龚文锋①②, 陆世东①②, 钟鉴宏①②, 张秋明③④, 王小波①②, 马良①②, 张志明①②, 向邦德①②, 黎乐群①②. 术前抗病毒治疗对HBV-DNA 阴性肝细胞癌患者术后病毒再激活及肝功能的影响*[J]. 中国肿瘤临床, 2016, 43(15): 668-673. DOI: 10.3969/j.issn.1000-8179.2016.15.421
引用本文: 龚文锋①②, 陆世东①②, 钟鉴宏①②, 张秋明③④, 王小波①②, 马良①②, 张志明①②, 向邦德①②, 黎乐群①②. 术前抗病毒治疗对HBV-DNA 阴性肝细胞癌患者术后病毒再激活及肝功能的影响*[J]. 中国肿瘤临床, 2016, 43(15): 668-673. DOI: 10.3969/j.issn.1000-8179.2016.15.421
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Wenfeng GONG1, 2, Shidong LU1, 2, Jianhong ZHONG1, 2, Qiuming ZHANG3, 4, Xiaobo WANG1. Influence of preoperative antiviral therapy on HBV reactivation and liver function after liver resection in HBV-DNA-negative hepatocellular carcinoma patients[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2016, 43(15): 668-673. DOI: 10.3969/j.issn.1000-8179.2016.15.421
Citation: Wenfeng GONG1, 2, Shidong LU1, 2, Jianhong ZHONG1, 2, Qiuming ZHANG3, 4, Xiaobo WANG1. Influence of preoperative antiviral therapy on HBV reactivation and liver function after liver resection in HBV-DNA-negative hepatocellular carcinoma patients[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2016, 43(15): 668-673. DOI: 10.3969/j.issn.1000-8179.2016.15.421
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术前抗病毒治疗对HBV-DNA 阴性肝细胞癌患者术后病毒再激活及肝功能的影响*

Influence of preoperative antiviral therapy on HBV reactivation and liver function after liver resection in HBV-DNA-negative hepatocellular carcinoma patients

    摘要
  • 摘要: 目的：评估术前抗病毒治疗对术后乙肝病毒再激活以及肝功能的影响。方法：2012年7 月至2016年3 月将广西医科大学附属肿瘤医院肝胆胰脾外科乙肝病毒DNA 阴性的HCC 患者分成抗病毒组（66例）及对照组（108 例），抗病毒组术前给予恩替卡韦分散片抗病毒治疗，对照组未给予抗病毒治疗。统计分析术后HBV 再激活及肝功能指标变化情况。结果：抗病毒组HBV 激活率为3%（2/ 66），对照组为27.8%（30/ 108）。 多因素分析显示小部分肝切术（HR= 4.695；95%CI：1.257- 17.537，P = 0.021）及术前未抗病毒治疗（HR= 8.164；95%CI：1.831- 36.397，P = 0.006）是术后HBV 再激活的危险因素。抗病毒组与未抗病毒组，激活组与未激活组术后7 天内肝功能指标差异无统计学意义（P > 0.05），术后30天比较，ALT 及ALB 差异有统计学意义（P < 0.05）。 结论：对于DNA阴性的HCC 患者，肝切除术可导致HBV 再激活，术前抗病毒治疗能有效降低HBV 再激活风险及保护肝功能。

     

    Abstract: Objective:To evaluate the effect of antiviral therapy on HBV reactivation and liver function after liver resection in patients with hepatocellular carcinoma (HCC). Methods:A total of 174 HBV-DNA(−)HCCpatientswererecruitedintotwogroups:antiviralther-apy group ( 66cases) and control group ( 108 cases). In the antiviral group, patients were given entecavir dispersible tablet, whereas no antiviral therapies were given in the control group. The HBV reactivation and liver function index rates were statistically analyzed.Re-sults: Rates of HBV reactivation after hepatectomy were 3. 0% and 27. 8% in the antiviral therapy group and control group,respectively. Multivariate analysis revealed that minor hepatectomy ( HR, 4. 695 ; 95% CI , 1. 257 - 17. 537 , P=0. 021 ) and no antiviral therapy ( HR, 8. 164 ; 95% CI , 1. 831 - 36. 397 , P=0. 006 ) were independent risk factors for HBV reactivation. The levels of ALT, TBil, ALB, and PT within 7 days af -ter liver resection were similar between the antiviral therapy group and the control group and between the reactivation group and no-reactivation group. However, the ALT and ALB levels were significantly better in the antiviral group compared with that in the control group after 30days.Conclusion: HBVreactivationcanoccurafterliverresectionforHBV-DNA(−)HCC patients. Preoperativeantiviral therapy can reduce the risk of HBV reactivation, thus protecting liver function in patients undergoing liver resection.

     

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