring the progression of liver fibrosis caused by chronic HCV infection.

关 键 词：慢性丙型肝炎 平均血小板体积和血小板计数比率 肝硬化 肝纤维化 相关性 

分 类 号：R575.2[医药卫生—消化系统]