肝豆状核变性患者脾切除术后外周血中性粒细胞减少影响因素分析  

Influencing factors for peripheral neutropenia in patients with hepatolenticular degeneration after splenectomy

作　　者：方明娟 许亚运 陈林 王佳炜 刘力生 赵雯 吴君霞 范贤峰 胡文彬 刘永凤 FANG Mingjuan;XU Yayun;CHEN Lin(Department of Neurology,Affiliated Hospital of Neurology Institute,An-hui University of Chinese Medicine,Hefei 230061,China)

机构地区：[1]安徽中医药大学神经病学研究所附属医院神经内科,安徽合肥230061

出　　处：《中风与神经疾病杂志》2024年第12期1118-1122,共5页Journal of Apoplexy and Nervous Diseases

基　　金：安徽省自然科学基金(2308085QH290);安徽中医药大学临床科学研究基金(2020sjyb06,2020sjzd11)。

摘　　要：目的分析肝豆状核变性也称Wilson病(WD)患者脾切除术后中性粒细胞减少的临床特征及影响因素。方法选择2018年1月—2023年3月于安徽中医药大学神经病学研究所附属医院住院的WD并行脾切除术61例患者,以脾切除术1年后中性粒细胞绝对值计数<1.7×10^(9)/L为观察组,≥1.7×10^(9)/L为对照组,比较两组患者脾切除1年后血常规变化情况;比较两组在一般资料、术前骨髓象资料、术前Child-Pugh评分、术前脾脏大小、手术方式、术后实验室指标等指标方面有无差别;分析中性粒细胞计数减少的影响因素。结果两组WBC、中性粒细胞、RBC、PLT均明显升高,中性粒细胞百分比明显下降,差异均有统计学意义(P<0.05),术后仍有39.34%(24/61)的患者中性粒细胞计数低于正常水平;观察组术前Child-Pugh评分、TBIL、AST、PT较对照组高,ALB较对照组低,差异均有统计学意义(P<0.05),两组腹水比例有差异有统计学意义(P<0.05);多因素分析显示术前Child-Pugh评分、TBIL、ALB是中性粒细胞减少的独立影响因素;结论脾切除术并不能完全纠正WD患者的中性粒细胞水平,可能与肝损害程度有关。Objective To investigate the clinical features of neutropenia after splenectomy in patients with hepatolenticular degeneration,also known as Wilson's disease(WD),and related influencing factors.Methods The patients with WD who were hospitalized and underwent splenectomy from January 2018 to March 2023 were enrolled as subjects.The patients with an absolute neutrophil count of<1.7×10^(9)/L at 1 year after splenectomy were enrolled as observation group,and those with an absolute neutrophil count of≥1.7×10^(9)/L were enrolled as control group.The two groups were compared in terms of the change in routine blood test results at 1 year after splenectomy,as well as the indicators such as general information,preoperative myelogram data,preoperative Child-Pugh score,preoperative spleen size,surgical procedures,and postoperative laboratory markers,and the influencing factors for the reduction in neutrophil count were analyzed.Results A total of 61 patients were included.At 1 year after splenectomy,both groups had significant increases in white blood cell count,neutrophil count,red blood cell count,and platelet count and a significant reduction in the percentage of neutrophils(P<0.05).After surgery,39.34%(24/61)of the patients still had a neutrophil count lower than the normal level.Before surgery,compared with the control group,the observation group had significantly higher Child-Pugh score,total bilirubin(TBIL),aspartate aminotransferase,and prothrombin time and a significantly lower level of albumin(ALB)(P<0.05),and there was also a significant difference in the proportion of patients with ascites between the two groups(P<0.05).The multivariate analysis showed that preoperative Child-Pugh score,TBIL,and ALB were independent influencing factors for neutropenia.Conclusion Splenectomy cannot completely correct neutrophil level in WD patients,which may be associated with the degree of liver damage.

关 键 词：肝豆状核变性 脾切除 中性粒细胞减少 影响因素 

分 类 号：R742.4[医药卫生—神经病学与精神病学]