[in Japanese]

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[in Japanese]

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It is reported that splenectomy improves thrombocytopenia and liver function in patients with chronic liver disease. However, exact significance of splenectomy still remains unsettled. Seventeen patients with chronic hepatitis C who were to receive IFN therapy, and eleven patients with decompensated liver cirrhosis, underwent splenectomy. Platelet count, white blood cell count, and that of neutrophils were significantly increased after splenectomy, and IFN therapy could be started in all patients. The results of IFN therapy demonstrated sustained viral response (SVR) in four patients, biochemical response (BR) in one, relapse in four and no response in five. Viral serotype of all the SVR cases were type 2. No patient withdrew from IFN therapy due to Thrombocytopenia.
Child-Pugh score was significantly improved after splenectomy. Levels of albumin, total bilirubin, prothrombin time, cholinesterase were similarly improved. Moreover, the number of CD34 positive hematopoietic stem cells in peripheral blood significantly increased after splenectomy.
In conclusion, splenectomy not only improves thrombocytopenia of patients with chronic liver disease, but promote the liver regeneration. It is suggested that splenectomy improves a long-term prognosis in patients with chronic liver disease.

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Purpose: Thrombocytopenia and hypersplenism are common complications in patients with liver cirrhosis. Splenectomy is also effective for correcting cirrhosis-associated thrombocytopenia; however, there are few prior studies regarding the benefits of splenectomy for reducing liver fibrosis. Previously, we found strong effect of platelets on promotion of liver regeneration. We have investigated the effect of thrombocytosis induced by splenectomy on suppression of fibrous change and acceleration of liver regeneration.
Methods: We admisnistered carbon tetrachloride (CCl₄) to C57BL6 female mice twice a week for 8 weeks to make liver fibrosis. To estimate the effect of trombocytosis on liver fibrosis, splenectomy was performed at 5 week in addition to CCl₄ administration. Results: Splenectomy significantly increased platelet counts in peripheral blood. Splenectomy increased liver/body weight ratio , mitotic index, and PCNA labeling index compared to mice with CCl₄ administration alone(p < 0.05, p < 0.01). Microarray analysis revealed that splenectomy upregulated gene sxpressions involved in cell proliferation in fibrotic liver. Splenectomy also significantly decreased liver fibrotic area, hydroxyproline contents, and TGF-beta expression in the liver compared to mice with CCl₄ administration alone(p < 0.01).
Conclusions: Our results suggest that thrombocytosis produced by splenectomy suppresses chronic liver fibrosis and also promote liver regeneration in cirrhotic liver.

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Patients with thrombocytopenia associated with chronic hepatitis or liver cirrhosis (LC) are sometimes difficult to treat with interferon (IFN) therapy. Chemotherapy for advanced hepatocellular carcinoma (HCC) does not always produce expected therapeutic effects, because it reduces blood cell counts, and makes it difficult to continue the treatment of HCC. In this study, we evaluated the usefulness of partial splenic embolization (PSE) as an auxiliary treatment for LC and HCC. The subjects were 61 patients who underwent PSE, consisting of 32, 14, and 17 treated with either of IFN, radiofrequency ablation (RFA), and continuous hepatic artery infusion (HAI), respectively. Platelet counts were significantly elevated 1 year after PSE. Albumin and cholesterol levels also rose after 1 year, suggesting that PSE improves liver function. The SVR rate in IFN-treated patients who received PSE was 36.4%, and that in those with a 1b high virus titer was 25%. Splenic abscess developed in 1 patient as a serious complication. In advanced HCC patients with a platelet count of less than 7×10⁴/μl, a combination of PSE and HAI improved the prognosis. These results suggest that PSE is useful as an auxiliary treatment for LC and advanced HCC.

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[in Japanese]

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