肝癌合并肝硬化患者血小板参数的变化及影响因素

目的分析肝癌合并肝硬化患者血小板参数的变化及影响因素。方法收集2011年1月-2012年12月吉林大学白求恩第一医院602例肝癌合并肝硬化、200例肝硬化患者的相关资料。应用SPSS19.0统计软件进行分析,计量资料符合正态分布的以均数±标准差(x±s)表示,两组之间的比较采用t检验,多组之间采用方差分析;非正态分布以中位数和四分位数间距M(P25~P75)]表示,组间分析用秩和检验。结果肝癌组的血小板(PLT)、血小板比容(PCT)值明显高于肝硬化组(t=5.019、5.017,P均=0.000),MPV/PLT值明显低于肝硬化组(t=5.877,P=0.000),平均血小板体积(MPV)、血小板分布宽度(PDW)差异没有统计学意义(t=-0.942,P=0.347;t=-1.040,P=0.298)。PLT、PCT、MPV/PLT诊断肝硬化后肝癌的ROC曲线下面积分别是0.636,0.633,0.639。PLT、PCT值减少与HCV感染密切相关。PLT、PCT值Child A级患者大于B级、C级(P0.01),肿瘤≥5 cm患者大于肿瘤≤2 cm和2~5cm者(P0.01)。MPV/PLT值Child A级患者小于B级、C级(P0.01),肿瘤≥5 cm患者小于肿瘤≤2 cm和2~5 cm者(P0.01)。结论 PLT、PCT、MPV/PLT可用于肝癌合并肝硬化患者的辅助诊断,其值主要受HCV、Child分级和肿瘤大小影响。

Changes in platelet parameters and their influential factors in cirrhotic patients with hepatocellular carcinoma

Objective To analyze the changes in platelet parameters and their influential factors in cirrhotic patients with hepatocellular car-cinoma （HCC）.Methods The clinical data of 602 cirrhotic patients with HCC who were admitted to the First Hospital of Jilin University from January 201 1 to December 2012,as well as 200 cirrhotic patients hospitalized during the same period,were collected.Statistical analy-sis was performed using SPSS 19.0.Normally distributed continuous data were expressed as mean ± standard deviation;comparison be-tween two groups was made by t test,and comparison between multiple groups was made by analysis of variance.Non-normally distributed data were expressed as median and interquartile range （P25 -P75 ）;comparison between groups was made by rank sum test.Results Com-pared with the cirrhotic group,the HCC group had significantly higher platelet count （PLT）and plateletcrit （PCT）（t=5.019,P=0.000;t=5.017,P=0.000）and a significantly lower mean platelet volume （MPV）/PLT （t=5.877,P=0.000）;there were no significant differences in MPV and platelet distribution width between the two groups （t=-0.942,P=0.347;t=-1.040,P=0.298）.The receiv-er operating characteristic （ROC）analysis showed that the area under the ROC curve was 0.636 for PLT,0.633 for PCT,and 0.639 for MPV/PLT in the diagnosis of HCC in cirrhotic patients.Decreases in PLT and PCT were closely related to hepatitis C virus （HCV）infec-tion.Patients with Child-Pugh class A cirrhosis had significantly higher PLT and PCT than those with Child-Pugh class B and C cirrhosis （P〈0.01）;patients with a maximum tumor diameter of≥5 cm had significantly higher PLT and PCT than those with maximum tumor di-ameters of2-5 cm and≤2 cm （P〈0.01）.Patients with Child-Pugh class A cirrhosis had a significantly lower MPV/PLT than those with Child-Pugh class B and C cirrhosis （P〈0.01）;patients with a maximum tumor diameter of≥5 cm had a significantly lower MPV/PLT than those with maximum tumor diameters of2-5 cm and≤2 cm （P〈0.01）.Conclusion PLT,PCT,and MPV/PLT can be used in the auxiliary diagnosis of HCC in cirrhotic patients,which are related to HCV,Child-Pugh classification,and tumor size.