CAJ | 학술논문

目的对部分符合外科脾切除术指征且有治疗意愿的失代偿期丙型肝炎肝硬化患者行脾切除术后给予小剂量干扰素联合利巴韦林抗病毒治疗,观察其疗效,并分析与疗效相关的可能影响因素. 方法对部分符合外科脾切除术指征且有治疗意愿的失代偿期丙型肝炎肝硬化患者行脾切除术,术后给予个体化小剂量干扰素(普通干扰素3 ～ 5MU,隔日一次；或聚乙二醇干扰素50μg/周)联合利巴韦林0.6 ～ 0.9 g/d抗病毒治疗,基因1b型疗程≥72周,基因2a型≥36周.监测血常规、肝功能、凝血项、甲状腺功能、自身抗体等指标,处理不良反应；并监测HCV RNA水平,对病毒学应答进行评估.连续变量两组间比较采用t检验或秩和检验,计数资料采用x2检验.结果 12例患者均完成个体化治疗并随访6个月,其中3例患者因不能耐受聚乙二醇干扰素调整为普通干扰素,6例因溶血反应调整利巴韦林剂量.10例(83.3％)获得持续病毒学应答(SVR),1例无应答,1例复发.其中获得快速病毒学应答(RVR)者3例,占25.0％；获得完全早期病毒学应答(cEVR)者6例,占50.0％;24周获得应答的患者2例,占16.7％.RVR、cEVR对SVR率具有较好预测作用,获得RVR者SVR率为100％；获得cEVR者SVR率为83.3％；获得24周病毒学应答者SVR率为100％. 结论对部分符合外科脾切除术指征且有治疗意愿的失代偿期丙型肝炎肝硬化患者可先行脾切除术,解决脾功能亢进,再行抗病毒治疗,以提高疗效；RVR、cEVR对SVR率具有较好预测作用；医师在抗病毒治疗早期与患者沟通、疗程中严密监测并给予患者足够的依从性教育和心理疏导是治疗得以维持的重要保证.
목적 대부분부합외과비절제술지정차유치료의원적실대상기병형간염간경화환자행비절제술후급여소제량간우소연합리파위림항병독치료,관찰기료효,병분석여료효상관적가능영향인소. 방법 대부분부합외과비절제술지정차유치료의원적실대상기병형간염간경화환자행비절제술,술후급여개체화소제량간우소(보통간우소3 ～ 5MU,격일일차；혹취을이순간우소50μg/주)연합리파위림0.6 ～ 0.9 g/d항병독치료,기인1b형료정≥72주,기인2a형≥36주.감측혈상규、간공능、응혈항、갑상선공능、자신항체등지표,처리불량반응；병감측HCV RNA수평,대병독학응답진행평고.련속변량량조간비교채용t검험혹질화검험,계수자료채용x2검험.결과 12례환자균완성개체화치료병수방6개월,기중3례환자인불능내수취을이순간우소조정위보통간우소,6례인용혈반응조정리파위림제량.10례(83.3％)획득지속병독학응답(SVR),1례무응답,1례복발.기중획득쾌속병독학응답(RVR)자3례,점25.0％；획득완전조기병독학응답(cEVR)자6례,점50.0％;24주획득응답적환자2례,점16.7％.RVR、cEVR대SVR솔구유교호예측작용,획득RVR자SVR솔위100％；획득cEVR자SVR솔위83.3％；획득24주병독학응답자SVR솔위100％. 결론 대부분부합외과비절제술지정차유치료의원적실대상기병형간염간경화환자가선행비절제술,해결비공능항진,재행항병독치료,이제고료효；RVR、cEVR대SVR솔구유교호예측작용；의사재항병독치료조기여환자구통、료정중엄밀감측병급여환자족구적의종성교육화심리소도시치료득이유지적중요보증.
Objective To evaluate the therapeutic effects and influencing factors of common antiviral therapy (low-dose interferon plus ribavirin,IFN+RBV) in patients with hepatitis C virus (HCV)-decompensated cirrhosis following splenectomy.Methods Twelve patients were treated postsurgery with low-dose IFN (300-500 MIU QOD) or pegylated (Peg)-IFN (50 μg/w) and RBV (0.6-0.9 g/d) for 72 weeks if carrying the 1b genotype or 48 weeks if carrying the 2a genotype.All patients were followed-up for 24 weeks after treatment completion to determine the virological response (VR)rates,measured as rapid (R)VR,complete early (cE)VR,24 hr (24)VR,and sustained (S)VR.Statistical comparisons were made using the t-test or rank sum test,and correlation analyses were made using the Chi-square test.Differences were considered significant at P ＜ 0.05.Results All 12 patients completed the treatment course and follow-up.Three patients could not tolerate the Peg-IFN and were switched to IFN,and six patients developed hemolysis that required RBV dose adjustment.The VR rates were:25.0％,RVR; 50.0％,cEVR; 16.7％,24VR; 86.0％,SVR.Only one patient was a non-responder,and only one relapsed.Of the patients who achieved SVR,100％ had shown RVR,83.3％ showed cEVR,and 50.0％ showed 24VR,suggesting that RVR and cEVR may effectively predict SVR.Conclusion Some HCV-decompensated cirrhosis patients may benefìt from antiviral therapy following surgical resolution of hypersplenism.The occurrence of RVR and cEVR in these patients is positively correlated with achieving SVR.Physician-patient communication during early antiviral treatment and close clinical monitoring accompanied by psychological counseling throughout promotes success of the treatment approach.