丙型肝炎肝硬化的“分级”及聚乙二醇干扰素α-2a联合利巴韦林的抗病毒治疗

Antiviral therapy with pegylated interferon alpha-2a plus ribavirin in patients with HCV related cirrhosis and to establish the grading for standard therapy

目的观察丙型肝炎肝硬化不同条件下抗病毒治疗的临床效果,拟定丙型肝炎肝硬化的分级规范治疗标准。方法选择确诊为丙型肝炎肝硬化的患者82例,以32例慢性丙型肝炎(CHC)患者为对照,根据肝硬化程度、脾功能亢进情况以及抗病毒治疗的耐受分为不同抗病毒治疗组:在采取造血因子刺激、脾栓塞或脾切除治疗后,观察患者脾功能亢进的缓解情况,解决脾功能亢进后,以标准治疗方案为基础,采取"分级"抗病毒治疗策略,可以实施更为主动的个体化治疗方案;分析不同组别的抗病毒治疗效果,并随访患者肝功能恢复状况。结果经过治疗后,各组患者白细胞及血小板计数显著升高,在给予抗病毒治疗后,脾栓塞及脾切除治疗组均有约60%患者获得早期病毒学应答(EVR),而其持续病毒学应答(SVR)比率分别为59.3%与63.6%,丙氨酸氨基转移酶(ALT)水平显著下降。结论丙型肝炎肝硬化"分级"抗病毒治疗策略,通过采取不同的抗病毒治疗方案,可以延缓病情进展,提高患者生活质量。

Objective To investigate the clinical efficacy of antiviral therapy in patients with HCV related cirrhosis and to establish the grading of standard antiviral therapy for these patients.Methods 82 patients diagnosed with HCV related cirrhosis were included in this study,and were divided into 3 groups depending on the degree of cirrhosis,hypersplenism and the tolerance of treatment.After treating with hematopoietic growth factors,partial splenic embolization or splenectomy,the improvement of hypersplenism was observed.Based on the standard antiviral therapy,more active response guided therapy were used to achieve more ideal effect.The effect of treatment and the liver function were analyzed.32 patients with chronic hepatitis C were studied as control.Results The count of white blood cells and platelets were increased significantly.The EVR rate of partial splenic embolization and splenectomy were about 60%,and the SVR rate were 59.3% and 63.6% respectively.The levels of ALT were decreased significantly.Conclusion We propose the grading strategy of antiviral therapy for patients with HCV related cirrhosis,which could slow down the rate of progression of the cirrhosis and improve the quality of life.