Hepatic vein waveform and splenomegaly predict improvement of prothrombin time after splenectomy in hepatitis C virus-related cirrhotic patients.
Hepatic vein waveform and splenomegaly predict improvement of prothrombin time after splenectomy in hepatitis C virus-related cirrhotic patients.
复制标题
肝静脉波形和脾肿大可预测丙型肝炎病毒相关肝硬化患者脾切除术后凝血酶原时间的改善。
DOI：
10.1111/hepr.12040
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发表时间：
2012
期刊：
影响因子：
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通讯作者：
Maehara Y.
中科院分区：
文献类型：
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作者：
Kinjo N;Nagao Y;Akahoshi T;Masahiro K;Hashimoto N;Uehara H;Kawanaka H;Tomikawa M;Shirabe K;Hashizume M;Maehara Y.
AimWhether肝功能可以恢复在肝硬化患者脾切除术后仍然存在争议。MethodsAll连续日本丙型肝炎肝硬化患者在九州大学医院2008年1月至2009年12月期间进行了选择性脾切除术被纳入本回顾性研究。凝血酶原时间，血清白蛋白和总胆红素浓度进行了审查，脾切除术前后进行分析，以澄清脾切除术是否改善肝硬化患者的肝功能，并确定改善肝功能的预测因素。Results凝血酶原时间和总血清胆红素浓度脾切除术后改善，但是，血清白蛋白浓度没有显着增加。脾切除术后12个月，52.3%的患者血清总胆红素下降超过0.3 mg/dL，52.3%的患者凝血酶原时间改善超过10%。多元线性回归分析确定肝静脉波形（HVWF）I型（P= 0.0174）和脾脏重量（P= 0.0394）是凝血酶原时间改善的独立预测因素，术前总血清胆红素（P= 0.0002）是总胆红素降低的唯一独立预测因素。HVWF I型患者脾切除后总胆红素和凝血酶原时间显着改善，而HVWF II型患者则没有改善。结论大约一半的肝硬化患者在脾切除后一年内凝血酶原时间和总胆红素有所改善。HVWF I型和脾肿大可能是丙型肝炎肝硬化患者脾切除术后凝血酶原时间改善的预测因素。
AimWhether hepatic function can recover in cirrhotic patients after splenectomy remains controversial.MethodsAll consecutive Japanese patients with hepatic cirrhosis due to hepatitis C who had undergone elective splenectomy in Kyushu University Hospital between January 2008 and December 2009 were included in this retrospective study. Prothrombin time, serum albumin and total bilirubin concentrations were reviewed before and after splenectomy and analyzed to clarify whether splenectomy improves hepatic function in patients with cirrhosis and to determine the factors predictive of improvement in hepatic function.ResultsProthrombin time and total serum bilirubin concentration improved after splenectomy; however, serum albumin concentrations did not increase significantly. Twelve months after splenectomy, total serum bilirubin had decreased by over 0.3 mg/dL in 52.3% of patients and prothrombin time had improved by over 10% in 52.3% of patients. Multiple linear regression analysis identified hepatic vein waveform (HVWF) type I (P= 0.0174) and spleen weight (P= 0.0394) as independent predictors of improvement in prothrombin time and preoperative total serum bilirubin (P= 0.0002) as the only independent predictor of decrease in total bilirubin. Total bilirubin and prothrombin time were significantly improved after splenectomy in patients with HVWF type I, however, they were not improved in patients with HVWF type II.ConclusionProthrombin time and total bilirubin improve in approximately half of cirrhotic patients within a year after splenectomy. HVWF type I and splenomegaly may be predictive factors for improvement in prothrombin time after splenectomy in patients with cirrhosis due to hepatitis C.