Clinical Observation On The Therapeutic Efficacy Of Combination PSE And Lamivudine In Patients With Cirrhotic Portal Hypertension Of Post-hepatitis B

Objective: To observe the efficacy and safety in patients with cirrhotic portal hypertension of post-hepatic B treated with partial splenic arterial embolization(PSE) and lamivudine, and compare with the therapeutic efficacy of PSE or lamivudine simply.Methods: 42 patients with cirrhotic portal hypertension of post-hepatic B were divided into three groups randomly, including 13 of them in therapeutic alliance group (PSE + lamivudine), 14 in PSE group and 15 in lamivudine group.The three groups of patients were given the peripheral blood cell counts, ultrasonography and endoscope examinations, in order to analyse the the red blood cell (RBC), white blood cell (WBC) and platelet(PLT) counts, the leghth and thickness of the spleen ,the inner diameter of portal vein and the degree of esophageal-gastric varix before treatment and 4 weeks, 24 weeks later.Results:1.The changes of peripheral blood cell counts of the three groups before and after treatment:(1).Changes of WBC counts of the three groups before and after treatment Before treatment, WBC counts of the therapeutic alliance group, PSE group and lamivudine group had no significant difference (P>0.05). They were significantly increased in therapeutic alliance group and PSE group 4 weeks after treatment comparing with those before treatment (P<0.05), while there was no significant difference in lamivudine group(P>0.05). WBC counts of the the three groups 24 weeks after treatment had no significant difference when compared with those 4 weeks after treatment(P>0.05), while they were still significantly more in therapeutic alliance group and PSE group than those in lamivudine group(P<0.05).(2).Changes of PLT counts of the three groups before and after treatmentBefore treatment, Plt counts of the three groups had no significant difference (P>0.05). They were significantly increased in therapeutic alliance group and PSE group 4 weeks after treatment comparing with those before treatment (P<0.05), while there was no significant difference in lamivudine group(P>0.05). 24 weeks after treatment, PLT counts of the the three groups had no significant difference when compared with those 4 weeks after treatment(P>0.05), while they were still significantly more in therapeutic alliance group and PSE group than those in lamivudine group(P<0.01, P<0.05), without significant difference between the two groups (P>0.05).(3). Changes of RBC counts of the three groups before and after treatmentBefore treatment, RBC counts of the three groups had no significant difference (P>0.05). They were significantly increased in therapeutic alliance group and PSE group 4 weeks after treatment compareing with those before treatment (P<0.05), while there was no significant difference in lamivudine group(P>0.05). 24 weeks after treatment, RBC counts of the the three groups had no significant difference when compared with those 4 weeks after treatment(P>0.05), while they were still significantly more in therapeutic alliance group and PSE group than those in lamivudine group (P<0.05).2.The changes of spleenic size of the three groups before and after treatment(1).Changes of the thickness of spleens in three groups before and after treatment The thickness of the spleen in the three groups had no significant difference before treatment and 4 weeks after treatment (P>0.05). They were significantly decreased in therapeutic alliance group and PSE group than those in lamivudine group 24 weeks after treatment when compared with those before treatment(P<0.05), while it had no significant difference in lamivudine group(P>0.05). Between the first two groups, there were no significant difference, but significantly different when compared with lamivudine group respectively(P<0.05).(2).Changes of lenghth of the spleen in the three groups before and after treatment The lenghth of the spleen in the three groups had no significant difference before treatment and 4 weeks after treatment (P>0.05). They were significantly decreased in therapeutic alliance group and PSE group than those in lamivudine group 24 weeks after treatment when compared with those before treatment(P<0.05), while there was no significant difference lamivudine group(P>0.05), without significant difference between the first two groups(P>0.05), but significant difference when compared with lamivudine group(P<0.05).3.The changes of inner diameter of portal vein of the three groups before and after treatmentBefore treatment, inner diameter of portal vein in the three groups had no significant difference(P>0.05). They were significantly decreased in therapeutic alliance group and PSE group 4 weeks after treatment when compared with those before treatment(P<0.01, P<0.05), while there was no significant difference in lamivudine group(P>0.05). 24 weeks after treatment, the inner diameter of portal vein of therapeutic alliance group had no significant difference when compared with that 4 weeks after treatment(P>0.05), while the diameter was decreased in lamivudine group( P<0.05).Among the three groups,there were significant difference between each of two groups.4.The changes of the degree of esophageal-gastric varix of the three groups before and after treatmentThe different degree of esophageal-gastric varix of the three groups had no significant difference before treatment(P>0.05) and 4 weeks after treatment comparing with those before treatment(P>0.05).The degree of esophageal-gastric varix in therapeutic alliance group and lamivudine group were significantly decreased 24 weeks after treatment(P<0.05), while there was no significant difference in PSE group(P>0.05).And between each two of the three groups,it became significantly better in therapeutic alliance group, lamivudine group and PSE group respectively(P<0.05).5.Adverse reactionsAll the patients had no serious adverse reactions. In therapeutic alliance group, one case had postoperative fever, and in PSE group, one case had postoperative fever and one got the spleen pain, but these symptoms disappeared after symptomatic treatment.In lamivudine group, there was one patient had nausea and mild gastric discomfort on the third day after taking the medication. The incidence of adverse reactions of the three groups had no significant difference (P>0.05).Conclution:The efficacy of combination PSE and lamivudine is better than PSE or lamivudine simply in the therapy of cirrhotic portal hypertension of post-hepatic B.