乙型肝炎相关性肝癌患者围手术期HBV DNA的变化及其影响因素

目的探讨乙型肝炎相关性肝癌患者围手术期HBV DNA水平变化的影响因素,比较抗病毒治疗与未抗病毒治疗对患者术后肝功能恢复的影响。方法选择65例未达到抗病毒治疗标准的乙型肝炎相关性肝癌患者,定量检测其术前和术后第3天的HBV DNA载量及白细胞介素(IL)-6、IL-10、IL-27的水平。根据术后HBV DNA载量,将患者分成HBV DNA升高(激活)组和不变组。升高组给予抗病毒治疗。记录所有患者术前、术后肝功能指标。用SPSS 17.0进行统计学分析。结果入组患者HBV激活率为37%(24/65),术前HBV DNA1×104 IU/ml的患者,术后HBV激活率为75%(18/24)。Logistic回归分析显示肿瘤直径(P=0.006)及肝切缘无水酒精注射(P=0.004)是引起HBV再激活的独立危险因素。ELISA结果示术后IL-10升高与HBV再激活有关(P=0.001),IL-6升高及IL-27降低与HBV不变有关(P=0.000)。术后HBV DNA升高且行抗病毒治疗的患者,术后肝功能恢复情况与其他患者比较差异无统计学意义(P0.05)。结论肝癌切除术可能引起患者HBV再激活,围手术期内应监测HBV DNA载量的变化。肿瘤直径、术中行肝切缘无水酒精注射术是HBV再激活的独立危险因素。患者术后IL-10、IL-6水平的变化可能与HBV DNA的变化有关。术后HBV再激活近期不会加重肝功能损伤,术后抗病毒治疗对患者近期肝功能的恢复无明显促进作用。

Changes in perioperative level of HBV DNA in patients with HBV-related hepatocellular carcinoma and their inlfuences

Objective To investigate the inlfuences in perioperative variations in serum levels of HBV DNA in patients with HBV-related hepatocellular carcinoma （HCC）, and to observe the differences in postoperative recovery of liver function between the antiviral treatment group and the non-antiviral treatment group of patients. Methods From Jan. 2012 to Aug. 2013, 65 patients whose preoperative serum levels of HBV DNA below the recommended level of antiviral treatment were included into the study. The serum levels of HBV DNA, IL-6, IL-10 and IL-27 preoperatively and on postoperative day 3 were measured. Using the postoperative serum levels of HBV DNA, the patients were divided into 2 groups：the high level group and low level group. Patients in the high level group received antiviral treatment, but the low level group did not. The changes in preoperative and postoperative liver function and other data of the patients were recorded and analyzed by the SPSS 17.0 software. Results The reactivation rate of serum HBV DNA in the HBsAg-positive HCC patients was 37%（24/65）. In patients with a preoperative HBV DNA level 0.05）. Conclusions Hepatectomy could reactivate HBV replication during the perioperative period. A close monitoring of HBV DNA during the perioperative period was necessary, especially in patients with low HBV DNA levels. The tumor diameter and injecting anhydrous alcohol into the resection margin were independent risk factors of postoperative increase in HBV DNA. Changes in serum IL-10 and IL-6 levels after hepatic resection might be related to the elevation of HBV DNA level. In addition, reactivation of HBV did not aggravate damages in postoperative liver function. Antiviral treatment did not promote recovery of liver function in the early stage.