恩替卡韦抗病毒对TACE治疗的HBV DNA阴性乙型肝炎相关性肝癌的影响

目的 探讨应用恩替卡韦预防治疗接受肝动脉化疗栓塞术（TACE）的乙型肝炎病毒（HBV）DNA阴性的乙型肝炎相关性肝细胞癌（HCC）患者对病毒激活的影响。方法 将45例HBV DNA阴性乙型肝炎相关性HCC患者随机分为观察组23例和对照组22例。两组患者均在常规护肝治疗基础上接受TACE治疗,观察组于TACE治疗前1周开始应用恩替卡韦分散片抗病毒治疗,对照组未行抗病毒治疗。采用荧光定量PCR法检测血清HBV DNA,采用微粒发光法检测血清HBV标志物,使用全自动生化分析仪检测血生化指标。观察并比较两组TACE后血清HBV DNA转阳和肝衰竭发生率及生存率情况。结果 在治疗24 w,观察组血清HBV DNA水平仍为<2 lg IU/mL,明显低于对照组的（4.10±2.86） lg IU/mL（P<0.01）,观察组HBV DNA转阳率为8.7%,明显低于对照组的36.4%（P<0.05）;观察组肝衰竭发生率为0.0%,对照组为22.7%,但两组差异无统计学意义（P>0.05）;在治疗12 w,观察组血清ALT为（56.75±20.74） IU/L,明显低于对照组的（125.78±42.75） IU/L,PTA为（48.65±8.26）%,明显高于对照组的（42.74±7.42）%（P<0.05）;在24 w,观察组血清ALT水平和Child-Pugh评分分别为（50.73±18.45）IU/L和（6.26±1.46）分,明显低于对照组的（97.48±30.56） IU/L和（7.84±1.65） 分,PTA为（52.45±9.10）%,明显高于对照组的（39.56±6.78）%（均P<0.01）;两组近期临床疗效差异无统计学意义(P>0.05);观察组2 a生存率为69.6%,明显高于对照组的36.4%（P<0.05）。结论 对接受TACE治疗的HBV DNA阴性的乙型肝炎相关性HCC患者,给予恩替卡韦抗病毒预防性治疗可以抑制HBV再激活,改善肝功能。

Effect of antiviral therapy with entecavir on HBV reactivation in serum HBV DNA negative hepatitis B virus infection-reduced patients with hepatocellular carcinoma receiving transcatheter arterial chemoemholization

Objective To investigate the effect of antiviral therapy with entecavir on HBV reactivation in serum HBV DNA negative hepatitis B virus infection-reduced patients with hepatocellular carcinoma （HCC） receiving transcatheter arterial chemoemholization（TACE）. Methods Forty-five patients with serum HBV DNA negative HBV-related HCC were randomly divided into observation group（n=23） and control group（n=22）. All patients in the two groups received TACE at base of conventional supporting treatment. Patients in observation group received entecavir before and after TACE. Serum HBV markers,HBV DNA and blood biochemical parameters were routinely assayed. The efficacy was evaluated by response evaluation criteria in solid tumors （RECIST） by world health organization. Results At the end of 24 w,serum HBV DNA in the observation group was still less than 2 lg IU/mL,while it increased to（4.10±2.86） lg IU/mL in the control group（P<0.05）;Serum HBV DNA positive rate in observation group was 8.7%,significantly lower than 36.4% in the control group（P<0.01）;The incidence of liver failure in observation group and control group were 0.0% and 22.7% respectively, without significant difference between the two groups（P>0.05）;At the end of 12 w,serum level of ALT in the observation group was （56.75±20.74） IU/L,significantly lower than （125.78±42.75） IU/L in the control group, and PTA was （48.65±8.26）%,significantly higher than （42.74±7.42）% in the control group （P<0.05）;At the end of 24 w,serum ALT level and Child-Pugh scores in observation group were （50.73±18.45） IU/L and（6.26±1.46）,respectively,significantly lower than （97.48±30.56） IU/L and（7.84±1.65） in the control group,and PTA was （52.45±9.10）%,significantly higher than （39.56±6.78） % in the control group （P<0.01）;There was no significant difference in clinical efficacy by RECIST between the two groups（P>0.05）;The 2-year survival rate in the observation group was 69.6%,significantly higher than 36.36% in the control group（P<0.05）,while there were no significant differences as respect to the 1-year survival rates between the two groups（P>0.05）. Conclusion Antiviral therapy with entecavir for serum HBV DNA negative HBV-related HCC patients can prevent the reactivation of hepatitis B virus, and improve liver function after TACE.