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혈소판 감소증을 보이는 간경변증환자에서 간질환의 중증도에 따른 혈청 Thrombopoientin의 의의

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dc.description.abstract목적 : TPO는 거핵세포의 발생과 혈소판의 생성을 특이적으로 조절하는 인자이며 간에서 주로 생성되므로 간질환에서의 혈소판 감소증과 관련이 있으리라 여겨진다. 본 연구에서는 혈소판 감소증을 동반한 간경변증 환자에서 혈청 TPO를 측정하고 질환의 중증도에 따라 차이가 있는지 알아보고자 하였다. 대상 및 방법 : 총 98예를 대상으로 하였다(간경변증 57예, 만성 간염 24예, 항암제 투여 후 혈소판 감소를 보인 혈액종양 7예, 급성 간염 5예, 정상대조군 5예). 이들의 혈소판치의 평균값(±SD, ×103/ul)은 각각 69.8(±32.5), 180.9(±44.4), 57.7(±43.2), 210(±85.5), 229(±29.7)였다. 생화학적 검사, CBC, 혈청 담즙산, prothrombin time, aPTT 등을 측정하였고, 혈청 TPO의 측정은 ELISA법으로 하였다(Quantikine, R&D system,U.S.A). 결과 : 평균 혈청 TPO치(pg/ml)는 간경변증, 만성간염예에서 각각 108, 86으로 정상 대조군의 122 pg/ml와 유의한 차이를 보이지 않았다. 간경변증에서 혈청 TPO치는 Child 분류 및 점수, 혈청 알부민, 프로트롬빈 시간, aPTT, 혈청 ALT, 혈청 담즙산 등과 유의한 상관관계를 보이지 않았으나 총빌리루빈 및 혈소판치와 유의한 상관관계를 보였다(p< 0.05, r=0.288, 0.287). 결론 : 정상 간기능을 가진 환자에서 혈소판 감소시 보이는 적절한 TPO 증가 반응이 간경변증 예에서는 관찰되지 않았다. 그리고 간경변증에서 혈청 T PO치는 간질환의 중증도와 유의한 상관관계가 없었다. 따라서 TPO가 만성 간질환에서 혈소판 감소증을 유발하는 데 기여하는지에 관해서는 좀 더 연구가 필요하리라 생각된다.-
dc.description.abstractBackground/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 T PO 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 T PO 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 TPO was significantly higher than LC (623±746 vs 108±63 pg/ml, p<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 hromboplastin 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.-
dc.publisherKorean Association for the Study of the Liver-
dc.title혈소판 감소증을 보이는 간경변증환자에서 간질환의 중증도에 따른 혈청 Thrombopoientin의 의의-
dc.title.alternativeThe Significance of Serum Thrombopoietin Levels in Cirrhotic Patients with Thrombocytopenia According to Disease Severity-
dc.identifier.bibliographicCitationThe Korean Journal of Hepatology, v.5, no.3, pp 208 - 216-
dc.citation.titleThe Korean Journal of Hepatology-
dc.subject.keywordAuthorLiver disease-
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Yeon, Jong Eun
Guro Hospital (Department of Gastroenterology and Hepatology, Guro Hospital)
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