脾切除术后抗病毒治疗对肝硬化患者肝脏储备及再出血风险的影响

目的评价脾切除术后抗病毒治疗对丙肝肝硬化患者肝脏储备及再出血风险的影响。方法收集长期随访资料完整的肝硬化脾切除患者的资料纳入回顾性统计分析。依照术后不同治疗方式分为两组:治疗组为抗病毒治疗42例和对照组为未抗病毒治疗33例。分别在治疗过程中6个不同时间点对各组患者凝血系列(APTT、PT、PTA、Fib)、肝脏功能(ALB、A/G)、PLT及门静脉宽度等主要指标进行统计分析。结果 PT在治疗组中的表达于术后60个月较抗病毒治疗前显著降低(P0.01),延缓了PT时间;APTT在治疗组和对照组术后均即刻出现下降(P0.05),但这种下降趋势于治疗组可保持到术后60个月,而对照组自术后6个月以后呈上升趋势;治疗组对PTA短期无改善,但术后60个月时较对照组差异有统计学意义(P0.01);术后6个月时治疗组和对照组Fib值均为最高点,但治疗组与各时间点差异均无统计学意义;PLT在术后即刻升高且与术前比较差异有统计学意义(P0.001),并随病程延长出现与ALB水平和A/G比值相同的先升后降趋势。治疗组较对照组能够使术后降低的门静脉宽度值和出血率延缓上升。结论肝硬化患者脾切除术后进行抗病毒治疗能够显著改善患者的凝血功能,降低再出血风险。

Effect of splenectomy complicated with antiviral therapy on liver reserve and rehaemorrhagia of patients with liver cirrhosis

Objective To evaluate the effects of splenectomy complicated with antiviral therapy on liver reserve and rehaemorrhagia of patients with liver cirrhosis. Methods Liver cirrhosis and splenectomy patients with long-term and complete follow-up data were collected for a retrospective statistical analysis. According to the different treatment ways, the patients were divided into treatment group （antiviral therapy, 42 cases） and control group （non-antiviral therapy, 33 cases）. Clotting series （APTT, PT, PTA, Fib） , hepatic function （ALB, A/G） , PLT and the width of portal vein were detected on different time during the therapeutic process. Results The expression of PT in treatment group after the treatment was significantly decrease compared with before the treatment when 60 months after surgery （P 〈0.01） , the results indicated that antiviral treatment could delay the PT time ; APTT levels were decreased immediately after surgery in treatment group and control group, however, the downtrend in treatment group could last 60 months, whereas 6 months in control group; PTA levels in treatment group showed no improvement in short-term, however, there was a highly significant difference between the treatment group and control group when 60 months after operation （P 〈 0.01 ）. The maximum value of Fib in two groups appeared at 6 months after surgery, but there was no significant difference among the 6 months after surgery and other months in treatment group. PLT levels were increased immediately after surgery in treatment group compared with before surgery （P 〈 0.001） , and decreased progressively in the later stage. ALB levels and the ratio of A/G were decreased compared with before surgery with the extension of disease. The width of portal vein and the bleeding rate were increased slowly compared with the control group. Conclusion Splenectomy complicated with antiviral therapy could ameliorate liver reserve and decrease the rehaemorrhagia risk of patients with liver cirrhosis.