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혈소판 감소증을 보이는 간경변증 환자에서 간질환의 중증도에 따른 혈청 thrombopoietin의 의의
권오상,김지훈,박상훈,연종은,변관수,이창홍,서연석,공휘 대한간학회 1999 Clinical and Molecular Hepatology(대한간학회지) Vol.5 No.3
Background/Aims: Thrombopoietin (TPO) is an important cytokine for megakaryocyte maturation and platelet production. Because the main site of its production is liver, the failing liver may have a role in thrombocytopenia in chronic liver disease. The aims of this study were to determine the serum TPO levels in cirrhotic patients with thrombocytopenia and clarify the relation between the serum TPO levels and liver function impairment. Method: Cirrhotic paitents with thrombocytopenia (LC, n=57, Child class A/B/C; 20/13/24), chronic hepatitis patients (CH, n=24), oncologic patients with thrombocytopenia induced by chemotherapy (HO, n=7), acute viral hepatitis patients (AVH, n=5) and healthy controls (HC, n=5) were enrolled. Serum TPO was measured by an ELISA method. Results: Although the mean platelets counts of LC (69±32, ×103/ul: mean±SD) were lower than those of HC (229±29, ×103/ul), serum TPO levels in LC (108±63 pg/ml: mean±SD) were not significantly different from HC (122±24 pg/ml). In HO, serum TPgnificantly higher than LC (623±746 vs 108±63 pg/ml, p$lt;0.05) inspite of comparable platelets counts. In LC, serum TPO level was not significantly different among Child class groups. It was not correlated with serum ALT, serum albumin levels, prothrombin time, serum bile acid, Child class, Child score and partial thromboplastin time, but weakly correlated with serum total bilirubin (p=0.038, r=0.288) and platelet counts (p=0.041, r=0.287). Conclusions: Although impaired hepatic production of TPO seems to be the main cause of low serum TPO levels in thrombocytopenic cirrhotic patients, there was no correlation between serum TPO level and the severity of liver dysfunction. The role of other factors such as megakaryocyte mass in bone marrow, portal hypertension and hypersplenism may be necessary to explain the putative mechanism between TPO and platelet numbers in liver cirrhosis with thrombocytopenia. (Korean J Hepatol 1999;5:208-216)