Foruny José R, Blázquez Javier, Moreno Ana, Bárcena Rafael, Gil-Grande Luis, Quereda Carmen, Pérez-Elías María J, Moreno Javier, Sánchez Juan, Muriel Alfonso, Rodriguez-Sagrado Miguel A, Moreno Santiago
Department of Hepatology and Gastroenterology, Hospital Ramón y Cajal, Madrid, Spain.
Eur J Gastroenterol Hepatol. 2005 Nov;17(11):1157-64. doi: 10.1097/00042737-200511000-00002.
Partial splenic embolization (PSE) is a non-surgical alternative for the treatment of hypersplenism. Thrombocytopenia precludes the use of pegylated interferon (peg-IFN) and ribavirin in cirrhotic patients with hepatitis C virus (HCV). We aimed to evaluate the role of PSE as a procedure allowing combined HCV therapy in this setting.
A retrospective analysis of the safety and rate of sustained virological response (SVR) after a full-dose course of peg-IFN plus ribavirin in eight HCV cirrhotic patients with severe hypersplenism undergoing PSE at a tertiary centre in Madrid, Spain, from May 2002 to August 2004.
Six patients (75%) were in Child-Pugh class B (median score 7). PSE significantly improved the mean platelet (P = 0.012), leucocyte (P = 0.017) and haemoglobin (P = 0.035) levels, and prothrombin activity (P = 0.012). After a mean of 20 weeks after PSE all patients started weight-adjusted ribavirin plus peg-IFN-alpha2b (n = 6) or 180 microg/week of peg-IFN-alpha2a (n = 2). Six subjects (75%) completed therapy with no peg-IFN dose reductions; the dose of ribavirin was reduced in two patients reaching haemoglobin levels of less than 10 g/dl (one also received erythropoietin and granulocyte colony-stimulating factor because of neutrophil counts < 300 cells/microl). Three patients (38%) achieved SVR. Portal vein thrombosis was observed in 50% of patients, but did not preclude antiviral therapy. The pathogenic mechanism was multifactorial. It was successfully managed with anticoagulant therapy in two cases.
PSE allowed the safe use of peg-IFN plus ribavirin in HCV cirrhotic patients with severe cytopenias who otherwise would never have been treated. The rate of SVR was 38%.
部分脾栓塞术（PSE）是治疗脾功能亢进的一种非手术替代方法。血小板减少症使得丙型肝炎病毒（HCV）肝硬化患者无法使用聚乙二醇化干扰素（peg-IFN）和利巴韦林。我们旨在评估PSE在此种情况下作为一种能使HCV联合治疗成为可能的操作所起的作用。
对2002年5月至2004年8月在西班牙马德里一家三级中心接受PSE的8例伴有严重脾功能亢进的HCV肝硬化患者，在接受全剂量疗程的peg-IFN加利巴韦林治疗后的安全性及持续病毒学应答（SVR）率进行回顾性分析。
6例患者（75%）为Child-Pugh B级（中位数评分7）。PSE显著改善了平均血小板水平（P = 0.012）、白细胞水平（P = 0.017）、血红蛋白水平（P = 0.035）以及凝血酶原活性（P = 0.012）。PSE后平均20周，所有患者开始使用根据体重调整剂量的利巴韦林加peg-IFN-α2b（n = 6）或每周180μg的peg-IFN-α2a（n = 2）。6例患者（75%）完成治疗且未减少peg-IFN剂量；2例血红蛋白水平低于10 g/dl的患者减少了利巴韦林剂量（其中1例因中性粒细胞计数<300个/μl还接受了促红细胞生成素和粒细胞集落刺激因子）。3例患者（38%）实现了SVR。50%的患者观察到门静脉血栓形成，但这并未妨碍抗病毒治疗。其发病机制是多因素的。2例患者通过抗凝治疗成功处理。
PSE使得peg-IFN加利巴韦林能够安全地用于原本因严重血细胞减少症而从未接受过治疗的HCV肝硬化患者。SVR率为38%。
