摘要
目的阐明小剂量聚乙二醇干扰素α-2a(PEG-IFNα-2a)联合标准剂量利巴韦林治疗脾切除后失代偿期丙型肝炎肝硬化患者的有效性及安全性。方法选取脾切除术后丙型肝炎肝硬化患者89例,术前均存在脾功能亢进导致的粒细胞及血小板减少,术后均恢复正常,且无严重术后并发症,肝功能Child-Pugh分级为A级或B级,开始给予小剂量PEG-IFNα-2a(135μg)联合标准剂量利巴韦林抗病毒治疗。结果 89例失代偿期丙型肝炎肝硬化患者在脾切术后白细胞、中性粒细胞、血小板均显著增加,后均有显著性差异;在小剂量PEG-IFNα-2a联合利巴韦林抗病毒过程中,除7例患者因再次出现粒细胞缺乏无法耐受干扰素治疗而终止治疗外,其余81例患者均完成了抗病毒疗程。在基因1型患者中有59.38%达到了持续病毒学应答(SVR),而非基因1型患者有56%达到SVR;达到SVR患者中又有37.5%的基因1型及28%的非基因1型患者出现了快速病毒学应答,基因1型和非基因1型患者cEVR及EoTR的发生率分别为54.69%比60%,64.06%比68%;在基因1型患者中无应答率及复发率分别为28.13%和4.69%,而非基因1型患者分别为24%和12%。结论肝功能Child-Pugh分级在A或B级的失代偿期肝硬化患者,脾功能亢进改善后,经过小剂量干扰素联合利巴韦林抗病毒治疗,仍可获得较为理想的病毒学应答。
Objective The objective is to evaluate the efficacy and tolerability of the combination therapy with low- dose of Pegylated Interferon alfa-2a plus SoC （standard-of-care） of ribavirin administered with chronic hepatitis C virus （HCV） infected decompensated cirrhosis underwent splenectomy. Methods A total of 89 decompensated liver cirrhosis patients with chronic HCV infection underwent splenectomy, who were impossibility of starting or continuing PEG-IFN and RBV because of neutropenia and/or thrombocytopenia. Antiviral treatment was started when neutrocyte and platelet counts were increasing and without severe surgical complications, Child-Pugh score with Grade A or 13. Results 89 patients with decompensated hepatitis C patients with cirrhosis, the number of the white blood cells, neutrophils, platelets were significantly increased, three were significant differences between the preoperative and postoperative of splenectomy. 81 patients complete the standard anti-viral treatment. A sustained virologic response （SVR） rate was 59. 38% in genotype 1 and 56% in non-genotype 1 patients, among these patients with SVR, 37.5% in genotype 1 and 28% in genotype 2 occurred rapid virological response（RVR）, and the complete early virological response（eEVR） were 54. 69% vs 60% in genotype 1 group,and the end of treatment virologic response（EoTR） ratios were 64. 06% vs 68% in non-genotype 1 group, respecttively. Non-response rate and relapse rate were 28.13% and 4.69% in genotype I group, and 24% and 12% in non genotype 1 group. Conch^ion The low-dose of PegIFN a-2a plus ribavirin antiviral therapy enable to obtain the ideal virological response in some HCV infected deeompensated cirrhosis with Child-Pugh Grade A or B, when the hypersplenism improved.
出处
《肝脏》
2013年第9期600-603,共4页
Chinese Hepatology
