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丙型肝炎肝硬化脾脏切除或部分脾动脉栓塞术后抗病毒疗效分析 被引量:2

Analysis of antiviral efficacy in patients with HCV related cirrhosis after splenectomy or partial splenic artery embolization
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摘要 目的观察丙型肝炎肝硬化合并脾功能亢进患者脾脏切除术后或部分脾动脉栓塞术后干扰素联合利巴韦林抗病毒治疗疗效及安全性评估。方法采用回顾性队列研究方法,收集47例丙型肝炎肝硬化行脾切除或部分脾动脉栓塞术患者,观察血常规、肝功能、凝血酶原活动度及HCV.RNA载量变化情况,了解干扰素联合利巴韦林抗病毒治疗疗效及抗病毒治疗不良反应发生情况。结果47例丙肝肝硬化患者中,HCV1b基因型40例(85%),HCV2a基因型7例(15%);手术前肝脏硬度测量值(LSM)(19.85±0.997)Kpa;相比于手术前,术后白细胞计数(WBC)(t=-4.863,P〈0.01)、血小板计数(PLT)(t=-5.912,P〈0.01)、凝血酶原时间活动度(PTA)(t=-2.331,P〈0.01)均显著上升;标准疗程抗病毒治疗后,47例患者中1例(2%)因精神异常、1例(2%)因肝性脑病等严重不良反应未能完成抗病毒治疗,45例完成抗病毒治疗中,26.7%(12例)获得了快速病毒学应答,57.8%(26例)获得了早期病毒学应答,80%(36例)获得了治疗结束时病毒学应答,62.2%(28例)获得了持续病毒学应答;HCV2a基因型患者快速病毒学应答(42.9%)、持续病毒学应答(100%)显著高于HCV1b基因型患者快速病毒学应答(23.7%)、持续病毒学应答(55.3%),P〈0.05。结论脾脏切除或部分脾动脉栓塞可有效改善脾功能亢进,术后抗病毒治疗疗效肯定,安全性良好。 Objective To observe the antiviral efficacy and security of combination therapy wlth interferon and ribavirin on hepatitis C patients with liver cirrhosis and the splenic function improvement after splenectomy or partial splenic artery embolization. Methods Forty-seven hepatitis C patients with liver cirrhosis given splenectomy or partial splenic artery embolization were retrospectively cohort analyzed, followed up testing changes included blood chemistry, liver function activity and HCV RNA level to realize the effect of antiviral therapy with interferon and ribavirin, and adverse reactions were recorded during the period of treatment. Results Among the 47 patients with hepatitis C cirrhosis, HCV 1 b genotype 40 cases, HCV 2a genotype 7 cases, liver stiffness measurement (LSM) pre-operation : ( 19.85± 0. 997) Kpa. Compared with pre-operation, the WBC(t = -4. 863, P 〈0. 01), PLT(t = -5.912, P 〈 0. 01), PTA(t = - 2. 331, P 〈 0. 01 ) rose significantly. During antiviral therapy, among the 47 patients, 1 case (2%) got psychosis, 1 case (2%) got hepatic encephalopathy, and stop antiviral treatment because of these serious adverse reaction, etc. Forty-five cases completed antiviral treatment, and 26.7% (12 cases) achieved RVR, 57.8% (26 cases)achieved EVR, 80% (36 cases)achieved ETVR, 62.2% (28 cases)achieved SVR; RVR (42. 9% ) , SVR ( 100% ) of 2a were significantly higher than l b RVR (23.7%) ,SVR(55.3% ) ,P 〈 0. 05. Conclusions Splenectomy or partial splenic artery embolization can effectively improve the function of spleen hyperfunction, ideal postoperative antiviral efficacy and security can be observed.
作者 胡金星 孙长宇 武淑环 李志勤 闫婧雅 李华 顾心雨 HU fin-zing, SUN Chang-yu, WU Shu-huan, LI Zhi-qin, YAN fing- ya, LI Hua, GU Xin-yu( Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China)
出处 《中国实用医刊》 2016年第5期7-9,共3页 Chinese Journal of Practical Medicine
关键词 丙肝肝硬化 脾功能亢进 抗病毒治疗 病毒学应答 Hepatitis CSpleen hyperfunction AntiviralVirological responsecirrhosis therapy
作者简介 通信作者:孙长宇,E-mail:changyu8188@163.com
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