TIPS Effect On Platelet Desialylation And Activation Of Cirrhotic Patient With Portal-hypertension

BackgroundTransjugular intrahepatic portosystemic shunt(TIPS)is one of the main treatment for portal hypertension related complications.As fatal complication have been controlled,liver failure occurred to be the main cause of death in patients with end stage liver cirrhosis.It have been shown that platelet count was an independent prognostic factor for liver failure and overall survival in patients who receive TIPS placement.Enhanced platelet clearance and decreased platelet production contribute to thrombocytopenia in patient with liver cirrhosis.In vivo,the primary mechanism of platelet clearance including hepatocytes and macrophages specificity identify and endocytosis desialylation platelet,and platelet activation and aggregation.Currently,the studies involve platelet and TIPS were confined to platelet count,while the results were remain controversial.PurposeAnalysis the effect of TIPS on platelet desialylation and activation,to evaluate the effect of TIPS on platelet clearance and platelet count of cirrhotic patient with portal-hypertension.Materials and MethodsAccording to the inclusion criteria,a total of 31 patients from January 2015 to June 2016 were included.Fasting peripheral venous blood sample were collected during before TIPS placement(tl),1 week after TIPS(t2)and3?6 months after TIPS(t3).Flow cytometry was used to investigated platelet activation(PAC-1 expression),desialylation(RCA-1 and sWAG expression)and plasma level of platelet microparticle(PMP).ELISA was adopted to detect the plasma level of Lipopolysaccharide(LPS).Meanwhile,data of platelet count(PLT),mean platelet volume(MPV,a surrogate marker of platelet turnover),plateletcrit(PCT),platelet distribution width(PDW)and platelet large cell ratio(PLCR)were collected.Results1.LPSThe level of plasma LPS after TIPS were significant lower than that before TIPS(43.0±17.9pg/ml VS 29.3±13.9pg/ml,P<0.01).Plasma level of LPS positive correlate with portal pressure gradient(r=0.63,P<0.01)and positive correlate with platelet PAC-1 expression(t=0.51,P<0.01).2.Platelet count,PCT,PDW,MPV and PLCR.Platelet count at t1,t2 and t3 were 97.0±86.3×109/L,87.2±50.6×109/L and 95.9±52.3×109/L,respectively,no significant difference were found(P=0.38).PCT at t1,t2 and t3 were 1.1±1.0%ml/L,0.9±0.6 ml/L and 1.0±0.6 ml/L,respectively,no statistically significant(P=0.20).PDW at t1,t2 and t3 were 14.6±2.2fl,13.4±2.1fl and 13.5±2.7fl,respectively,t1 significant higher than t2 and t3(P=0.01).MPV at t1,t2 and t3 were 11.7±0.9fL,11.1 ±0.9fL and 11.0±0.9fL,respectively,MPV before TIPS were significant higher than 1 week after TIPS and the follow up(P<0.01).PLCR at t1,t2 and t3 were 38.6±6.8%,33.2±7.0%and 33.0±7.5%,respectively,PLCR before TIPS were significant higher than 1 week after TIPS and the follow up(P<0.01).3.Platelet activationPlatelet PAC-1 expression at t1,t2 and t3 were 37.1±25.3%,19.4±17.5%and 14.8±14.8%,respectively,TIPS induced a significant decrease of PAC-1 expression(P<0.01).Corresponding,the plasma level of PMP post-TIPS were significant lower than the level pre-TIPS with 14.6±10.4×105/ml,8.0±6.3×105/ml and 5.6±3.2×105/ml at t1,t2 and t3,respectively.At present study,we found that platelet PAC-1 expression was negative correlate with platelet count(r=-0.27,P=0.01),positive correlate with MPV(r=0.41,P<0.01).4.Platelet desialylationPlatelet RCA-1 expression at t1,t2 and t3 were 8.5±8.2%,13.9±14.6%,and 9.6±9.9%,respectively,t1 significant higher than t2 and t3(P=0.01).Platelet sWAG expression at t1,t2 and t3 were 11.5±12.7%,14.6±14.5%and 11.6±8.0%,respectively,with no statistically significant(P=0.40).ConclusionTIPS attenuate platelet activation subsequent to reduce bacterial translocation,but have limited effect on platelet desialylation.Although TIPS placement failed to improve thrombocytopenia but prolong platelet life span and attenuate platelet turn over reducing platelet clearance of patient with liver cirrhosis.