脾栓塞术后抗病毒治疗丙肝肝硬化临床观察

目的观察丙型肝炎肝硬化并脾功能亢进患者部分脾栓塞术（P SE）后小剂量干扰素联合利巴韦林抗病毒治疗的疗效,评估其安全性。方法选取部分脾栓塞术后,脾功能亢进缓解的基因2型丙型肝炎肝硬化患者,给予干扰素α-2b3MU,隔日一次,利巴韦林0.9g/d抗病毒治疗,疗程7 2周。监测肝功能、血常规、甲状腺功能、肾功能、凝血功能、HCVRNA。观察治疗期间的不良反应并及时处理,抗病毒治疗结束后继续随访2 4周。结果 1 3例丙型肝炎肝硬化患者在部分脾栓塞术后白细胞、血小板计数较术前有显著的提高（P〈0.01）;全部患者均完成抗病毒治疗并接受随访24周;3例出现溶血性贫血,减少利巴韦林剂量。其中84.6%获得持续病毒学应答（SVR）,2例复发;治疗过程中未发生死亡或严重不良反应。结论丙型肝炎肝硬化患者行部分脾栓塞术可消除脾亢性血细胞减少症,术后给予小剂量干扰素联合利巴韦林进行抗病毒治疗可获得较好的SVR,且安全性高,耐受性良好。

Clinical observation of the antiviral efficacy after partial splenic embolization in the patients with hepatitis C virus-decompensated cirrhosis

Objective To observed the antiviral efficacy of combination therapy with low-dose interferon and ribavirin （RBV） in postoperative Partial splenic embolization （PSE） in patients with hepatitis C virus （HCV）-decompensated cirrhosis, and to evaluate the safety. Methods The patients were enrolled with hepatitis C virus （HCV）-decompensated cirrhosis carrying the genotype 2 and were accepted the surgery of PSE, and then were treated with IFNα-2b 3 MU QOD and RBV 0.9g/d. The treatment completion need 72 weeks. Follow-up testing included liver function, blood chemistry, thyroid function, renal function, coagula- tion function index and HCV RNA level. The complications were on watch and were dealt timely during the treatment. The patients were followed-up for 24 weeks after the treatment completion. Results There was a significant increase on the number of the white blood cells, neutrophils, platelets in postoperative of PSE （P〈 0.01 ） in 13 patients. All the patients completed the treatment course and follow-up. 3 patients developed hemolysis that required RBV adjustment. The sustained virologic response （SVR） rate was 84.6%, 2 patient recur. No death and no severe complication occur during the therapy. Conclusions PSE on hepatitis C virus （HCV）-decompensated cirrhosis can resolute of hypersplenism. The sequence of treatment low-dose IFN combination with RBV have a good SVR, and have a high safety and a good tolerance.