TACE联合核苷(酸)类似物抗病毒治疗乙肝相关性肝癌的疗效观察

目的 观察经导管肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)联合核苷(酸)类似物(nucleos (t) ide,NAs)抗病毒治疗乙肝相关性肝癌的临床效果.方法 2010年2月至2015年1月大连医科大学附属第二医院确诊为乙肝相关性肝癌且行TACE术患者共181例,经过筛选后将最终的107例患者分为两组:治疗组(TACE联合抗病毒组)57例;对照组(TACE组)50例.术后随访12个月,每3个月1次,比较两组乙肝病毒(hepatitis B virus,HBV)再激活发生率、乙肝病毒DNA定量(HBV DNA)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBIL)的变化.结果 治疗组最终47例、对照组最终43例患者完成12个月的随访.两组治疗后3个月、6个月,患者的ALT、AST、TBIL变化均无明显差异(P＞0.05),治疗后12个月,两组患者的ALT、AST、TBIL差异有显著性意义(P＜0.05).HBV DNA转阴率在3个月、6个月、12个月治疗组分别为17.02％、38.30％、42.55％,对照组分别为4.65％、13.95％、13.95％.治疗后3个月,两组患者的HBV DNA转阴率差异无显著性意义(P＞0.05),在6个月、12个月时,两组患者的HBV DNA转阴率差异有显著性意义(P＜0.05).在随访的12个月中,对照组有15例发生乙肝病毒激活,治疗组有4例发生乙肝病毒激活,HBV激活率在两组间差异有显著性意义(P＜0.05).结论 TACE可以导致HBV的激活,NAs可以抑制HBV复制.TACE联合NAs抗病毒治疗可以提高乙肝相关性肝癌患者的临床治疗效果,改善患者的肝功能.

Effect of combined antiviral therapy of TACE and nucleos(t)ide analogues on HBV-related liver cancer

Objective To study the clinical effect of transcatheter arterial chemoembolization (transcatheter arterial chemoembolization,TACE) combined with nucleos (t) ide analogs (nucleos (t) ide,NAs) against hepatitis B virus-related liver cancer.Methods Totally 181 cases,who were diagnosed with HBV-related liver cancer and underwent TACE between February 2010 and January 2015 in the Second Affiliated Hospital of Dalian Medical University,were retrospectively reviewed.After screening,107 patients were finally enrolled in the study and divided into two groups:the treatment group (TACE combined with anti-virus group,n =47) and the control group (TACE group,n =43).Postoperative follow-up was performed once every three months.HBV (hepatitis B virus,HBV) reactivation incidence,HBV DNA quantification (HBV DNA),alanine aminotransferase (ALT),aspartate aminotransferase (AST),and total bilirubin(TBIL) changes.were compared between the two groups.Results There were no significant differences (P ＞0.05) in ALT,AST,and TBIL changes between the two groups after treatment for 3 months and 6 months.The values became statistically significant (P ＜ 0.05) at 12 months after treatment between the groups.Treated HBV-DNA negative rate in 3 months,6 months,12 months were 17.02％,38.30％,42.55％ in the treatment group,and 4.65％,13.95％,13.95％ in the control group,respectively.The HBV-DNA negative rate were not statistically significant (P ＞ 0.05) between the two groups at 3 months after treatment,but were significant different (P ＜ 0.05) at 6 months and 12 months after treatment.In the 12 months of follow-up,the control group had 15 cases of hepatitis B virus activation and the treatment group had 4 cases;HBV activation rates between the two groups were statistically significant (P ＜ 0.05).Conclusion Conventional TACE can lead to the activation of HBV,NAs can inhibit HBV replication.Combined therapy of conventional TACE and NAs antiviral in the treatment of patients with hepatitis B related liver cancer,can improve the effect of clinical treatment and liver function of patients.