Objective To investigate the clinical effect of antiviral therapy on decompensated cirrhotic pa-tient with hepatitis C virus.Methods Eighty-five decompensated cirrhotic patient with hepatitis C virus in our hospital were divided into treatment group (45 cases)and control group (40 cases)according to the different treat-ment methods.While 40 healthy subjects over the same period in our hospital were selected as controls.All pa-tients were treated by splenic embolization and basic supporting therapy.When reaching antiviral therapy stand-ard,the treatment group was treated with pegylated interferon and ribavirin therapy,while the control group re-ceived with ribavirin antiviral therapy.The treatment period in the two groups was 24 weeks.General informa-tion,liver function and Child-Pugh score changes,the antiviral efficacy and adverse events in the two groups were compared.The leptin levels were detected by radioactive immunohistochemistry,and the adiponectin levels were detected by enzyme-linked immunosorbent assay.Results After treatment,ALT and Child-Pugh score in the two groups were significantly lower than those before treatment (P <0.05).And the degree of improvement in treat-ment group was significantly better than that of the control group (P <0.05).Albumin,TBiL and PTA in treat-ment group were significantly improved than those before treatment (P <0.05).Albumin,TBiL and PTA in the control group were slightly improved after treatment,but the difference was not statistically significant (P >0.05).Viral response rate between the two groups were statistically different (P <0.05 ).RVR,EVR,ETVR and SVR of non-type gene Ⅰ in the treatment group and SVR of non-type gene Ⅰ in the control group were signif-icantly higher than the corresponding gene type Ⅰ(P <0.05).The differences of RVR,EVR,ETVR and SVR rate of genotype Ⅰ in the two groups were statistically significant (P < 0.05 ).The difference of RVR,EVR, ETVR and SVR rate of non-genetic type Ⅰ in the two groups were statistically significant (P <0.05 ).Adverse reactions could be tolerated during the treatment,and the symptoms were improved after treatment.The leptin and adiponectin levels in treatment group and control group before treatment were significantly higher than those of the normal control group (P <0.05).The leptin and adiponectin levels after treatment significantly decreased than those before treatment (P < 0.05 )Two indicators in the control group after treatment has decreased,but there was no significant difference (P >0.05).Conclusion The efficacy of pegylated interferon and ribavirin anti-viral therapy in decompensated cirrhotic patient with hepatitis C virus after hypersplenism splenic embolization can effectively inhibit the further deterioration of liver function,inhibition of viral replication and delay progression of liver disease,and the adverse reaction is small.It can be applied in clinical practice.Leptin and adiponectin has a high expression in hepatitis C patients with cirrhosis,suggesting that leptin and adiponectin can be used as the as-sessment of severity of the patient.%目的 探讨抗病毒治疗在丙型肝炎失代偿期肝硬化患中的临床应用效果.方法 选择2014年1月至2016年6月于我院住院治疗的失代偿期丙型肝炎肝硬化脾功能亢进行脾栓塞术患者85例,根据治疗方法不同分为治疗组(45例)和对照组(40例).同时选取40名同期于我院行健康查体者作为健康对照组.所有患者均给予保肝退黄、降转氨酶等对症治疗,同时给予脾动脉栓塞术达到抗病毒标准后,治疗组给予聚乙二醇干扰素联合利巴韦林抗病毒治疗,对照组给予利巴韦林抗病毒治疗,2组治疗周期均为24周.比较2组患者一般资料、肝功能指标及Child-Pugh评分变化、抗病毒疗效及不良反应发生情况.采用放射性免疫法检测各组瘦素表达水平,采用酶联免疫吸附法检测各组脂连蛋白表达水平.结果 经治疗后,2组丙氨酸转氨酶(ALT)和Child-Pugh评分均较治疗前显著降低(P<0.05).且治疗组改善程度显著优于对照组(P<0.05).治疗组白蛋白、总胆红素(TBiL)和凝血酶原活动度(PTA)均较治疗前显著改善(P<0.05).对照组治疗后白蛋白、TBiL和PTA虽较治疗前略改善,但差异无统计学意义(P>0.05).2组患者病毒应答率比较差异具有统计学意义(P<0.05).治疗组非基因Ⅰ型快速病毒学应答(RVR)、早期病毒学应答(EVR)、治疗结束时病毒学应答(ETVR)及持续病毒学应答(SVR)与对照组非基因Ⅰ型的SVR率均显著高于相应的基因Ⅰ型(P<0.05).2组基因Ⅰ型RVR、EVR、ETVR及SVR率比较差异均具有统计学意义(P<0.05).2组非基因 Ⅰ 型RVR、EVR、ETVR及SVR率比较差异具有统计学意义(P<0.05).治疗期间不良反应均可耐受,经对症处理后症状缓解.治疗组和对照组治疗前瘦素和脂连蛋白水平显著高于健康对照组(P<0.05).治疗组治疗后瘦素和脂连蛋白水平较治疗前显著下降(P<0.05).对照组治疗后2项指标虽有下降,但与治疗前比较差异无统计学意义(P>0.05).结论 失代偿期丙型肝炎肝硬化合并脾功能亢进患者行脾栓塞术后给予聚乙二醇干扰素联合利巴韦林抗病毒治疗可有效抑制患者肝功能进一步恶化,抑制病毒复制,延缓肝病进展,且不良反应小,安全性良好,可在临床推广应用,瘦素和脂连蛋白在丙型肝炎肝硬化患者中呈高表达,提示其可作为丙型肝炎肝硬化病情程度评估的有效指标.
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