摘要
目的探讨恩替卡韦抗病毒治疗对乙型肝炎相关肝细胞癌肝动脉化疗栓塞术(TACE)预后的影响。方法选取2011年1月—2018年3月在南方医院肝肿瘤中心首次接受TACE治疗的HCC患者170例,包括恩替卡韦治疗组114例,对照组(未抗病毒治疗)56例。记录治疗前基线的人口学资料,ALT、AST、TBil、Alb、PLT和Child-Pugh分级,HBeAg和HBV DNA水平,AFP、BCLC分期,以及治疗后4~8周的HBV DNA水平,ALT、AST、TBil、Alb和Child-Pugh分级变化和治疗后长期的生存状况。观察患者的短期和长期临床获益(总生存期)。计量资料两组间比较采用t检验或Mann-Whitney U检验;计数资料两组间比较采用χ2检验。对治疗前临床相关指标进行多因素logistic分析,以发现与乙型肝炎再活动的相关危险因素。Kaplan-Meier法分析总生存期的生存曲线,log-rank检验生存曲线间差异性。结果恩替卡韦治疗组患者乙型肝炎再活动的发生率与对照组比较无差异(15.79%vs 16.07%,χ2=0.002,P=0.962)。PLT水平在乙型肝炎再活动组与无乙型肝炎再活动组间差异有统计学意义(Z=-2.183,P=0.029)。多因素分析结果显示,HBV DNA水平是乙型肝炎再活动的独立危险因素(HR=1.000,P=0.015)。恩替卡韦组的1、3和5年生存率分别是56.20%、30.30%和13.20%,对照组的1、3和5年生存率分别是60.60%、27.20%和16.30%,两组在总体生存率上差异无统计学意义(χ2=0.049,P=0.755)。结论抗病毒治疗可以抑制乙型肝炎相关HCC患者TACE术后HBV复制,从而减少TACE治疗的肝毒性。
Objective To investigate the effect of entecavir(ETV)antiviral therapy on the prognosis of patients with hepatitis B virus(HBV)-related hepatocellular carcinoma(HCC)receiving transcatheter arterial chemoembolization(TACE).Methods A total of 170 HCC patients who received TACE for the first time in Liver Cancer Center of Nanfang Hospital from January 2011 to March 2018 were enrolled,among whom 114 patients were treated with ETV(ETV treatment group)and 56 patients did not receive antiviral therapy(control group).Baseline demographic data,alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil),albumin(Alb),platelet count(PLT),Child-Pugh class,HBeAg and HBV DNA levels,alpha-fetoprotein,and BCLC stage were recorded before treatment,and the changes in HBV DNA level,ALT,AST,TBil,Alb,and Child-Pugh class were observed at weeks 4-8 after treatment;long-term survival was also observed after treatment.Short-and long-term clinical benefits(overall survival)were observed for all patients.The t-test or the Mann-Whithey U test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups.Multivariate logistic regression analyses were performed for related clinical indices before treatment to identify the risk factors for HBV reactivation.The Kaplan-Meier method was used to analyze the survival curves of overall survival,and the log-rank test was used for comparison of survival curves.Results There was no significant difference in the incidence rate of HBV reactivation between the ETV treatment group and the control group(15.79%vs 16.07%,χ2=0.002,P=0.962).The univariate analysis showed that PLT was a risk factor for HBV reactivation(Z=-2.183,P=0.029),and the multivariate analysis showed that HBV DNA level was an independent risk factor for HBV reactivation(hazard ratio=1.000,P=0.015).The 1-,3-,and 5-year survival rates were 56.20%,30.30%,and 13.20%,respectively,in the ETV treatment group and 60.60%,27.20%,and 16.30%,respectively,in the control group.There was no significant difference in overall survival rate between the two groups(χ2=0.049,P=0.755).Conclusion Antiviral therapy can inhibit HBV replication after TACE in patients with HBV-related HCC,thereby reducing the hepatotoxicity of TACE.
作者
何伟猛
张植明
侯金林
何雅婧
HE Weimeng;ZHANG Zhiming;HOU Jinlin;HE Yajing(Department of Infectious Diseases,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Hepatology Unit,Shenzhen Hospital,Southern Medical University,Shenzhen,Guangdong 518133,China)
出处
《临床肝胆病杂志》
CAS
北大核心
2021年第3期601-605,共5页
Journal of Clinical Hepatology
基金
广东省自然科学基金(1914050005908)
广东省医学科学技术研究基金(A2019480)
深圳市三名工程项目资助(SZSM201911001)。
关键词
肝肿瘤
化学栓塞
治疗性
恩替卡韦
预后
Liver Neoplasms
Chemoembolization,Therapeutic
Entecavir
Prognosis
