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目的通过对丙型病毒性肝炎(hepatitis C,HCV)肝损害患者骨髓象的分析,探讨骨髓巨核细胞发育成熟对血小板减少的影响。方法将2010年2月至2015年10月解放军第三〇二医院收治的278例无脾功能亢进或已行脾切除、且排除其他肝炎病毒重叠感染、自身免疫性肝炎及脂肪肝的丙型病毒性肝炎患者作为研究对象(其中丙型慢性肝炎患者120例、丙型肝炎肝硬化患者80例、丙型肝衰竭肝炎患者23例、HCV肝炎血小板正常患者55例),采用骨髓图象分析系统对患者异常形态的巨核细胞进行分析,并检测所有患者空腹静脉血的丙型肝炎病毒定量(hepatitis C virus RNA,HCV RNA)、天冬氨酸氨基转移酶(aspartate aminotransferase,AST)、血小板计数(platelet,PLT)、网织血小板(reticulated platelet,RP)、平均血小板体积(mean platelet volum,MPV)、血小板分布宽度(platelet distribution width,PDW)等指标,采用SPSS 19.0统计软件对各项指标进行统计学分析。结果随着丙型肝炎患者肝损害的加重,HCV RNA含量、APRI评分及PDW、RP均明显高于对照组(HCV肝炎血小板正常组),差异有统计学意义(P<0.05),PLT均明显低于对照组,差异有统计学意义(P<0.05);HCV RNA含量、APRI评分与病程、血小板功能指标呈正相关,与血小板计数指标呈负相关;巨核细胞发生了幼稚巨核细胞增多(>7个)、体积偏小、可见幼稚产板巨核细胞、产板巨核细胞减低或消失(0~2个)、巨核细胞破坏明显、裸核增多(>20个)、空泡变性(细胞质出现大小不一空泡或空泡呈环状排列于浆缘)、产血小板数量少的巨核细胞、巨核细胞周围血小板少于3~5颗、出现多分叶核巨细胞及变性巨核细胞等一系列发育异常及形态学的改变。结论丙型肝炎病毒含量与血小板数、质量及骨髓巨核系统发育成熟具有相关性,可能是引起血小板减少的因素之一。
OBJECTIVE: To analyze the effect of bone marrow megakaryocyte maturation on thrombocytopenia by analyzing the bone marrow of patients with hepatic impairment of hepatitis C (HCV). Methods 278 cases of non-hypersplenism or splenectomy admitted to the 202nd Hospital of PLA from February 2010 to October 2015 and excluding other hepatitis C virus infections, autoimmune hepatitis and fatty liver hepatitis C virus Patients with hepatitis were selected as the study subjects (120 patients with chronic hepatitis C, 80 patients with hepatitis C cirrhosis, 23 patients with hepatitis C and 55 patients with normal HCV hepatitis). The bone marrow imaging system The abnormal morphology of megakaryocytes were analyzed and all patients were tested for fasting venous blood samples of hepatitis C virus RNA, aspartate aminotransferase (AST), platelet count , PLT, RP, MPV, PDW and other parameters were analyzed by SPSS 19.0 statistical software for statistics of various indicators analysis. Results With the exacerbation of liver damage in patients with hepatitis C, the contents of HCV RNA, APRI, PDW and RP were significantly higher than those in the control group (HCV-induced normal platelet group), the difference was statistically significant (P <0.05) (P <0.05). There was a positive correlation between HCV RNA content, APRI score and duration of disease and platelet function index, negatively correlated with platelet count index; megakaryocyte increased naive megakaryocyte (> 7) ), The volume is too small, we can see the juvenile plate megakaryocyte megakaryocyte, megakaryocyte plate production decreased or disappeared (0 ~ 2), megakaryocyte damage was obvious, increased nuclear (> 20), vacuolar degeneration (cytoplasm size does not appear A vacuole or vacuolar ring arranged in the plasma margin), the small number of platelets produce megakaryocytes, megakaryocytes around the platelet less than 3 to 5, there appear a large number of multinucleate cell giant cell and degeneration of megakaryocytes and a series of abnormalities and morphological Changes in learning. Conclusion Hepatitis C virus is associated with the number of platelets, mass, and the development and maturation of the megakaryocytic system of the bone marrow, which may be one of the factors that cause thrombocytopenia.