抗病毒治疗对HBVDNA阳性原发性肝癌术后临床转归的影响

目的探讨抗病毒治疗对HBVDNA阳性原发性肝癌（PHC）术后临床转归的影响。方法将56例HBVDNA阳性PHC术后患者随机分成两组：治疗组26例,在肝癌切除术后应用拉米夫定（100mg/d）治疗;对照组采用单纯手术切除;观察并比较两组患者肝功能、HBVDNA定量、AFP、Child-Pugh评分、无瘤生存率等。结果在术后3个月时,治疗组血清HBVDNA水平明显下降（P〈0.05）;在术后6个月时,治疗组血清HBVDNA水平显著下降（P〈0.01）,血清丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、总胆红素（TBIL）显著下降,ALB显著升高,Child-Pugh评分显著降低（P〈0.01）;而对照组术前术后HBVDNA水平无明显变化（P〉0.05）,ALT、AST、TBIL、ALB及Child-Pugh评分等指标虽有改善,但与术前相比差异无统计学意义（P〉0.05）。随访3年,对照组与治疗组的无瘤生存率1～,2～,3～年分别为76.82%、53.49%、36.11%和89.05%、70.04%、64.66%,两组之间差异有统计学意义。结论肝癌根治术后抗HBV治疗能降低肿瘤复发率,延长无瘤生存期,改善患者预后,因此对术前HBV-DNA阳性（HBVDAN≥1.0×103copies/mL）肝癌患者,宜尽早联合抗病毒治疗。

Influence of Antiviral Therapy on the Clinical Postoperative Prognosis of Primary Liver Cancer with Positive HBV DNA

Objective To evaluate the effects of antiviral therapy in prevention of tumor recurrence after curative treatment for primary hepatic cancer（PHC） with positive HBV DNA.Methods 56 PHC patients（positive HBV DNA） undergoing radical liver resection were randomly divided into treatment group（26 cases,serum HBV-DNA ≥1.0 × 103 copies/mL） and control group（30 cases,serum HBV DNA ≥1.0 × 103 copies/mL）.The treatment group received antiviral therapy with lamivudine（100 mg/d） after operation,and the control group received no antiviral therapy after operation.The liver function,HBV-DNA concentration,Alpha fetal protein（AFP）,Child-Pugh score and tumor-free survival rate were observed and compared.Results In the treatment group：3 months after surgery,the serum HBV DNA level decreased obviously（P 0.05）;6 months after surgery,the serum HBV DNA level decreased significantly（P 0.01）,the serum alanine aminotransferase enzymes（ALT）,aspartate amino transferase（AST）,total bilirubin（TBIL） decreased significantly,ALB increased significantly,and the Child-Pugh score declined significantly（P 0.01）.In the control group：the preoperative and postoperative HBV DNA level had no obvious changes（P 0.05）;the ALT,AST,TBIL,ALB,and Child-Pugh score improved,but the differences were not statistically significant（P 0.05） compared with the preoperative conditions.With 3-year follow-up,the 1-,2-,3-year tumor-free survival rate was 76.82%,53.49%,36.11% in the control group,and 89.05%,70.04%,64.66% in the treatment group,the differences of tumor-free survival rate between the two groups were statistically significant.Conclusions The study suggests that antiviral therapy after radical liver resection in patients with PHC can improve the liver function and reduce the tumor recurrence.Patients with HBV DNA ≥1.0 × 103 copies/mL should receive antiviral therapy as early as possible.