| Hepatitis C is caused by the hepatitis C virus (Hepatitis C virus, HCV). It is a latent,persistent and progressive disease, and pandemic all over the world. The prevalence ofHCV in the world has been estimated to be1.7billion, which takes3.2percent of theworld population, and the number is more than40million in China. Because there was nocharacteristic of clinical manifestation after HCV infection, most patients progress to hasgrown into liver the cirrhosis, accompanied by other clinical syndromes, such assplenomegaly, hypersplenism, and decreased blood cells, which have serious impacts onthe implementation of the interferon antiviral therapy. Presently, it is difficult to controlhypersplenism through non-surgical treatment, and there was no specific drugs to curb it,which easily result in neutropenia and thrombocytopenia, even bleeding. Combinedsurgical and interventional treatment, including splenectomy and interventional splenicartery embolization therapy could resolve splenomegaly and hypersplenism in somedegree. However, the spleen, as an important peripheral immune organ, has anti-infectionimmune function, and many scholars have proposed to maximally retain spleen functionand splenic tissue, and don’t advocate the splenectomy, making it a controversial issue. With the increasing effectiveness of the HCV antiviral therapy, the postoperativelong-term quality of life and other indicators were elevated in HCV cirrhosis accompaniedby hypersplenism patients, and whether these are related with antiviral therapy isbecoming a hotspot. Hypersplenism not only results in the decrease of white blood cellsand platelets, causing coagulopathy and bleeding tendencies, but also has a negative effecton patients’ physical and mental health. There was close relation between the cirrhosisformation and the complex immune regulatory mechanisms of spleen, and the changes ofimmune factors indirectly involved in the process of liver fibrosis.Portal venous system resistance and the increase of collateral shunt also are theimportant factors in promoting hypersplenism. Therefore, there is increasing evidence thathypersplenism, cirrhosis and portal hypertension are in reciprocal causation. It is not onlythe secondary lesions of cirrhosis. It is feasible and beneficial for the liver cirrhosispatients to initiate the anti-viral treatment after splenectomy.This is a retrospective study in which155patients (97cases received splenicresection,58cases received spleen-preserving treatment) with HCV cirrhosisaccompanied with hypersplenism or splenectomy in four affiliated hospitals of the FourthMilitary Medical University and Xi’an Jiaotong University were included from January2000to May2012. Firstly, the dynamic clinical efficacy of antiretroviral therapy afterspleen resection (there were42cases in antiretroviral treatment group, and33cases in nonanti-viral therapy group) including patients’ coagulation, liver reserve function and portalhypertension were observed. Furthermore, these patients were followed for five years anda comprehensive assessment questionnaire of quality of life (WHOQOL-BREF) was usedto determine the quality of life (QOL) in HCV cirrhosis patients accompanied withhypersplenism (28patients in splenectomy group30cases in spleen-preserving treatmentgroup), and the intervention effect of peginterferon α-2a and ribavirin antiviral therapy onpatients’QOLwere evaluated.The results are as follows:As compared to before antiviral therapy, PT was significantly decreased at postoperative60months in antiviral therapy group (P<0.01), thus slowing down PT time.APTT was immediately decreased after splenectomy in both antiviral therapy group andcontrol group (P<0.05). which continued until60months after splenectomy in antiviraltherapy group, but it was increased at post-splenectomy6months in control group. Therewas no improvement of PTA in antiviral therapy group in the short-term, however,significantly difference was observed at post-splenectomy60months between antiviraltherapy group and control group (P<0.01). The values of Fib at post-splenectomy6months in antiviral therapy group and control group were peak, and there were nosignificant differences between antiviral therapy group and at different times points. Inaddition, the value of PLT was immediately increased at post-splenectomy (P<0.001).With the progression of the disease, both the levels of ALB and A/G ratio were decreased,as compared with pre-splenectomy. The decreased portal vein width followingsplenectomy increased significantly slowly in antiviral therapy group, compared with thecontrol group.By observing four aspects of health status, including subjective feels, physiologicalsituation, psychological state and social relations, we found that there was no significantlydifference in the5years survival quality between splenectomy group andspleen-preserving group; however, the5years survival quality was poor in splenectomygroup, as compared with spleen-preserving patients taking antiviral therapy, butspleen-preserving combined antiviral treatment could significantly improve the5yearssurvival quality.In conclusion, the change of immune function was observed after splenectomy, whichindirectly improves the liver reserve function, delays the process of liver cirrhosis andpromotes hepatic cell regeneration, but the curative effect is limited. Combinedantiretroviral therapy at post-splenectomy will play an important role in the liver reservefunction, stability/protection of blood coagulation, reduction portal vein width andimprovement of the5years survival. |
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