降低血小板激活预测肝脏衰减和肝硬化患者的死亡率
Benedikt S Hofer1,2,3,4, Ksenia Brusilovskaya1,3,4, Benedikt Simbrunner1,2,3,4
1Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.
Hepatology (Baltimore, Md.)
|December 27, 2023
概括
血小板激活在肝硬化影响预后. 保存的PAR-1和PAR-4激活预测了更好的结果,而上腺素激活增加了血栓形成的风险,为出血和凝固事件提供了洞察力.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 血液学 血液学 血液学
- 临床医学 临床医学
背景情况:
- 肝硬化与改变的初级血液静止和血小板功能有关.
- 血小板激活在肝硬化的预后意义是有争议的,由于血小板缩而导致的测试限制.
- 了解血小板激活的作用对于预测肝硬化患者的临床结果至关重要.
研究的目的:
- 为了研究血小板激活在肝硬化患者的预后价值.
- 为了将血小板激活与出血事件,血栓栓塞,疾病减补和死亡率相关联.
主要方法:
- 对107名肝硬化患者进行前性研究,同时进行肝静脉压梯度 (HVPG) 和血小板激活测量.
- 通过使用蛋白酶激活受体 (PAR) -1,PAR-4或上腺素刺激的流动细胞计评估血小板激活.
- 随访时间为25.3个月,记录失补偿,死亡率和血栓塞栓事件.
主要成果:
- 较高的PAR-4诱导血小板激活独立预测了较低的脱补偿风险 (调整HR:0.95/100MFI).
- 较高的PAR-1-诱导性血小板激活独立预测了更长的生存时间 (调整HR:每100MFI0.93).
- 增加上腺素诱导的血小板激活与较高的血栓形成风险 (HR:1.07每10MFI) 和门静脉血栓形成风险 (PVT) (HR:1.08每10MFI) 有关.
结论:
- 保存的PAR-1和PAR-4诱导性血小板激活与降低了肝硬化脱补偿和死亡风险有关.
- 升高的上腺素诱导性血小板激活是血栓栓塞事件的危险因素,特别是PVT.
- 在这个患者队列中,HVPG仍然是主要出血事件的主要危险因素.
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