| Objective:To analyze the efficacy of partial splenic embolization (PSE) on hepatitis C virus cirrhotic patients with hypersplenism and evaluate antiviral treatment to the patients undergoing PSE.Methods:In 76 HCV cirrhotic patients with severe hypersplenism(neutrophils <1.0×109 / L and / or PLT <50×109 / L) in digestive department of China-Japan union hospital from January 2006 to January 2009,23 cases were treated with partial splenic artery embolization.After PSE, 21 patients turned the contraindication for Peg-IFN to the indication.15 patients started antiviral treatment with Peg-IFNα- 2a (180μg) plus ribavirin (800-1200mg) which lasted 48w and 24w followed up as standarded dose group.6 patients used Peg-IFNα- 2a (90μg) plus ribavirin (800-1200mg) which lasted 72w and 24w followed up as small dose long-course group .Other 53 patients weren't undergone PSE and antiviral treatment as the control group. Diagnosis of Chinese Medical Association, 2004 credits will be infectious and parasitic, liver credits will be jointly formulated the "Hepatitis C Prevention Guide" in the diagnostic criteria of chronic hepatitis C, according to imaging, biochemistry and / or pathological diagnosis kinetic energy of hypersplenism with portal cirrhosis. Biochemical analyzer using Beckman liver function; application of real-time fluorescence quantitative polymerase chain reaction for the detection of serum HCV RNA content; using PCR-microplate hybridization-ELASA law, to conserved HCV RNA sequences for the core area of the primers, by PCR serum samples were amplified and then sandwich hybridization with specific probes, the final color of the serum by ELISA in detection of HCV RNA were classified.Results: 23 cases with hypersplenism in patients with hepatitis C cirrhosis and partial splenic artery embolization 1 week, a transient white blood cell count was significantly increased, after declining steadily on, fluctuations in the (5.03±0.88)×109 / L～(5.35±0.88)×109 / L range, compared with pre-embolization P <0.05; platelet count also on the PSE increased significantly after 1 week to 2 weeks, rose to the highest level, then decreased gradually stabilized, to the spleen 3 months after embolization fluctuations in (171.47±40.11)×109 / L～(147.70±37.59)×109 / L range, compared with pre-embolization P <0.001. Hemoglobin, red blood cell count in the spleen within 3 months after embolization with no significant change. Further 23 patients the level of neutrophils and platelets were stratified analysis, a total of 21 patients with neutrophil recovery to 1.0×109 / L or more, and platelet recovery to 50×109 / L or more to the interferon antiviral treatment standards, application of Peg-IFNα-2a and ribavirin antiviral therapy. 21 cases of hepatitis C patients with cirrhosis type 2b (33.33%) dominated, 1a-type (23.81%) second, followed by 1b-type (19.05%), 2a-type (19.05%) and did not separate the type (4.76% ). Non-genotype 1 patients with RVR, EVR, SVR was 16.67%, 75%, 75% higher than genotype 1 patients (RVR 11.11%, EVR 66.67%, SVR 55.56%); depending on the application Peg-IFNα-2a different doses and treatment, divided into the standard dose group (Peg-IFNα-2a 180μg / w, 48 weeks) and low-dose long-course group (Peg-IFNα-2a 90μg / w, course of 72 weeks), the standard dose group and low-dose long-course group SVR rate was 66.67%, 50%, respectively P> 0.05; recurrence rates were 20% and 33.33%, P> 0.05. Whether the standard dose or low-dose long-course group at 24 weeks end of treatment follow-up of Child-Pugh score were lower than the former; the control group were followed up for 72 weeks at the end of Child-Pugh score was 9.26±2.13, and P before and follow-up <0.05. And standard dose group and low dose treatment group was no longer one cases of patients with primary liver cancer, upper gastrointestinal bleeding and hepatic encephalopathy and other complications in the control group, 2 patients developed hepatocellular carcinoma , 3 patients had upper gastrointestinal bleeding, 2 cases of hepatic encephalopathy. Peg-IFNα-2a and ribavirin in antiviral treatment, 33.33% of neutropenic patients; 23.81% of the patients thrombocytopenia; 42.86% of patients with varying degrees of anemia, but sustained hemoglobin greater than 80g / L. hepatitis C patients with cirrhosis after PSE abdominal pain, fever, nausea, vomiting complications after embolization. Incidence was 69.57% and abdominal pain, fever 56.52%, nausea, vomiting 43.47%. And there is one case of splenic abscess patients after anti-inflammatory therapy, her condition improved.Conclusion: The PSE can significantly ease the hepatitis C cirrhosis and hypersplenism, this group of researchers in 21 cases (91.3%) patients with neutrophil recovery to 1.0×109 / L or more, and platelet recovery to 50×109 / L or more to the interferon antiviral therapy. One non-genotype 1 patients RVR, EVR, SVR was 16.67%, 75%, 75% higher than genotype 1 patients (RVR 11.11%, EVR 66.67%, SVR 55.56%). Line of standard-dose group and individual long-course treatment of small doses of the antiviral efficacy of the patients were better, SVR rates were 66.67%, 50%, relapse rate were 20% and 33.33%, there was no significant statistical difference. Standard treatment and individual therapy can effectively control the disease progress, Child-Pugh score than those patients was significantly reduced, and no patients with primary liver cancer, upper gastrointestinal bleeding and hepatic encephalopathy and other serious complications. PSE security is good, and postoperative complications in this group of symptoms were abdominal pain (69.57%), fever (56.52%), nausea and vomiting (43.47%), no severe complications and death.
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