原发性肝癌三维适形放疗致乙型肝炎病毒再激活相关研究

目的：探讨原发性肝癌患者中三维适形放疗（three dimensional conformal radiotherapy，3D-CRT）致乙型肝炎病毒（HBV）再激活的相关因素。方法入组56例接受3D-CRT治疗的原发性肝癌患者为研究对象，并按放疗后是否接受抗病毒治疗分为A组（抗病毒治疗组，32例）和B组（未接受抗病毒治疗组，24例）。统计HBV再激活率、HBV再激活危险因素、HBV再激活相关性肝炎、丙氨酸氨基转移酶（alanine aminotransferase， ALT）升高情况、肝功能损伤程度、放射性肝损伤（radiation-induced liver disease，RILD）发生率及转归等情况。结果3D-CRT治疗后12周，A组患者的HBV再激活率低于B组（13.64%vs 41.67%），差异有统计学意义（P＜0.05）；两组ALT升高2倍的患者比例的差异无统计学意义（P＞0.05）；A组再激活相关性肝炎发生率低于B组（6.25% vs 25.0%），差异有统计学意义（P＜0.05）；两组患者的肝功能损伤程度的差异无统计学意义（P＞0.05）；随访3个月时A组和B组的RILD发生率（6.25%vs 16.67%）的差异无统计学意义（P＞0.05）。B组患者中，HBV再激活患者和HBV未激活患者的Child-Pugh分级构成、HBV DNA水平的差异差异均具有统计学意义（均P＜0.05）。结论3D-CRT技术是治疗肝癌的重要方案，HBV再激活及RILD是肝癌3D-CRT治疗时较为常见的并发症，3D-CRT治疗后的抗病毒治疗可以降低HBV再激活率及HBV再激活相关性肝炎的发生率。

Related factors of reactivation of hepatitis B virus induced by three dimensional conformal radiotherapy in primary liver cancer

Objective To explore the related factors of reactivation of hepatitis B virus induced by three dimen-sional conformal radiotherapy (3D-CRT) in primary hepatic carcinoma. Method Fifty-six patients with primary liver cancer who were administered with 3D-CRT therapy were enrolled. Based on whether the antiviral treatment was fol-lowed by radiotherapy, all patients were divided into two groups. Group A (with following antiviral treatment group):32 cases; group B (without following antiviral treatment): 24 cases. Statistical analysis was carried out, including HBV reactivation rates and risk factors for HBV reactivation, HBV reactivation induced hepatitis, elevated ALT and liver function damage degree, and the incidence of RILD. Result In the 12th week after 3D-CRT treatment, total HBV reactivation rates of group A was lower than that of group B, with statistically significant difference (P<0.05);The two groups had similar proportion of cases with doubled ALT level (P>0.05). The incidence of reactivation in-duced hepatitis in group A (6.25%) is significantly lower than that of group B (25.0%) (P<0.05); and liver function damage degrees in both groups were similar (P>0.05), so were the incidence of RILD (6.25 vs 16.67%; χ2=1.5556, P=1.5556). In respect of HBV reactivation and inactivation, Child-Pugh, hierarchical structure and HBV DNA level, the two groups had statistically significant difference (P<0.05). Conclusion 3D-CRT technology is an important treat-ment for advanced liver cancer, of which the HBV reactivation and RILD are common complications; antiviral treat-ment can reduce the HBV reactivation rate and the incidence of HBV reactivation induced hepatitis after 3D-CRT treatment.