丙肝肝硬化失代偿期患者抗病毒疗效及病理分析

目的:观察小剂量干扰素联合利巴韦林治疗失代偿期丙型肝炎肝硬化患者的疗效及肝组织病理变化,分析两者之间的关系。方法:选取并发症消除后的失代偿期丙型肝炎肝硬化患者,给予小剂量PEG-IFNα-2a135μg每周1次,利巴韦林0.6⁰.9g/d抗病毒治疗,疗程48周。监测患者肝功能、血常规、甲状腺功能,肾功、HCV RNA,对病毒学应答进行评估。于治疗前及疗程结束后24周给患者行肝穿,活组织病理检查,做组织学炎症活动度和纤维化程度评分,观察治疗后患者上述指标的变化。结果:21例患者全部完成抗病毒疗程并随访24周;66.7%获得持续病毒学应答(SVR),5例复发,2例无应答;其中16例患者肝组织学评估结果有明显改善,2例无变化,3例加重。结论:失代偿期丙型肝炎肝硬化患者给予小剂量干扰素联合利巴韦林抗病毒治疗可获得较好的SVR,肝组织炎症及纤维化程度得到改善,且与抗病毒疗效密切相关。

Anti-virus efficacy and pathological analysis for patients with hepatitis C virus(HCV)-decompensated cirrhosis

Objective：To observe efficacy and pathological changes of liver tissue of a combination therapy of low-dose inter-feron and Ribavirin（RBV） in patients with hepatitis C virus（HCV）-decompensated cirrhosis, and analyze relationship of the efficacyand the pathological changes. Methods：The patients were enrolled with hepatitis C virus（HCV）-decompensated cirrhosis without thecomplications, and were treated with low-dose PEG-IFN α-2a （135ug）one time a week and RBV （0. 6-0. 9g/ d ）. The treatmentlasted for 48 weeks. Follow-up tests included liver function, blood chemistry, thyroid function,renal function, and HCV RNA level.The virological response was evaluated. The patients were taken needle biopsy sections of the liver before and 24 weeks after the treat-ment,and the results were assessed according to the modified histological activity index and hepatic fibrosis scoring system. The chan-ges of the above indexes after the treatment were observed. Results： Twenty-one patients completed the treatment and followed up for24 weeks. A sustained virological response（SVR）rate was 66. 7%, five cases recurred, and two case was not responded. 16 patientshad the significant pathological changes of the liver, two cases had no changes, and three cases were aggravated. Conclusions： Thetreatment of low-doseinterferon combined with RBV has a good SVR in the patients with hepatitis C virus（HCV）-decompensated cir-rhosis, and has better changes of inflammation and fibrosis. The changes have a close relationship with the efficacy of anti-virus.