核苷（酸）类似物在乙型肝炎相关原发性肝癌介入栓塞化疗中的作用*

张健珍; 张春兰; 曾春燕; 杨慧勤; 孟玉

doi:10.3969/j.issn.1000-8179.2016.22.895

核苷（酸）类似物在乙型肝炎相关原发性肝癌介入栓塞化疗中的作用*

Therapeutic effects of nucleoside analogues (acid) and transarterial chemoembolization in hepatitis B-related primary liver cancer

摘要

摘要: 目的：探讨核苷（酸）类似物在乙型肝炎相关原发性肝癌介入栓塞化疗中的作用。方法：回顾性分析广州市第八人民医院2011年1 月至2015年12月诊断收治的乙型肝炎相关原发性肝癌患者174 例，根据病情需要及患者个人意愿分为对照组72例和研究组102 例。对照组采用肝动脉化疗栓塞术（transarterial chemoembolization ，TACE 术）介入治疗。研究组采用TACE 术联合核苷（酸）类似物抗病毒治疗。结果：两组年龄、性别、肿瘤大小及实验室检查等基线资料比较无统计学差异（P > 0.05）。治疗后研究组和对照组相比，研究组各时点的肝功能均明显改善（P < 0.05）；治疗12、24、48W 的AFP 及CAl99水平均较对照组明显降低（P <0.05）。研究组乙型肝炎病毒DNA （hepatitis B virus DNA ，HBV DNA）不可测率在治疗后4、12、24、48W 分别为13.73% 、33.33% 、50.0% 、76.47% ，对照组分别为11.11% 、16.67% 、22.22% 、25.00% ，研究组治疗12、24、48WHBVDNA不可测率明显高于对照组（P <0.05）。研究组1 年、3 年生存率分别是96.08% 、90.20％，对照组分别为83.33% 、63.89% ，研究组1、3 年生存率明显高于对照组（P <0.05）。研究组治疗的显效率、有效率及总有效率均明显高于对照组（P < 0.05）。结论：肝动脉介入栓塞化疗治疗基础上联合核苷（酸）类似物抗病毒治疗可明显改善乙型肝炎相关原发性肝癌患者 ALT 水平，降低AFP 、CA199 水平，降低HBVDNA 水平，提高HBVDNA 不可测率，保障抗肿瘤治疗的顺利进行，从而提高生存率、延长生存期。有必要开展深入研究，以进—步明确抗病毒治疗在肝癌综合治疗中的作用。

Abstract: Objective:To investigate the therapeutic effects of nucleoside analogues (acid) and transarterial chemoembolization (TACE) on hepatitis B- related primary liver cancer. Methods:Cases from Guangzhou Eighth People's Hospital were retrospectively analyzed between January2011and December2015. A total of 174 patients were diagnosed with hepatitis B-related primary liver cancer. Pa-tients were categorized based on needs and individual goals. The control group included patients who were classified based on needs (n=72), whereas the research group included patients who were classified based on individual goals (n=102 ). In the control group, 72 patients underwent TACE. In the research group, 102 patients received nucleoside analogue (acid) and TACE. Results:The two groups did not differ significantly in terms of basic clinical parameters, such as age, sex, tumor size, and laboratory examination (P>0. 05). After treatment, the research group was compared with the control group. The liver function of patients in the research group significantly improved ( P<0. 05). AFP and CA 199 levels significantly decreased after 12, 24, and 48weeks of treatment in the research group (P<0. 05). The research group had HBVDNA unpredictable rates of 13. 73% ,33. 33% ,50. 0% , and 76. 47% after 4, 12, 24, and 48weeks of treatment, respectively. The control group had HBVDNA unpredictable rates of 11. 11%, 16. 67%, 22. 22%, and 25. 00% after 12, 24, and 48weeks of treatment, respectively. The HBVDNA unpredictable rate was significantly higher in the control group ( P<0. 05). The treat -ment effects in theresearch group were better than that of the control group (P<0. 05). In the research group, the 1- and 3-year surviv -al rates were 96. 08% and 90. 20%, respectively. In the control group, the 1- and 3-year survival rates were83. 33% and 63. 89%, respec -tively. The difference in survival rates between the two groups was statistically significant ( P<0. 05). Conclusion: TACE based on com-bined nucleoside analogue (acid) and antiviral treatment improved ALT levels in patients with hepatitis B-related primary liver cancer and decreased AFP, CA199 , and HBVDNA levels. Moreover, the HBVDNA unpredictable rate was modified to facilitate the TACE proce -dure, therefore improving the survival rates of patients and prolonging survival. Therefore, the therapeutic actions of antiviral treatment on hepatitis B-related primary liver cancer should be further investigated.

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